Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATHBALLONADMI.XTREME 9/40/130

Facility

$1,000.00

Hospital Charge Code	5709003838
Hospital Revenue Code	272
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$500.00

CATH BALLON AMPHN 1 5/20/150

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270657934
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

CATH BALLON AMPHN 1 5/20/150

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270657934
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

CATH BALLON AMPHN 2 5/120/150

Facility

$1,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270661861
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$547.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATH BALLON AMPHN 2 5/120/150

Facility

$1,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270661861
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATH BALLON ECLIPSE DUAL 6X15

Facility

$9,250.00

Service Code	HCPCS C2628
Hospital Charge Code	270697182S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

CATH BALLON ECLIPSE DUAL 6X15

Facility

$9,250.00

Service Code	HCPCS C2628
Hospital Charge Code	270697182S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$2,775.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

CATH BALLON PTA DILAIT 14LP3-2

Facility

$2,650.00

Hospital Charge Code	270662854
Hospital Revenue Code	278
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$641.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

CATH BALLON PTA DILAIT 14LP3-2

Facility

$2,650.00

Hospital Charge Code	270662854
Hospital Revenue Code	278
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$1,325.00
Rate for Payer: Aetna Commercial	$795.00
Rate for Payer: Aetna Medicare Advantage	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$675.75
Rate for Payer: Cigna Commercial	$1,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

CATH BALLON PTA DILATI 14LP2-8

Facility

$2,650.00

Hospital Charge Code	270662853
Hospital Revenue Code	278
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$1,325.00
Rate for Payer: Aetna Commercial	$795.00
Rate for Payer: Aetna Medicare Advantage	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$675.75
Rate for Payer: Cigna Commercial	$1,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

CATH BALLON PTA DILATI 14LP2-8

Facility

$2,650.00

Hospital Charge Code	270662853
Hospital Revenue Code	278
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$641.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

CATH BALLON STERLING 6X2X80

Facility

$1,976.25

Hospital Charge Code	2709005798
Hospital Revenue Code	272
Min. Negotiated Rate	$296.44
Max. Negotiated Rate	$296.44
Rate for Payer: Qualcare PPO/HMO/WC	$296.44

CATH BALLON STERLING 6X2X80

Facility

$1,976.25

Hospital Charge Code	2709005798
Hospital Revenue Code	272
Min. Negotiated Rate	$256.91
Max. Negotiated Rate	$988.12
Rate for Payer: Aetna Commercial	$592.88
Rate for Payer: Aetna Medicare Advantage	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.94
Rate for Payer: Cigna Commercial	$988.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.91
Rate for Payer: Oxford Commercial	$988.12
Rate for Payer: Qualcare PPO/HMO/WC	$296.44
Rate for Payer: UnitedHealthcare Commercial	$988.12

CATH BALLON STERLING 7X2X80

Facility

$1,976.25

Hospital Charge Code	2709005799
Hospital Revenue Code	272
Min. Negotiated Rate	$296.44
Max. Negotiated Rate	$296.44
Rate for Payer: Qualcare PPO/HMO/WC	$296.44

CATH BALLON STERLING 7X2X80

Facility

$1,976.25

Hospital Charge Code	2709005799
Hospital Revenue Code	272
Min. Negotiated Rate	$256.91
Max. Negotiated Rate	$988.12
Rate for Payer: Aetna Commercial	$592.88
Rate for Payer: Aetna Medicare Advantage	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.94
Rate for Payer: Cigna Commercial	$988.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.91
Rate for Payer: Oxford Commercial	$988.12
Rate for Payer: Qualcare PPO/HMO/WC	$296.44
Rate for Payer: UnitedHealthcare Commercial	$988.12

CATHBALLON UT/SDS OTW 10/2/75

Facility

$1,355.00

Hospital Charge Code	2709005863
Hospital Revenue Code	272
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

CATHBALLON UT/SDS OTW 10/2/75

Facility

$1,355.00

Hospital Charge Code	2709005863
Hospital Revenue Code	272
Min. Negotiated Rate	$176.15
Max. Negotiated Rate	$677.50
Rate for Payer: Aetna Commercial	$406.50
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$677.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.15
Rate for Payer: Oxford Commercial	$677.50
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$677.50

CATHBALLON UT/SDS OTW 10/6/75

Facility

$1,355.00

Hospital Charge Code	2709005865
Hospital Revenue Code	272
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

CATHBALLON UT/SDS OTW 10/6/75

Facility

$1,355.00

Hospital Charge Code	2709005865
Hospital Revenue Code	272
Min. Negotiated Rate	$176.15
Max. Negotiated Rate	$677.50
Rate for Payer: Aetna Commercial	$406.50
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$677.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.15
Rate for Payer: Oxford Commercial	$677.50
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$677.50

CATHBALLON UT/SDS OTW 4/6/6/75

Facility

$1,020.00

Hospital Charge Code	2709004840
Hospital Revenue Code	272
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$306.00
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.60
Rate for Payer: Oxford Commercial	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Commercial	$510.00

CATHBALLON UT/SDS OTW 4/6/6/75

Facility

$1,020.00

Hospital Charge Code	2709004840
Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

CATHBALLON UT/SDS OTW 4/6/75

Facility

$1,020.00

Hospital Charge Code	2709005840
Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

CATHBALLON UT/SDS OTW 4/6/75

Facility

$1,020.00

Hospital Charge Code	2709005840
Hospital Revenue Code	272
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$306.00
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.60
Rate for Payer: Oxford Commercial	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Commercial	$510.00

CATHBALLON UT/SDS OTW 5/6/6/75

Facility

$1,020.00

Hospital Charge Code	2709005844
Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

CATHBALLON UT/SDS OTW 5/6/6/75

Facility

$1,020.00

Hospital Charge Code	2709005844
Hospital Revenue Code	272
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$306.00
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.60
Rate for Payer: Oxford Commercial	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Commercial	$510.00

Know your out-of-pocket cost for care.

All Charges