Heights University Hospital

All Charges

Charge

Type

Setting

Price

BALN EC 12x40x80 AB35W12040080

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644437C
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

BALN EC 12x60x80 AB35W12060080

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644431C
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

BALN EC 12x60x80 AB35W12060080

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644431C
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

BALN EC 7x150x13 AB35W07150135

Facility

$725.00

Hospital Charge Code	270644035V
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

BALN EC 7x150x13 AB35W07150135

Facility

$725.00

Hospital Charge Code	270644035V
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

BALN EC 8x40x80 AB35W08040080

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644441C
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

BALN EC 8x40x80 AB35W08040080

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644441C
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

BALN EC 8x60x80 AB35W08060080

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644036C
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

BALN EC 8x60x80 AB35W08060080

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644036C
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

BALNETAR/240ML

Facility

$89.00

Hospital Charge Code	60632529
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

BALNETAR/240ML

Facility

$89.00

Hospital Charge Code	60632529
Hospital Revenue Code	250
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

BALN EVERC 6.0x80 AB35W0608013

Facility

$975.00

Hospital Charge Code	270642507C
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$292.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

BALN EVERC 6.0x80 AB35W0608013

Facility

$975.00

Hospital Charge Code	270642507C
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

BALN IAB 7 5F 34C 068400047901

Facility

$5,075.00

Service Code	HCPCS C1725
Hospital Charge Code	270634433N
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,522.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

BALN IAB 7 5F 34C 068400047901

Facility

$5,075.00

Service Code	HCPCS C1725
Hospital Charge Code	270634433N
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

BALN IAB 7 5F 34C 068400047901

Facility

$4,313.75

Service Code	HCPCS C1725
Hospital Charge Code	270634433
Hospital Revenue Code	278
Min. Negotiated Rate	$647.06
Max. Negotiated Rate	$1,043.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,043.93
Rate for Payer: Qualcare PPO/HMO/WC	$647.06

BALN IAB 7 5F 34C 068400047901

Facility

$4,313.75

Service Code	HCPCS C1725
Hospital Charge Code	270634433
Hospital Revenue Code	278
Min. Negotiated Rate	$647.06
Max. Negotiated Rate	$2,156.88
Rate for Payer: Aetna Commercial	$1,294.12
Rate for Payer: Aetna Medicare Advantage	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,100.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,100.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,100.01
Rate for Payer: Cigna Commercial	$2,156.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,043.93
Rate for Payer: Qualcare PPO/HMO/WC	$647.06

BALN MAV MON 2.75x12 389281227

Facility

$1,295.00

Hospital Charge Code	270638417C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALN MAV MON 2.75x12 389281227

Facility

$1,295.00

Hospital Charge Code	270638417C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$388.50
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALN NINJA OTW 225x10 563FX022

Facility

$880.00

Hospital Charge Code	270637412
Hospital Revenue Code	272
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

BALN NINJA OTW 225x10 563FX022

Facility

$880.00

Hospital Charge Code	270637412
Hospital Revenue Code	272
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$264.00
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.40
Rate for Payer: Oxford Commercial	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Commercial	$440.00

BALN NINJA OTW 225x15 563FX122

Facility

$880.00

Hospital Charge Code	270637720
Hospital Revenue Code	272
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$264.00
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.40
Rate for Payer: Oxford Commercial	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Commercial	$440.00

BALN NINJA OTW 225x15 563FX122

Facility

$880.00

Hospital Charge Code	270637720
Hospital Revenue Code	272
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

BALN QUAN MON 4 5x12 380801245

Facility

$1,295.00

Hospital Charge Code	270640730C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$388.50
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALN QUAN MON 4 5x12 380801245

Facility

$1,295.00

Hospital Charge Code	270640730C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

Know your out-of-pocket cost for care.

All Charges