Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON SPRINTER RX 5.0x15MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651235
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALLOON SPRINTER RX 5.0x15MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651235
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALLOON SPRNTER RX 2.25X12MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651190S
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALLOON SPRNTER RX 2.25X12MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651190S
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALLOON SPRNT LEGEND 1.25x10MM

Facility

$675.00

Hospital Charge Code	270650879
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON SPRNT LEGEND 1.25x10MM

Facility

$675.00

Hospital Charge Code	270650879
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
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) NJ Health	$135.00
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	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON SPRNT LEGEND 1.25x15MM

Facility

$675.00

Hospital Charge Code	270650880
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON SPRNT LEGEND 1.25x15MM

Facility

$675.00

Hospital Charge Code	270650880
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
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) NJ Health	$135.00
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	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON SPRNT LEGEND 1.25x20MM

Facility

$675.00

Hospital Charge Code	270650881
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON SPRNT LEGEND 1.25x20MM

Facility

$675.00

Hospital Charge Code	270650881
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
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) NJ Health	$135.00
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	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON SPRNTR LEGEND 1.25x6MM

Facility

$675.00

Hospital Charge Code	270650876
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
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) NJ Health	$135.00
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	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON SPRNTR LEGEND 1.25x6MM

Facility

$675.00

Hospital Charge Code	270650876
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON STERLING 1.5x20 142cm

Facility

$1,493.50

Hospital Charge Code	270644389
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$448.05
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON STERLING 1.5x20 142cm

Facility

$2,325.00

Hospital Charge Code	270644389C
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$562.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: Qualcare PPO/HMO/WC	$348.75

BALLOON STERLING 1.5x20 142cm

Facility

$2,325.00

Hospital Charge Code	270644389C
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$1,162.50
Rate for Payer: Aetna Commercial	$697.50
Rate for Payer: Aetna Medicare Advantage	$697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$592.88
Rate for Payer: Cigna Commercial	$1,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: Qualcare PPO/HMO/WC	$348.75

BALLOON STERLING 1.5x20 142cm

Facility

$1,493.50

Hospital Charge Code	270644389
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$361.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON STERLING 2.0X20

Facility

$1,891.25

Hospital Charge Code	270645081C
Hospital Revenue Code	278
Min. Negotiated Rate	$283.69
Max. Negotiated Rate	$457.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.68
Rate for Payer: Qualcare PPO/HMO/WC	$283.69

BALLOON STERLING 2.0X20

Facility

$1,891.25

Hospital Charge Code	270645081C
Hospital Revenue Code	278
Min. Negotiated Rate	$283.69
Max. Negotiated Rate	$945.62
Rate for Payer: Aetna Commercial	$567.38
Rate for Payer: Aetna Medicare Advantage	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$482.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$482.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$482.27
Rate for Payer: Cigna Commercial	$945.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.68
Rate for Payer: Qualcare PPO/HMO/WC	$283.69

BALLOON STERLING 2.0x20mm

Facility

$1,493.50

Hospital Charge Code	270645081
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$448.05
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON STERLING 2.0x20mm

Facility

$1,493.50

Hospital Charge Code	270645081
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$361.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON STERLING 2x40mm 142cm

Facility

$1,493.50

Hospital Charge Code	270645210
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$361.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON STERLING 2x40mm 142cm

Facility

$1,493.50

Hospital Charge Code	270645210
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$448.05
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON STERLING 2x40MMx142CM

Facility

$1,824.50

Hospital Charge Code	270645210C
Hospital Revenue Code	278
Min. Negotiated Rate	$273.68
Max. Negotiated Rate	$912.25
Rate for Payer: Aetna Commercial	$547.35
Rate for Payer: Aetna Medicare Advantage	$547.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.25
Rate for Payer: Cigna Commercial	$912.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.53
Rate for Payer: Qualcare PPO/HMO/WC	$273.68

BALLOON STERLING 2x40MMx142CM

Facility

$1,824.50

Hospital Charge Code	270645210C
Hospital Revenue Code	278
Min. Negotiated Rate	$273.68
Max. Negotiated Rate	$441.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.53
Rate for Payer: Qualcare PPO/HMO/WC	$273.68

BALLOON STERLING 3.5x40 135cm

Facility

$1,493.50

Hospital Charge Code	270637588
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$448.05
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

Know your out-of-pocket cost for care.

All Charges