Heights University Hospital

All Charges

Charge

Type

Setting

Price

SIZER MOD PLUS PROFILE 457CC

Facility

$1,000.00

Hospital Charge Code	270669942
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 575CC

Facility

$1,000.00

Hospital Charge Code	270671031
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 575CC

Facility

$1,000.00

Hospital Charge Code	270671031
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 616CC

Facility

$1,000.00

Hospital Charge Code	270671032
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 616CC

Facility

$1,000.00

Hospital Charge Code	270671032
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 659CC

Facility

$1,000.00

Hospital Charge Code	270671033
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 659CC

Facility

$1,000.00

Hospital Charge Code	270671033
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER RD VOL 325cc MAM 3513255

Facility

$223.25

Hospital Charge Code	270632429
Hospital Revenue Code	272
Min. Negotiated Rate	$29.02
Max. Negotiated Rate	$111.62
Rate for Payer: Aetna Commercial	$66.97
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.93
Rate for Payer: Cigna Commercial	$111.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.02
Rate for Payer: Oxford Commercial	$111.62
Rate for Payer: Qualcare PPO/HMO/WC	$33.49
Rate for Payer: UnitedHealthcare Commercial	$111.62

SIZER RD VOL 325cc MAM 3513255

Facility

$223.25

Hospital Charge Code	270632429
Hospital Revenue Code	272
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Qualcare PPO/HMO/WC	$33.49

SIZER ROUND VOL 375CC 350375S

Facility

$223.25

Hospital Charge Code	270621639
Hospital Revenue Code	272
Min. Negotiated Rate	$29.02
Max. Negotiated Rate	$111.62
Rate for Payer: Aetna Commercial	$66.97
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.93
Rate for Payer: Cigna Commercial	$111.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.02
Rate for Payer: Oxford Commercial	$111.62
Rate for Payer: Qualcare PPO/HMO/WC	$33.49
Rate for Payer: UnitedHealthcare Commercial	$111.62

SIZER ROUND VOL 375CC 350375S

Facility

$223.25

Hospital Charge Code	270621639
Hospital Revenue Code	272
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Qualcare PPO/HMO/WC	$33.49

SIZERS BREAST

Facility

$1,500.00

Hospital Charge Code	270665521
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SIZERS BREAST

Facility

$1,500.00

Hospital Charge Code	270665521
Hospital Revenue Code	270
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

SIZERS BREAST 800CC

Facility

$1,500.00

Hospital Charge Code	270665519
Hospital Revenue Code	270
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

SIZERS BREAST 800CC

Facility

$1,500.00

Hospital Charge Code	270665519
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SIZERS BREAST HIGH PROFILE 750

Facility

$1,500.00

Hospital Charge Code	270665522
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SIZERS BREAST HIGH PROFILE 750

Facility

$1,500.00

Hospital Charge Code	270665522
Hospital Revenue Code	270
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

SIZERS BREAST HIGH PROFILE 800

Facility

$1,500.00

Hospital Charge Code	270665520
Hospital Revenue Code	270
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

SIZERS BREAST HIGH PROFILE 800

Facility

$1,500.00

Hospital Charge Code	270665520
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SIZERS CLR CDED FLX TOE4460001

Facility

$2,306.45

Hospital Charge Code	270611674
Hospital Revenue Code	272
Min. Negotiated Rate	$345.97
Max. Negotiated Rate	$345.97
Rate for Payer: Qualcare PPO/HMO/WC	$345.97

SIZERS CLR CDED FLX TOE4460001

Facility

$2,306.45

Hospital Charge Code	270611674
Hospital Revenue Code	272
Min. Negotiated Rate	$299.84
Max. Negotiated Rate	$1,153.22
Rate for Payer: Aetna Commercial	$691.93
Rate for Payer: Aetna Medicare Advantage	$691.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$588.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$588.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$588.14
Rate for Payer: Cigna Commercial	$1,153.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.84
Rate for Payer: Oxford Commercial	$1,153.22
Rate for Payer: Qualcare PPO/HMO/WC	$345.97
Rate for Payer: UnitedHealthcare Commercial	$1,153.22

SIZER TISSUE EXPANDER 650CC

Facility

$2,000.00

Hospital Charge Code	270676082
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SIZER TISSUE EXPANDER 650CC

Facility

$2,000.00

Hospital Charge Code	270676082
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SIZER TISSUE EXPANDER 685CC

Facility

$2,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270676081
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SIZER TISSUE EXPANDER 685CC

Facility

$2,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270676081
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$600.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

Know your out-of-pocket cost for care.

All Charges