Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON FORTREX OTW 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

BALLOON HERNIA *********

Facility

$1,889.00

Hospital Charge Code	1606193
Hospital Revenue Code	272
Min. Negotiated Rate	$245.57
Max. Negotiated Rate	$944.50
Rate for Payer: Aetna Commercial	$566.70
Rate for Payer: Aetna Medicare Advantage	$566.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$481.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$481.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$481.69
Rate for Payer: Cigna Commercial	$944.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.57
Rate for Payer: Oxford Commercial	$944.50
Rate for Payer: Qualcare PPO/HMO/WC	$283.35
Rate for Payer: UnitedHealthcare Commercial	$944.50

BALLOON HERNIA *********

Facility

$1,889.00

Hospital Charge Code	1606193
Hospital Revenue Code	272
Min. Negotiated Rate	$283.35
Max. Negotiated Rate	$283.35
Rate for Payer: Qualcare PPO/HMO/WC	$283.35

BALLOON HP ULTRA 15 FRX5 MM

Facility

$2,320.00

Service Code	HCPCS C1726
Hospital Charge Code	270684718
Hospital Revenue Code	278
Min. Negotiated Rate	$348.00
Max. Negotiated Rate	$561.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: Qualcare PPO/HMO/WC	$348.00

BALLOON HP ULTRA 15 FRX5 MM

Facility

$2,320.00

Service Code	HCPCS C1726
Hospital Charge Code	270684718
Hospital Revenue Code	278
Min. Negotiated Rate	$348.00
Max. Negotiated Rate	$1,160.00
Rate for Payer: Aetna Commercial	$696.00
Rate for Payer: Aetna Medicare Advantage	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.60
Rate for Payer: Cigna Commercial	$1,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: Qualcare PPO/HMO/WC	$348.00

BALLOON IABP 8FR 25cc

Facility

$4,010.00

Hospital Charge Code	270629772
Hospital Revenue Code	272
Min. Negotiated Rate	$521.30
Max. Negotiated Rate	$2,005.00
Rate for Payer: Aetna Commercial	$1,203.00
Rate for Payer: Aetna Medicare Advantage	$1,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,022.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,022.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,022.55
Rate for Payer: Cigna Commercial	$2,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.30
Rate for Payer: Oxford Commercial	$2,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$601.50
Rate for Payer: UnitedHealthcare Commercial	$2,005.00

BALLOON IABP 8FR 25cc

Facility

$4,010.00

Hospital Charge Code	270629772
Hospital Revenue Code	272
Min. Negotiated Rate	$601.50
Max. Negotiated Rate	$601.50
Rate for Payer: Qualcare PPO/HMO/WC	$601.50

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682S
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682S
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682N
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,312.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682N
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON INTRAGASTRIC ORBERA

Facility

$9,875.00

Service Code	HCPCS L8699
Hospital Charge Code	270693542
Hospital Revenue Code	278
Min. Negotiated Rate	$1,481.25
Max. Negotiated Rate	$2,389.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,481.25

BALLOON INTRAGASTRIC ORBERA

Facility

$9,875.00

Service Code	HCPCS L8699
Hospital Charge Code	270693542
Hospital Revenue Code	278
Min. Negotiated Rate	$1,481.25
Max. Negotiated Rate	$4,937.50
Rate for Payer: Aetna Commercial	$2,962.50
Rate for Payer: Aetna Medicare Advantage	$2,962.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,518.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,518.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,518.12
Rate for Payer: Cigna Commercial	$4,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,481.25

BALLOON JADEOTW014120x5.0x150

Facility

$775.00

Hospital Charge Code	270705572
Hospital Revenue Code	279
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$232.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.75
Rate for Payer: Oxford Commercial	$387.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$387.50

BALLOON JADEOTW014120x5.0x150

Facility

$775.00

Hospital Charge Code	270705572
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x1.5x120

Facility

$775.00

Hospital Charge Code	270705193
Hospital Revenue Code	279
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$232.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.75
Rate for Payer: Oxford Commercial	$387.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$387.50

BALLOON JADEOTW014150x1.5x120

Facility

$775.00

Hospital Charge Code	270705193
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x1.5x240

Facility

$775.00

Hospital Charge Code	270705194
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x1.5x240

Facility

$775.00

Hospital Charge Code	270705194
Hospital Revenue Code	279
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$232.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.75
Rate for Payer: Oxford Commercial	$387.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$387.50

BALLOON JADEOTW.014 150x1.5x8

Facility

$775.00

Hospital Charge Code	270705196
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW.014 150x1.5x8

Facility

$775.00

Hospital Charge Code	270705196
Hospital Revenue Code	279
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$232.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.75
Rate for Payer: Oxford Commercial	$387.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$387.50

BALLOON JADEOTW014150x2.0x100

Facility

$775.00

Hospital Charge Code	270705197
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x2.0x100

Facility

$775.00

Hospital Charge Code	270705197
Hospital Revenue Code	279
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$232.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.75
Rate for Payer: Oxford Commercial	$387.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$387.50

Know your out-of-pocket cost for care.

All Charges