Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON WH PANTERA PRO 4.0/25

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701037S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON WH PANTERA PRO 4.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701032S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON WH PANTERA PRO 4.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701032S
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

BALLO VOY NC 3.5x12m1011756-12

Facility

$1,275.00

Hospital Charge Code	270643181C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLO VOY NC 3.5x12m1011756-12

Facility

$1,275.00

Hospital Charge Code	270643181C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLO VOY NC 4.0x12m 101175812

Facility

$1,275.00

Hospital Charge Code	270643183C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLO VOY NC 4.0x12m 101175812

Facility

$1,275.00

Hospital Charge Code	270643183C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLO VOY RX 3.0x15m 101139615

Facility

$1,275.00

Hospital Charge Code	270643205C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLO VOY RX 3.0x15m 101139615

Facility

$1,275.00

Hospital Charge Code	270643205C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLO VOY RX 3.0x8m 1011396-08

Facility

$1,275.00

Hospital Charge Code	270643204C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$382.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLO VOY RX 3.0x8m 1011396-08

Facility

$1,275.00

Hospital Charge Code	270643204C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALL TIP DISPOSABLE DIRECT

Facility

$1,390.00

Hospital Charge Code	270670711
Hospital Revenue Code	272
Min. Negotiated Rate	$180.70
Max. Negotiated Rate	$695.00
Rate for Payer: Aetna Commercial	$417.00
Rate for Payer: Aetna Medicare Advantage	$417.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.45
Rate for Payer: Cigna Commercial	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.70
Rate for Payer: Oxford Commercial	$695.00
Rate for Payer: Qualcare PPO/HMO/WC	$208.50
Rate for Payer: UnitedHealthcare Commercial	$695.00

BALL TIP DISPOSABLE DIRECT

Facility

$1,390.00

Hospital Charge Code	270670711
Hospital Revenue Code	272
Min. Negotiated Rate	$208.50
Max. Negotiated Rate	$208.50
Rate for Payer: Qualcare PPO/HMO/WC	$208.50

BALL TIP GIDE WIRE 3.0MMX100CM

Facility

$716.15

Hospital Charge Code	270663171
Hospital Revenue Code	270
Min. Negotiated Rate	$107.42
Max. Negotiated Rate	$107.42
Rate for Payer: Qualcare PPO/HMO/WC	$107.42

BALL TIP GIDE WIRE 3.0MMX100CM

Facility

$716.15

Hospital Charge Code	270663171
Hospital Revenue Code	270
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$358.07
Rate for Payer: Aetna Commercial	$214.84
Rate for Payer: Aetna Medicare Advantage	$214.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.62
Rate for Payer: Cigna Commercial	$358.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.10
Rate for Payer: Oxford Commercial	$358.07
Rate for Payer: Qualcare PPO/HMO/WC	$107.42
Rate for Payer: UnitedHealthcare Commercial	$358.07

BALL TOTAL HIP 28 MM +3 NECK L

Facility

$1,650.00

Hospital Charge Code	270657405
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

BALL TOTAL HIP 28 MM +3 NECK L

Facility

$1,650.00

Hospital Charge Code	270657405
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$495.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

BALL TOTAL HIP 28MM +5 NECK L

Facility

$1,750.00

Hospital Charge Code	270657407
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

BALL TOTAL HIP 28MM +5 NECK L

Facility

$1,750.00

Hospital Charge Code	270657407
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

BALL TOTAL HIP 32 MM +0

Facility

$14,000.00

Hospital Charge Code	270657398
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$4,200.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

BALL TOTAL HIP 32 MM +0

Facility

$14,000.00

Hospital Charge Code	270657398
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

BALL TOTAL HIP 32 MM +5

Facility

$1,750.00

Hospital Charge Code	270657402
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

BALL TOTAL HIP 32 MM +5

Facility

$1,750.00

Hospital Charge Code	270657402
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

BALL VOYAG NC 2.75x8m101175308

Facility

$255.00

Hospital Charge Code	270643025
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

BALL VOYAG NC 2.75x8m101175308

Facility

$255.00

Hospital Charge Code	270643025
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

Know your out-of-pocket cost for care.

All Charges