Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON MCV BILI 12F 4MM 6734

Facility

$1,839.25

Hospital Charge Code	270609409
Hospital Revenue Code	272
Min. Negotiated Rate	$275.89
Max. Negotiated Rate	$275.89
Rate for Payer: Qualcare PPO/HMO/WC	$275.89

BALLOON MCV BILI 18F 6MM 6738

Facility

$1,801.65

Hospital Charge Code	270609410
Hospital Revenue Code	272
Min. Negotiated Rate	$234.21
Max. Negotiated Rate	$900.83
Rate for Payer: Aetna Commercial	$540.50
Rate for Payer: Aetna Medicare Advantage	$540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.42
Rate for Payer: Cigna Commercial	$900.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.21
Rate for Payer: Oxford Commercial	$900.83
Rate for Payer: Qualcare PPO/HMO/WC	$270.25
Rate for Payer: UnitedHealthcare Commercial	$900.83

BALLOON MCV BILI 18F 6MM 6738

Facility

$1,801.65

Hospital Charge Code	270609410
Hospital Revenue Code	272
Min. Negotiated Rate	$270.25
Max. Negotiated Rate	$270.25
Rate for Payer: Qualcare PPO/HMO/WC	$270.25

BALLOON MCV BILI 24F 8MM 6742

Facility

$1,801.65

Hospital Charge Code	270609411
Hospital Revenue Code	272
Min. Negotiated Rate	$270.25
Max. Negotiated Rate	$270.25
Rate for Payer: Qualcare PPO/HMO/WC	$270.25

BALLOON MCV BILI 24F 8MM 6742

Facility

$1,801.65

Hospital Charge Code	270609411
Hospital Revenue Code	272
Min. Negotiated Rate	$234.21
Max. Negotiated Rate	$900.83
Rate for Payer: Aetna Commercial	$540.50
Rate for Payer: Aetna Medicare Advantage	$540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.42
Rate for Payer: Cigna Commercial	$900.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.21
Rate for Payer: Oxford Commercial	$900.83
Rate for Payer: Qualcare PPO/HMO/WC	$270.25
Rate for Payer: UnitedHealthcare Commercial	$900.83

BALLOON MINI TREK OTW 1.2x12mm

Facility

$850.00

Hospital Charge Code	270646869
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2x12mm

Facility

$850.00

Hospital Charge Code	270646869
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$425.00

BALLOON MINI TREK OTW 1.2X12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646869C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2X12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646869C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2x15mm

Facility

$850.00

Hospital Charge Code	270646870
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2x15mm

Facility

$850.00

Hospital Charge Code	270646870
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$425.00

BALLOON MINI TREK OTW 1.2X15MM

Facility

$1,075.00

Service Code	HCPCS C1725
Hospital Charge Code	270646870C
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

BALLOON MINI TREK OTW 1.2X15MM

Facility

$1,075.00

Service Code	HCPCS C1725
Hospital Charge Code	270646870C
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$322.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

BALLOON MINI TREK OTW 1.2x8mm

Facility

$850.00

Hospital Charge Code	270646868
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2x8mm

Facility

$850.00

Hospital Charge Code	270646868
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2X8MM

Facility

$850.00

Hospital Charge Code	270646868C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2X8MM

Facility

$850.00

Hospital Charge Code	270646868C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.5x12mm

Facility

$850.00

Hospital Charge Code	270645297
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$425.00

BALLOON MINI TREK OTW 1.5x12mm

Facility

$850.00

Hospital Charge Code	270645297
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.5x12MM

Facility

$1,075.00

Service Code	HCPCS C1725
Hospital Charge Code	270645297C
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

BALLOON MINI TREK OTW 1.5x12MM

Facility

$1,075.00

Service Code	HCPCS C1725
Hospital Charge Code	270645297C
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$322.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

BALLOON MINI TREK OTW 1.5x15mm

Facility

$850.00

Hospital Charge Code	270645298
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.5x15mm

Facility

$850.00

Hospital Charge Code	270645298
Hospital Revenue Code	272
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$425.00

BALLOON MINI TREK OTW 1.5x15MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645298C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.5x15MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645298C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

Know your out-of-pocket cost for care.

All Charges