Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON JADEOTW014150x2.5x60

Facility

$775.00

Hospital Charge Code	270705209
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 JADEOTW014150x2.5x80

Facility

$775.00

Hospital Charge Code	270705210
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 JADEOTW014150x2.5x80

Facility

$775.00

Hospital Charge Code	270705210
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.0x100

Facility

$775.00

Hospital Charge Code	270705217
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.0x100

Facility

$775.00

Hospital Charge Code	270705217
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 JADEOTW014150x3.0x120

Facility

$775.00

Hospital Charge Code	270705212
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 JADEOTW014150x3.0x120

Facility

$775.00

Hospital Charge Code	270705212
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.0x150

Facility

$775.00

Hospital Charge Code	270705213
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 JADEOTW014150x3.0x150

Facility

$775.00

Hospital Charge Code	270705213
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.0x240

Facility

$775.00

Hospital Charge Code	270705214
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.0x240

Facility

$775.00

Hospital Charge Code	270705214
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 JADEOTW014150x3.0x40

Facility

$775.00

Hospital Charge Code	270705215
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.0x40

Facility

$775.00

Hospital Charge Code	270705215
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 JADEOTW014150x3.0x80

Facility

$775.00

Hospital Charge Code	270705216
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 JADEOTW014150x3.0x80

Facility

$775.00

Hospital Charge Code	270705216
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.5x120

Facility

$775.00

Hospital Charge Code	270705218
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.5x120

Facility

$775.00

Hospital Charge Code	270705218
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 JADEOTW014150x3.5x150

Facility

$775.00

Hospital Charge Code	270705219
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.5x150

Facility

$775.00

Hospital Charge Code	270705219
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 JADEOTW014150x3.5x240

Facility

$775.00

Hospital Charge Code	270705220
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.5x240

Facility

$775.00

Hospital Charge Code	270705220
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 JADEOTW014150x3.5x40

Facility

$775.00

Hospital Charge Code	270705221
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014150x3.5x40

Facility

$775.00

Hospital Charge Code	270705221
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 JADEOTW014150x3.5x60

Facility

$775.00

Hospital Charge Code	270705222
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 JADEOTW014150x3.5x60

Facility

$775.00

Hospital Charge Code	270705222
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

Know your out-of-pocket cost for care.

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