Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON TREK RX 4.5mm x 12mm

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645291
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BALLOON TREK RX 4.5MM x 12MM

Facility

$850.00

Hospital Charge Code	270645291C
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 TREK RX 4.5MM x 12MM

Facility

$850.00

Hospital Charge Code	270645291C
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 TREK RX 4.5MM x 15MM

Facility

$850.00

Hospital Charge Code	270645292C
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 TREK RX 4.5MM x 15MM

Facility

$850.00

Hospital Charge Code	270645292C
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 TREK RX 5.0MM x 12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645293C
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 TREK RX 5.0MM x 12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645293C
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 TREK RX 5.0MM x 15MM

Facility

$850.00

Hospital Charge Code	270645294C
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 TREK RX 5.0MM x 15MM

Facility

$850.00

Hospital Charge Code	270645294C
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 TREX 3.75MM x 06MM

Facility

$400.00

Hospital Charge Code	270645277
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

BALLOON TREX 3.75MM x 06MM

Facility

$400.00

Hospital Charge Code	270645277
Hospital Revenue Code	272
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$120.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$200.00

BALLOON TREX 3.75MM X 08MM

Facility

$400.00

Hospital Charge Code	270645278
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

BALLOON TREX 3.75MM X 08MM

Facility

$400.00

Hospital Charge Code	270645278
Hospital Revenue Code	272
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$120.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$200.00

BALLOON ULTRAVER .035 5X100MM

Facility

$1,150.00

Hospital Charge Code	270671199
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$345.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

BALLOON ULTRAVER .035 5X100MM

Facility

$1,150.00

Hospital Charge Code	270671199
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

BALLOON ULTRAVER .035 5X60MM

Facility

$1,150.00

Hospital Charge Code	270671200
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$345.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

BALLOON ULTRAVER .035 5X60MM

Facility

$1,150.00

Hospital Charge Code	270671200
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

BALLOON URO MAX KIT 5MM

Facility

$1,033.25

Hospital Charge Code	270650769
Hospital Revenue Code	272
Min. Negotiated Rate	$134.32
Max. Negotiated Rate	$516.62
Rate for Payer: Aetna Commercial	$309.98
Rate for Payer: Aetna Medicare Advantage	$309.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.48
Rate for Payer: Cigna Commercial	$516.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.32
Rate for Payer: Oxford Commercial	$516.62
Rate for Payer: Qualcare PPO/HMO/WC	$154.99
Rate for Payer: UnitedHealthcare Commercial	$516.62

BALLOON URO MAX KIT 5MM

Facility

$1,033.25

Hospital Charge Code	270650769
Hospital Revenue Code	272
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$154.99

BALLOON URO MAX ULTRA 15FR 6cm

Facility

$2,006.20

Hospital Charge Code	270651426
Hospital Revenue Code	272
Min. Negotiated Rate	$260.81
Max. Negotiated Rate	$1,003.10
Rate for Payer: Aetna Commercial	$601.86
Rate for Payer: Aetna Medicare Advantage	$601.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.58
Rate for Payer: Cigna Commercial	$1,003.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.81
Rate for Payer: Oxford Commercial	$1,003.10
Rate for Payer: Qualcare PPO/HMO/WC	$300.93
Rate for Payer: UnitedHealthcare Commercial	$1,003.10

BALLOON URO MAX ULTRA 15FR 6cm

Facility

$2,006.20

Hospital Charge Code	270651426
Hospital Revenue Code	272
Min. Negotiated Rate	$300.93
Max. Negotiated Rate	$300.93
Rate for Payer: Qualcare PPO/HMO/WC	$300.93

BALLOON URO MAX ULTRA 24FR 8cm

Facility

$2,182.15

Hospital Charge Code	270651427
Hospital Revenue Code	272
Min. Negotiated Rate	$327.32
Max. Negotiated Rate	$327.32
Rate for Payer: Qualcare PPO/HMO/WC	$327.32

BALLOON URO MAX ULTRA 24FR 8cm

Facility

$2,182.15

Hospital Charge Code	270651427
Hospital Revenue Code	272
Min. Negotiated Rate	$283.68
Max. Negotiated Rate	$1,091.08
Rate for Payer: Aetna Commercial	$654.64
Rate for Payer: Aetna Medicare Advantage	$654.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.45
Rate for Payer: Cigna Commercial	$1,091.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.68
Rate for Payer: Oxford Commercial	$1,091.08
Rate for Payer: Qualcare PPO/HMO/WC	$327.32
Rate for Payer: UnitedHealthcare Commercial	$1,091.08

BALLOON U/T DIAMOND 5x10x135cm

Facility

$1,080.00

Hospital Charge Code	270637206
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$261.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.36
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

BALLOON U/T DIAMOND 5x10x135cm

Facility

$1,080.00

Hospital Charge Code	270637206
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$324.00
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.36
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

Know your out-of-pocket cost for care.

All Charges