Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON CATH LUTONIX 5x80MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270678054S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON CATH LUTONIX 5x80MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270678054
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON CATH LUTONIX 6x100MM

Facility

$8,250.00

Hospital Charge Code	270675785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$2,475.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON CATH LUTONIX 6x100MM

Facility

$8,250.00

Hospital Charge Code	270675785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON CATH MONORAIL 4x20cm

Facility

$1,493.50

Hospital Charge Code	270651414
Hospital Revenue Code	272
Min. Negotiated Rate	$194.16
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$448.05
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.16
Rate for Payer: Oxford Commercial	$746.75
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Commercial	$746.75

BALLOON CATH MONORAIL 4x20cm

Facility

$1,493.50

Hospital Charge Code	270651414
Hospital Revenue Code	272
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$224.03
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON CATH MONORAIL 4x2cm

Facility

$1,493.50

Hospital Charge Code	270651415
Hospital Revenue Code	272
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$224.03
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON CATH MONORAIL 4x2cm

Facility

$1,493.50

Hospital Charge Code	270651415
Hospital Revenue Code	272
Min. Negotiated Rate	$194.16
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$448.05
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.16
Rate for Payer: Oxford Commercial	$746.75
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Commercial	$746.75

BALLOON CATH MONORAIL 4x4

Facility

$1,493.50

Hospital Charge Code	270651416
Hospital Revenue Code	272
Min. Negotiated Rate	$194.16
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$448.05
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.16
Rate for Payer: Oxford Commercial	$746.75
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Commercial	$746.75

BALLOON CATH MONORAIL 4x4

Facility

$1,493.50

Hospital Charge Code	270651416
Hospital Revenue Code	272
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$224.03
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON CATH MONORAIL 5X2

Facility

$1,493.50

Hospital Charge Code	270651419
Hospital Revenue Code	272
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$224.03
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON CATH MONORAIL 5X2

Facility

$1,493.50

Hospital Charge Code	270651419
Hospital Revenue Code	272
Min. Negotiated Rate	$194.16
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$448.05
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.16
Rate for Payer: Oxford Commercial	$746.75
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Commercial	$746.75

BALLOON CATH MUSTANG 4x200MM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270675782
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATH MUSTANG 4x200MM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270675782
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATH MUSTANG 5x200MM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270670958
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATH MUSTANG 5x200MM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270670958
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATH MUSTANG 5x60MM 5F

Facility

$1,250.00

Hospital Charge Code	270675462
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATH MUSTANG 5x60MM 5F

Facility

$1,250.00

Hospital Charge Code	270675462
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOONCATHOCCLSCEPTERC4X10MM

Facility

$8,125.00

Service Code	HCPCS C2628
Hospital Charge Code	270693917S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

BALLOONCATHOCCLSCEPTERC4X10MM

Facility

$8,125.00

Service Code	HCPCS C2628
Hospital Charge Code	270693917S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$2,437.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

BALLOONCATHOCCLSCEPTERC4X15MM

Facility

$7,000.00

Service Code	HCPCS C2628
Hospital Charge Code	270693918S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

BALLOONCATHOCCLSCEPTERC4X15MM

Facility

$7,000.00

Service Code	HCPCS C2628
Hospital Charge Code	270693918S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,100.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

BALLOONCATHOCCLSCEPTERXC4X11MM

Facility

$9,775.00

Service Code	HCPCS C2628
Hospital Charge Code	270693920S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$4,887.50
Rate for Payer: Aetna Commercial	$2,932.50
Rate for Payer: Aetna Medicare Advantage	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,492.62
Rate for Payer: Cigna Commercial	$4,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

BALLOONCATHOCCLSCEPTERXC4X11MM

Facility

$9,775.00

Service Code	HCPCS C2628
Hospital Charge Code	270693920S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,365.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

BALLOON CATH OTW 4x120MM 150CM

Facility

$1,866.90

Hospital Charge Code	270674896
Hospital Revenue Code	278
Min. Negotiated Rate	$280.04
Max. Negotiated Rate	$933.45
Rate for Payer: Aetna Commercial	$560.07
Rate for Payer: Aetna Medicare Advantage	$560.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.06
Rate for Payer: Cigna Commercial	$933.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.79
Rate for Payer: Qualcare PPO/HMO/WC	$280.04

Know your out-of-pocket cost for care.

All Charges