Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON ADMIRAL XTREME 8X60MM

Facility

$625.00

Hospital Charge Code	270943366
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON ADMIRAL XTREME 8x60x80

Facility

$625.00

Hospital Charge Code	270639582C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON ADMIRAL XTREME 8x60x80

Facility

$625.00

Hospital Charge Code	270639582C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON ADMIRAL XTREME 9x20x80

Facility

$625.00

Hospital Charge Code	270644092
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON ADMIRAL XTREME 9x20x80

Facility

$625.00

Hospital Charge Code	270644092
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON ADMIRAL XTREME 9x40x80

Facility

$625.00

Hospital Charge Code	270644093C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON ADMIRAL XTREME 9x40x80

Facility

$625.00

Hospital Charge Code	270644093C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON ADMIRAL XTREME 9X40X80

Facility

$800.00

Service Code	HCPCS C1725
Hospital Charge Code	270641872
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

BALLOON ADMIRAL XTREME 9X40X80

Facility

$800.00

Service Code	HCPCS C1725
Hospital Charge Code	270641872
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

BALLOON ADVANCED MICRO 2X40MM

Facility

$2,450.00

Hospital Charge Code	270671136
Hospital Revenue Code	272
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$367.50
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

BALLOON ADVANCED MICRO 2X40MM

Facility

$2,450.00

Hospital Charge Code	270671136
Hospital Revenue Code	272
Min. Negotiated Rate	$318.50
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$735.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.50
Rate for Payer: Oxford Commercial	$1,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Commercial	$1,225.00

BALLOON AD X 5X40 SBE050040138

Facility

$1,530.00

Hospital Charge Code	270639158C
Hospital Revenue Code	278
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna Commercial	$459.00
Rate for Payer: Aetna Medicare Advantage	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$390.15
Rate for Payer: Cigna Commercial	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.26
Rate for Payer: Qualcare PPO/HMO/WC	$229.50

BALLOON AD X 5X40 SBE050040138

Facility

$1,530.00

Hospital Charge Code	270639158C
Hospital Revenue Code	278
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$370.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.26
Rate for Payer: Qualcare PPO/HMO/WC	$229.50

BALLOON AMPHIRION 3.0/120/150

Facility

$1,525.00

Service Code	HCPCS C1725
Hospital Charge Code	270636984
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

BALLOON AMPHIRION 3.0/120/150

Facility

$1,525.00

Service Code	HCPCS C1725
Hospital Charge Code	270636984
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$457.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

BALLOON AMPHIRION DEEP 1.5x20

Facility

$1,800.00

Hospital Charge Code	270636987
Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

BALLOON AMPHIRION DEEP 1.5x20

Facility

$1,800.00

Hospital Charge Code	270636987
Hospital Revenue Code	272
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$540.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$900.00

BALLOON AMPHIRION DEEP 2.0x210

Facility

$1,875.00

Hospital Charge Code	270643232
Hospital Revenue Code	272
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

BALLOON AMPHIRION DEEP 2.0x210

Facility

$1,875.00

Hospital Charge Code	270643232
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$562.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.75
Rate for Payer: Oxford Commercial	$937.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Commercial	$937.50

BALLOON AMPHIRION DEEP 2.5x210

Facility

$1,875.00

Service Code	HCPCS C1725
Hospital Charge Code	270642536
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

BALLOON AMPHIRION DEEP 2.5x210

Facility

$1,875.00

Service Code	HCPCS C1725
Hospital Charge Code	270642536
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$562.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

BALLOON AMPHIRION DEEP 2.5x80

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270636981
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$487.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

BALLOON AMPHIRION DEEP 2.5x80

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270636981
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

BALLOON AMPHIRION DEEP 2x120

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270636980
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

BALLOON AMPHIRION DEEP 2x120

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270636980
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

Know your out-of-pocket cost for care.

All Charges