Heights University Hospital

All Charges

Charge

Type

Setting

Price

EXPANDER TISS 350 SALN 3546212

Facility

$6,875.00

Hospital Charge Code	270639512
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,062.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

EXPANDER TISS 350 SALN 3546212

Facility

$6,875.00

Hospital Charge Code	270639512
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

EXPANDER TISS BREAST 480-575CC

Facility

$9,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270697126
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$2,812.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

EXPANDER TISS BREAST 480-575CC

Facility

$9,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270697126
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

EXPANDER TISS CONTOUR 354-2213

Facility

$6,572.00

Hospital Charge Code	270618760
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$1,971.60
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISS CONTOUR 354-2213

Facility

$6,572.00

Hospital Charge Code	270618760
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISS CONTOUR 354-2214

Facility

$4,636.85

Hospital Charge Code	270617555
Hospital Revenue Code	278
Min. Negotiated Rate	$695.53
Max. Negotiated Rate	$1,122.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.12
Rate for Payer: Qualcare PPO/HMO/WC	$695.53

EXPANDER TISS CONTOUR 354-2214

Facility

$4,636.85

Hospital Charge Code	270617555
Hospital Revenue Code	278
Min. Negotiated Rate	$695.53
Max. Negotiated Rate	$2,318.43
Rate for Payer: Aetna Commercial	$1,391.06
Rate for Payer: Aetna Medicare Advantage	$1,391.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,182.40
Rate for Payer: Cigna Commercial	$2,318.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.12
Rate for Payer: Qualcare PPO/HMO/WC	$695.53

EXPANDER TISS CONTOUR 354-2215

Facility

$4,636.85

Hospital Charge Code	270617111
Hospital Revenue Code	278
Min. Negotiated Rate	$695.53
Max. Negotiated Rate	$2,318.43
Rate for Payer: Aetna Commercial	$1,391.06
Rate for Payer: Aetna Medicare Advantage	$1,391.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,182.40
Rate for Payer: Cigna Commercial	$2,318.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.12
Rate for Payer: Qualcare PPO/HMO/WC	$695.53

EXPANDER TISS CONTOUR 354-2215

Facility

$4,636.85

Hospital Charge Code	270617111
Hospital Revenue Code	278
Min. Negotiated Rate	$695.53
Max. Negotiated Rate	$1,122.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.12
Rate for Payer: Qualcare PPO/HMO/WC	$695.53

EXPANDER TISSUE 3542214

Facility

$6,572.00

Hospital Charge Code	270617565
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 3542214

Facility

$6,572.00

Hospital Charge Code	270617565
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$1,971.60
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 550cc LOW PRO-

Facility

$6,572.00

Hospital Charge Code	270632103
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 550cc LOW PRO-

Facility

$6,423.25

Hospital Charge Code	270632104
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$3,211.62
Rate for Payer: Aetna Commercial	$1,926.97
Rate for Payer: Aetna Medicare Advantage	$1,926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,637.93
Rate for Payer: Cigna Commercial	$3,211.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

EXPANDER TISSUE 550cc LOW PRO-

Facility

$6,423.25

Hospital Charge Code	270632104
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$1,554.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

EXPANDER TISSUE 550cc LOW PRO-

Facility

$6,572.00

Hospital Charge Code	270632103
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$1,971.60
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 650cc 3546215

Facility

$6,572.00

Hospital Charge Code	270633213
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 650cc 3546215

Facility

$6,572.00

Hospital Charge Code	270633213
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$1,971.60
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 650cc MED 9200

Facility

$8,475.00

Service Code	HCPCS C1789
Hospital Charge Code	270679520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$4,237.50
Rate for Payer: Aetna Commercial	$2,542.50
Rate for Payer: Aetna Medicare Advantage	$2,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,161.12
Rate for Payer: Cigna Commercial	$4,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

EXPANDER TISSUE 650cc MED 9200

Facility

$8,475.00

Service Code	HCPCS C1789
Hospital Charge Code	270679520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$2,050.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

EXPANDERTISSUEALLOX2 225-280CC

Facility

$9,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270698080
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$2,700.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

EXPANDERTISSUEALLOX2 225-280CC

Facility

$9,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270698080
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

EXPANDER TISSUE CPX 450CC

Facility

$9,875.00

Hospital Charge Code	270701488
Hospital Revenue Code	278
Min. Negotiated Rate	$1,481.25
Max. Negotiated Rate	$2,389.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,481.25

EXPANDER TISSUE CPX 450CC

Facility

$9,875.00

Hospital Charge Code	270701488
Hospital Revenue Code	278
Min. Negotiated Rate	$1,481.25
Max. Negotiated Rate	$4,937.50
Rate for Payer: Aetna Commercial	$2,962.50
Rate for Payer: Aetna Medicare Advantage	$2,962.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,518.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,518.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,518.12
Rate for Payer: Cigna Commercial	$4,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,481.25

EXPANDER TISSUE MED HT 270 CC

Facility

$8,225.00

Hospital Charge Code	270677729
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.75
Max. Negotiated Rate	$4,112.50
Rate for Payer: Aetna Commercial	$2,467.50
Rate for Payer: Aetna Medicare Advantage	$2,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.38
Rate for Payer: Cigna Commercial	$4,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.75

Know your out-of-pocket cost for care.

All Charges