Heights University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT HIGH PROFILE 700CC

Facility

$3,750.00

Hospital Charge Code	270670917
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 HIGH PROFILE 700CC

Facility

$3,750.00

Hospital Charge Code	270670917
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 HIGH PROFILE 750CC

Facility

$3,750.00

Hospital Charge Code	270670918
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 HIGH PROFILE 750CC

Facility

$3,750.00

Hospital Charge Code	270670918
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 HIGH PROFILE 800CC

Facility

$3,750.00

Hospital Charge Code	270670919
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 HIGH PROFILE 800CC

Facility

$3,750.00

Hospital Charge Code	270670919
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 IFUSE 7.0MMX 40MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685122
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0MMX 40MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685122
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0MMX 45MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685121
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0MMX 45MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685121
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0MMX 55MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685120
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0MMX 55MM

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685120
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$4,500.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

IMPLANT IFUSE 7.0X60MM

Facility

$17,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270696619
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$5,229.00
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IMPLANT IFUSE 7.0X60MM

Facility

$17,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270696619
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IMPLANT KIT 9x7x7mm

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675247
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$1,875.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

IMPLANT KIT 9x7x7mm

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675247
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

IMPLANT LAT 18X12X50MM 10DEG

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694531
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$8,775.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

IMPLANT LAT 18X12X50MM 10DEG

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694531
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

IMPLANT LOOP RECORDE

Facility

$22,680.00

Service Code	HCPCS 33282
Hospital Charge Code	7411033
Hospital Revenue Code	361
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$11,340.00
Rate for Payer: Aetna Commercial	$6,804.00
Rate for Payer: Aetna Medicare Advantage	$6,804.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,783.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,783.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,783.40
Rate for Payer: Cigna Commercial	$11,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,948.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,402.00

IMPLANT LOOP RECORDE

Facility

$22,680.00

Service Code	HCPCS 33282
Hospital Charge Code	7411033
Hospital Revenue Code	361
Min. Negotiated Rate	$3,402.00
Max. Negotiated Rate	$3,402.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,402.00

IMPLANT MAMMARY SALINE 575cc

Facility

$2,728.00

Hospital Charge Code	270630701
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 MAMMARY SALINE 575cc

Facility

$2,728.00

Hospital Charge Code	270630701
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 MAM SALN 425cc 3501670

Facility

$2,728.00

Hospital Charge Code	270630698
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 MAM SALN 425cc 3501670

Facility

$2,728.00

Hospital Charge Code	270630698
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 MAM SALN 475cc 3501680

Facility

$2,728.00

Hospital Charge Code	270630699
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

Know your out-of-pocket cost for care.

All Charges