Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

BALLOON C PANTERA LEO 2.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700921S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 2.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700921S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 2.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700924S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 2.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700924S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 2.25/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700922S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 2.25/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700922S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 2.75/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700940S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 2.75/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700940S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 2.75/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700920S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 2.75/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700920S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 3.0/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700938S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 3.0/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700938S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 3.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700919S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 3.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700919S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 3.25/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700936S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 3.25/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700936S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 3.25/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700918S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 3.25/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700918S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 3.5/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700934S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 3.5/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700934S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 3.5/30

Facility

$350.00

Hospital Charge Code	270700917
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 3.5/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700917S
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$175.00

BALLOON C PANTERA LEO 3.5/30

Facility

$350.00

Hospital Charge Code	270700917
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 3.5/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700917S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

Know your out-of-pocket cost for care.

All Charges