Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT BREAST RD275cc354-2640

Facility

$3,224.00

Hospital Charge Code	270632176
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$1,612.00
Rate for Payer: Aetna Commercial	$967.20
Rate for Payer: Aetna Medicare Advantage	$967.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$822.12
Rate for Payer: Cigna Commercial	$1,612.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

IMPLANT BREAST RD275cc354-2640

Facility

$3,224.00

Hospital Charge Code	270632176
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$780.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

IMPLANT BREAST ROUND 225CC

Facility

$3,224.00

Hospital Charge Code	270621090
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$780.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

IMPLANT BREAST ROUND 225CC

Facility

$3,224.00

Hospital Charge Code	270621090
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$1,612.00
Rate for Payer: Aetna Commercial	$967.20
Rate for Payer: Aetna Medicare Advantage	$967.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$822.12
Rate for Payer: Cigna Commercial	$1,612.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

IMPLANT BREAST SM RND 255CC

Facility

$5,475.00

Service Code	HCPCS C1789
Hospital Charge Code	270698115
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$1,642.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

IMPLANT BREAST SM RND 255CC

Facility

$5,475.00

Service Code	HCPCS C1789
Hospital Charge Code	270698115
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

IMPLANT BRST SAL 350cc 3501655

Facility

$2,728.00

Hospital Charge Code	270631845
Hospital Revenue Code	278
Min. Negotiated Rate	$409.20
Max. Negotiated Rate	$660.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.18
Rate for Payer: Qualcare PPO/HMO/WC	$409.20

IMPLANT BRST SAL 350cc 3501655

Facility

$2,728.00

Hospital Charge Code	270631845
Hospital Revenue Code	278
Min. Negotiated Rate	$409.20
Max. Negotiated Rate	$1,364.00
Rate for Payer: Aetna Commercial	$818.40
Rate for Payer: Aetna Medicare Advantage	$818.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$695.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$695.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$695.64
Rate for Payer: Cigna Commercial	$1,364.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.18
Rate for Payer: Qualcare PPO/HMO/WC	$409.20

IMPLANT BRST SALI 225c 3501630

Facility

$2,852.00

Hospital Charge Code	270634094
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$855.60
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 225c 3501630

Facility

$2,852.00

Hospital Charge Code	270634094
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 250c 3501635

Facility

$2,852.00

Hospital Charge Code	270631841
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 250c 3501635

Facility

$2,852.00

Hospital Charge Code	270631841
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$855.60
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 275c 3501640

Facility

$2,852.00

Hospital Charge Code	270631842
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 275c 3501640

Facility

$2,852.00

Hospital Charge Code	270631842
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$855.60
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 300c 3501645

Facility

$2,852.00

Hospital Charge Code	270631843
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$855.60
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 300c 3501645

Facility

$2,852.00

Hospital Charge Code	270631843
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 325c 3501650

Facility

$2,852.00

Hospital Charge Code	270631844
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 325c 3501650

Facility

$2,852.00

Hospital Charge Code	270631844
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$855.60
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT CONVEX 8X25X10

Facility

$37,800.00

Hospital Charge Code	270656931
Hospital Revenue Code	278
Min. Negotiated Rate	$5,670.00
Max. Negotiated Rate	$9,147.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,147.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,670.00

IMPLANT CONVEX 8X25X10

Facility

$37,800.00

Hospital Charge Code	270656931
Hospital Revenue Code	278
Min. Negotiated Rate	$5,670.00
Max. Negotiated Rate	$18,900.00
Rate for Payer: Aetna Commercial	$11,340.00
Rate for Payer: Aetna Medicare Advantage	$11,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,639.00
Rate for Payer: Cigna Commercial	$18,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,147.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,670.00

IMPLANT EXT HIGH PROFILE 500cc

Facility

$3,750.00

Hospital Charge Code	270673556
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT EXT HIGH PROFILE 500cc

Facility

$3,750.00

Hospital Charge Code	270673556
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT EXT HIGH PROFILE 550cc

Facility

$3,750.00

Hospital Charge Code	270673555
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT EXT HIGH PROFILE 550cc

Facility

$3,750.00

Hospital Charge Code	270673555
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT EXT HIGH PROFILE 600cc

Facility

$3,750.00

Hospital Charge Code	270673557
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Know your out-of-pocket cost for care.

All Charges