Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 23 6623

Facility

$309.65

Hospital Charge Code	270604796
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 23 6623

Facility

$309.65

Hospital Charge Code	270604796
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 24 6624

Facility

$309.65

Hospital Charge Code	270604797
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 24 6624

Facility

$309.65

Hospital Charge Code	270604797
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 RETRL INJ DIS 15m 4546

Facility

$762.95

Hospital Charge Code	270627935
Hospital Revenue Code	272
Min. Negotiated Rate	$99.18
Max. Negotiated Rate	$381.48
Rate for Payer: Aetna Commercial	$228.88
Rate for Payer: Aetna Medicare Advantage	$228.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.55
Rate for Payer: Cigna Commercial	$381.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.18
Rate for Payer: Oxford Commercial	$381.48
Rate for Payer: Qualcare PPO/HMO/WC	$114.44
Rate for Payer: UnitedHealthcare Commercial	$381.48

BALLOON RETRL INJ DIS 15m 4546

Facility

$762.95

Hospital Charge Code	270627935
Hospital Revenue Code	272
Min. Negotiated Rate	$114.44
Max. Negotiated Rate	$114.44
Rate for Payer: Qualcare PPO/HMO/WC	$114.44

BALLOON RX NC TREK 2.25x12mm

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270646350
Hospital Revenue Code	272
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.75
Rate for Payer: Oxford Commercial	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Commercial	$337.50

BALLOON RX NC TREK 2.25x12mm

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270646350
Hospital Revenue Code	272
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$101.25
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON RX NC TREK 2.25X12MM

Facility

$850.00

Hospital Charge Code	270646350C
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 RX NC TREK 2.25X12MM

Facility

$850.00

Hospital Charge Code	270646350C
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 RX NC TREK 2.25x15mm

Facility

$850.00

Hospital Charge Code	270646351
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 RX NC TREK 2.25x15mm

Facility

$850.00

Hospital Charge Code	270646351
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON RX NC TREK 2.25X15MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646351C
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 RX NC TREK 2.25X15MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646351C
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 RX NC TREK 2.25x20mm

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646465
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 RX NC TREK 2.25x20mm

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646465
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 RX NC TREK 2.25x6mm

Facility

$850.00

Hospital Charge Code	270646348
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 RX NC TREK 2.25x6mm

Facility

$850.00

Hospital Charge Code	270646348
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON RX NC TREK 2.25X6MM

Facility

$850.00

Hospital Charge Code	270646348C
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 RX NC TREK 2.25X6MM

Facility

$850.00

Hospital Charge Code	270646348C
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 RX NC TREK 2.25x8mm

Facility

$850.00

Hospital Charge Code	270646349
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON RX NC TREK 2.25x8mm

Facility

$850.00

Hospital Charge Code	270646349
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 RX NC TREK 2.25X8MM

Facility

$850.00

Hospital Charge Code	270646349C
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 RX NC TREK 2.25X8MM

Facility

$850.00

Hospital Charge Code	270646349C
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