Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON NC PANTERA LEO 5.0/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700973S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON NC PANTERA LEO 5.0/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700973S
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 NC PANTERA LEO 5.0/8

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701019S
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 NC PANTERA LEO 5.0/8

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701019S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON NCRS PTA AB14W02504015

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677S
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLOON NCRS PTA AB14W02504015

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677S
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$461.58
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLOON NEPHROSTOMY

Facility

$1,348.50

Hospital Charge Code	270650767
Hospital Revenue Code	272
Min. Negotiated Rate	$202.28
Max. Negotiated Rate	$202.28
Rate for Payer: Qualcare PPO/HMO/WC	$202.28

BALLOON NEPHROSTOMY

Facility

$1,348.50

Hospital Charge Code	270650767
Hospital Revenue Code	272
Min. Negotiated Rate	$175.31
Max. Negotiated Rate	$674.25
Rate for Payer: Aetna Commercial	$404.55
Rate for Payer: Aetna Medicare Advantage	$404.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$343.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$343.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$343.87
Rate for Payer: Cigna Commercial	$674.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.31
Rate for Payer: Oxford Commercial	$674.25
Rate for Payer: Qualcare PPO/HMO/WC	$202.28
Rate for Payer: UnitedHealthcare Commercial	$674.25

BALLOON NINJA OTW 2.5x10mm

Facility

$1,099.45

Hospital Charge Code	270639422
Hospital Revenue Code	272
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$164.92
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALLOON NINJA OTW 2.5x10mm

Facility

$1,099.45

Hospital Charge Code	270639422
Hospital Revenue Code	272
Min. Negotiated Rate	$142.93
Max. Negotiated Rate	$549.73
Rate for Payer: Aetna Medicare Advantage	$329.83
Rate for Payer: Aetna Commercial	$329.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.36
Rate for Payer: Cigna Commercial	$549.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.93
Rate for Payer: Oxford Commercial	$549.73
Rate for Payer: Qualcare PPO/HMO/WC	$164.92
Rate for Payer: UnitedHealthcare Commercial	$549.73

BALLOON OCCLUSION 262924

Facility

$1,016.85

Hospital Charge Code	270632205
Hospital Revenue Code	272
Min. Negotiated Rate	$152.53
Max. Negotiated Rate	$152.53
Rate for Payer: Qualcare PPO/HMO/WC	$152.53

BALLOON OCCLUSION 262924

Facility

$1,016.85

Hospital Charge Code	270632728
Hospital Revenue Code	272
Min. Negotiated Rate	$132.19
Max. Negotiated Rate	$508.43
Rate for Payer: Aetna Commercial	$305.06
Rate for Payer: Aetna Medicare Advantage	$305.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.30
Rate for Payer: Cigna Commercial	$508.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.19
Rate for Payer: Oxford Commercial	$508.43
Rate for Payer: Qualcare PPO/HMO/WC	$152.53
Rate for Payer: UnitedHealthcare Commercial	$508.43

BALLOON OCCLUSION 262924

Facility

$1,016.85

Hospital Charge Code	270632205
Hospital Revenue Code	272
Min. Negotiated Rate	$132.19
Max. Negotiated Rate	$508.43
Rate for Payer: Aetna Commercial	$305.06
Rate for Payer: Aetna Medicare Advantage	$305.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.30
Rate for Payer: Cigna Commercial	$508.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.19
Rate for Payer: Oxford Commercial	$508.43
Rate for Payer: Qualcare PPO/HMO/WC	$152.53
Rate for Payer: UnitedHealthcare Commercial	$508.43

BALLOON OCCLUSION 262924

Facility

$1,016.85

Hospital Charge Code	270632728
Hospital Revenue Code	272
Min. Negotiated Rate	$152.53
Max. Negotiated Rate	$152.53
Rate for Payer: Qualcare PPO/HMO/WC	$152.53

BALLOON OPTA LP 8x4 80cm

Facility

$1,325.00

Hospital Charge Code	270626132
Hospital Revenue Code	272
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$198.75
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON OPTA LP 8x4 80cm

Facility

$1,325.00

Hospital Charge Code	270626132
Hospital Revenue Code	272
Min. Negotiated Rate	$172.25
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) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.25
Rate for Payer: Oxford Commercial	$662.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Commercial	$662.50

BALLOON OPTA PRO CRD 4197040S

Facility

$1,237.65

Hospital Charge Code	270625961
Hospital Revenue Code	272
Min. Negotiated Rate	$160.89
Max. Negotiated Rate	$618.83
Rate for Payer: Aetna Commercial	$371.30
Rate for Payer: Aetna Medicare Advantage	$371.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.60
Rate for Payer: Cigna Commercial	$618.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.89
Rate for Payer: Oxford Commercial	$618.83
Rate for Payer: Qualcare PPO/HMO/WC	$185.65
Rate for Payer: UnitedHealthcare Commercial	$618.83

BALLOON OPTA PRO CRD 4197040S

Facility

$1,237.65

Hospital Charge Code	270625961
Hospital Revenue Code	272
Min. Negotiated Rate	$185.65
Max. Negotiated Rate	$185.65
Rate for Payer: Qualcare PPO/HMO/WC	$185.65

BALLOON OPTILUME 24/18F 3CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699438
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

BALLOON OPTILUME 24/18F 3CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699438
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

BALLOON OPTILUME 24/18F 5CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

BALLOON OPTILUME 24/18F 5CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

BALLOON OPTILUME 30/24F 3CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

BALLOON OPTILUME 30/24F 3CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$3,592.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

BALLOON OPTILUME 30/24F 5CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699441
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

Know your out-of-pocket cost for care.

All Charges