Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALLN EC 6x100 AB35W06100F135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644321C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLN EC 6x100 AB35W06100F135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644321C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$257.25
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLN EC 6x150mm AB35W06150135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644428C
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLN EC 6x150mm AB35W06150135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644428C
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$244.02
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLN EC 6X30mm AB35W06030135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644466C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$204.33
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 6X30mm AB35W06030135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644466C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 6X40mm AB35W06040135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270641871C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 6X40mm AB35W06040135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270641871C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$204.33
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x100mm AB35W07100135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644471C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$204.33
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x100mm AB35W07100135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644471C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x120mm AB35W07120135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644017C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$204.33
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x120mm AB35W07120135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644017C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x200mm AB35W07200135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644472C
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLN EC 7x200mm AB35W07200135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644472C
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$244.02
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLN EC 7x20mm AB35W07020135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644468C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$257.25
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLN EC 7x20mm AB35W07020135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644468C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLN EC 7x30mm AB35W07030135

Facility

$725.00

Hospital Charge Code	270644469C
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

BALLN EC 7x30mm AB35W07030135

Facility

$725.00

Hospital Charge Code	270644469C
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$217.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

BALLN EC 7x40mm AB35W07040135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270643856C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$257.25
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLN EC 7x40mm AB35W07040135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270643856C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLN EC 7x60mm AB35W07060135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644403C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x60mm AB35W07060135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644403C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$204.33
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x80mm AB35W07080135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644470C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$204.33
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x80mm AB35W07080135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644470C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 8x20mm AB35W08020080

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644473C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$257.25
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

Know your out-of-pocket cost for care.

All Charges