Heights University Hospital

All Charges

Charge

Type

Setting

Price

CATH BALLN ADM EXTRM 5/150/130

Facility

$1,092.50

Service Code	HCPCS C1725
Hospital Charge Code	270658390
Hospital Revenue Code	278
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$546.25
Rate for Payer: Aetna Commercial	$327.75
Rate for Payer: Aetna Medicare Advantage	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.59
Rate for Payer: Cigna Commercial	$546.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.38
Rate for Payer: Qualcare PPO/HMO/WC	$163.88

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,147.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518S
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,147.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518C
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518C
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,147.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518S
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 6X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685243
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 6X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685243
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALL NC VOYAGER 2.75x8

Facility

$1,275.00

Hospital Charge Code	2709003706
Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
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) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.75
Rate for Payer: Oxford Commercial	$637.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Commercial	$637.50

CATH BALL NC VOYAGER 2.75x8

Facility

$1,275.00

Hospital Charge Code	2709003706
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$191.25
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

CATH BALL NC VOYAGER 3.5x8

Facility

$1,275.00

Hospital Charge Code	2709003708
Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
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) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.75
Rate for Payer: Oxford Commercial	$637.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Commercial	$637.50

CATH BALL NC VOYAGER 3.5x8

Facility

$1,275.00

Hospital Charge Code	2709003708
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$191.25
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

CATH BALLN DIAMD 5x2x75C 16437

Facility

$1,044.50

Hospital Charge Code	270628314V
Hospital Revenue Code	278
Min. Negotiated Rate	$156.68
Max. Negotiated Rate	$252.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.77
Rate for Payer: Qualcare PPO/HMO/WC	$156.68

CATH BALLN DIAMD 5x2x75C 16437

Facility

$1,044.50

Hospital Charge Code	270628314V
Hospital Revenue Code	278
Min. Negotiated Rate	$156.68
Max. Negotiated Rate	$522.25
Rate for Payer: Aetna Commercial	$313.35
Rate for Payer: Aetna Medicare Advantage	$313.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.35
Rate for Payer: Cigna Commercial	$522.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.77
Rate for Payer: Qualcare PPO/HMO/WC	$156.68

CATH BALLN DIAMD 6x4x75C 16463

Facility

$1,044.50

Hospital Charge Code	270618563V
Hospital Revenue Code	278
Min. Negotiated Rate	$156.68
Max. Negotiated Rate	$522.25
Rate for Payer: Aetna Commercial	$313.35
Rate for Payer: Aetna Medicare Advantage	$313.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.35
Rate for Payer: Cigna Commercial	$522.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.77
Rate for Payer: Qualcare PPO/HMO/WC	$156.68

CATH BALLN DIAMD 6x4x75C 16463

Facility

$1,044.50

Hospital Charge Code	270618563V
Hospital Revenue Code	278
Min. Negotiated Rate	$156.68
Max. Negotiated Rate	$252.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.77
Rate for Payer: Qualcare PPO/HMO/WC	$156.68

Know your out-of-pocket cost for care.

All Charges