Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON RAPTOR OTW 2.75x15mm

Facility

$1,099.45

Hospital Charge Code	270637414
Hospital Revenue Code	272
Min. Negotiated Rate	$142.93
Max. Negotiated Rate	$549.73
Rate for Payer: Aetna Commercial	$329.83
Rate for Payer: Aetna Medicare Advantage	$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 RAPTOR OTW 2.75x15mm

Facility

$1,099.45

Hospital Charge Code	270637414
Hospital Revenue Code	272
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$164.92
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALLOON RAPTOR OTW 3.0x10mm

Facility

$1,099.45

Hospital Charge Code	270637561
Hospital Revenue Code	272
Min. Negotiated Rate	$142.93
Max. Negotiated Rate	$549.73
Rate for Payer: Aetna Commercial	$329.83
Rate for Payer: Aetna Medicare Advantage	$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 RAPTOR OTW 3.0x10mm

Facility

$1,099.45

Hospital Charge Code	270637561
Hospital Revenue Code	272
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$164.92
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALLOON REPLCMT MCV 12 6612

Facility

$309.65

Hospital Charge Code	270604784
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 12 6612

Facility

$309.65

Hospital Charge Code	270604784
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 13 6613

Facility

$309.65

Hospital Charge Code	270604785
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 13 6613

Facility

$309.65

Hospital Charge Code	270604785
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 14 6614

Facility

$616.00

Hospital Charge Code	270604786
Hospital Revenue Code	278
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$149.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.07
Rate for Payer: Qualcare PPO/HMO/WC	$92.40

BALLOON REPLCMT MCV 14 6614

Facility

$616.00

Hospital Charge Code	270604786
Hospital Revenue Code	278
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$308.00
Rate for Payer: Aetna Commercial	$184.80
Rate for Payer: Aetna Medicare Advantage	$184.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.08
Rate for Payer: Cigna Commercial	$308.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.07
Rate for Payer: Qualcare PPO/HMO/WC	$92.40

BALLOON REPLCMT MCV 15 6615

Facility

$309.65

Hospital Charge Code	270604787
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 15 6615

Facility

$309.65

Hospital Charge Code	270604787
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 16 6616

Facility

$309.65

Hospital Charge Code	270604789
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 16 6616

Facility

$309.65

Hospital Charge Code	270604789
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 17 6617

Facility

$309.65

Service Code	HCPCS C1726
Hospital Charge Code	270604790
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 17 6617

Facility

$309.65

Service Code	HCPCS C1726
Hospital Charge Code	270604790
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 18 6618

Facility

$309.65

Hospital Charge Code	270604791
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 18 6618

Facility

$309.65

Hospital Charge Code	270604791
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 19 6619

Facility

$309.65

Hospital Charge Code	270604792
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 19 6619

Facility

$309.65

Hospital Charge Code	270604792
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 20 6620

Facility

$309.65

Hospital Charge Code	270604793
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 20 6620

Facility

$309.65

Hospital Charge Code	270604793
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 21 6621

Facility

$309.65

Hospital Charge Code	270604794
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 21 6621

Facility

$309.65

Hospital Charge Code	270604794
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 22 6622

Facility

$309.65

Service Code	HCPCS C1726
Hospital Charge Code	270604795
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

Know your out-of-pocket cost for care.

All Charges