Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON CATH XXL 16-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270624070
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CATH XXL 16-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270624070
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$429.82
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CATH XXL 16-6/5.8/75cm

Facility

$1,564.00

Service Code	HCPCS C1725
Hospital Charge Code	270626887
Hospital Revenue Code	278
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$378.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.49
Rate for Payer: Qualcare PPO/HMO/WC	$234.60

BALLOON CATH XXL 16-6/5.8/75cm

Facility

$1,564.00

Service Code	HCPCS C1725
Hospital Charge Code	270626887
Hospital Revenue Code	278
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$782.00
Rate for Payer: Aetna Commercial	$469.20
Rate for Payer: Aetna Medicare Advantage	$469.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.82
Rate for Payer: Cigna Commercial	$782.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.49
Rate for Payer: Qualcare PPO/HMO/WC	$234.60

BALLOON CATH XXL 18-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270627285
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$429.82
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CATH XXL 18-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270627285
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CERVICAL RIPENING 18FR

Facility

$14.05

Hospital Charge Code	270654379
Hospital Revenue Code	272
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.11

BALLOON CERVICAL RIPENING 18FR

Facility

$14.05

Hospital Charge Code	270654379
Hospital Revenue Code	272
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$7.03
Rate for Payer: Aetna Commercial	$4.21
Rate for Payer: Aetna Medicare Advantage	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.58
Rate for Payer: Cigna Commercial	$7.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.83
Rate for Payer: Oxford Commercial	$7.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.11
Rate for Payer: UnitedHealthcare Commercial	$7.03

BALLOON CHOCOLATE 4 X 80 MM

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270687486
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

BALLOON CHOCOLATE 4 X 80 MM

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270687486
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

BALLOON COATED 24FR 5CM 12CM

Facility

$17,125.00

Hospital Charge Code	270703746
Hospital Revenue Code	272
Min. Negotiated Rate	$2,568.75
Max. Negotiated Rate	$2,568.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75

BALLOON COATED 24FR 5CM 12CM

Facility

$17,125.00

Hospital Charge Code	270703746
Hospital Revenue Code	272
Min. Negotiated Rate	$2,226.25
Max. Negotiated Rate	$8,562.50
Rate for Payer: Aetna Commercial	$5,137.50
Rate for Payer: Aetna Medicare Advantage	$5,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,366.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,366.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,366.88
Rate for Payer: Cigna Commercial	$8,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,226.25
Rate for Payer: Oxford Commercial	$8,562.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75
Rate for Payer: UnitedHealthcare Commercial	$8,562.50

BALLOON CODA 10FR 120cm .035

Facility

$1,810.00

Hospital Charge Code	270638236
Hospital Revenue Code	272
Min. Negotiated Rate	$271.50
Max. Negotiated Rate	$271.50
Rate for Payer: Qualcare PPO/HMO/WC	$271.50

BALLOON CODA 10FR 120cm .035

Facility

$1,810.00

Hospital Charge Code	270638236
Hospital Revenue Code	272
Min. Negotiated Rate	$235.30
Max. Negotiated Rate	$905.00
Rate for Payer: Aetna Commercial	$543.00
Rate for Payer: Aetna Medicare Advantage	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.55
Rate for Payer: Cigna Commercial	$905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.30
Rate for Payer: Oxford Commercial	$905.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.50
Rate for Payer: UnitedHealthcare Commercial	$905.00

BALLOON CODA 10X120 035 G31236

Facility

$1,810.00

Hospital Charge Code	270638236V
Hospital Revenue Code	278
Min. Negotiated Rate	$271.50
Max. Negotiated Rate	$438.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.02
Rate for Payer: Qualcare PPO/HMO/WC	$271.50

BALLOON CODA 10X120 035 G31236

Facility

$1,810.00

Hospital Charge Code	270638236V
Hospital Revenue Code	278
Min. Negotiated Rate	$271.50
Max. Negotiated Rate	$905.00
Rate for Payer: Aetna Commercial	$543.00
Rate for Payer: Aetna Medicare Advantage	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.55
Rate for Payer: Cigna Commercial	$905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.02
Rate for Payer: Qualcare PPO/HMO/WC	$271.50

BALLOON CONQUEST 6 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690213
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON CONQUEST 6 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690213
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON CONQUEST 7 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690214
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON CONQUEST 7 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690214
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON CONQUEST 8 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690215
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON CONQUEST 8 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690215
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON COYOTE 3.5x40MM 145CM

Facility

$1,493.50

Service Code	HCPCS C1725
Hospital Charge Code	270676781
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
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) NJ Health	$298.70
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	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON COYOTE 3.5x40MM 145CM

Facility

$1,493.50

Service Code	HCPCS C1725
Hospital Charge Code	270676781
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$361.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON COYOTE 4x220MM 150CM

Facility

$1,866.90

Service Code	HCPCS C1725
Hospital Charge Code	270674155
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