Heights University Hospital

All Charges

Charge

Type

Setting

Price

BRA SURGICAL EXTRA EXTRA LARGE

Facility

$132.50

Hospital Charge Code	270665572
Hospital Revenue Code	272
Min. Negotiated Rate	$17.23
Max. Negotiated Rate	$66.25
Rate for Payer: Aetna Commercial	$39.75
Rate for Payer: Aetna Medicare Advantage	$39.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.79
Rate for Payer: Cigna Commercial	$66.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.23
Rate for Payer: Oxford Commercial	$66.25
Rate for Payer: Qualcare PPO/HMO/WC	$19.88
Rate for Payer: UnitedHealthcare Commercial	$66.25

BRA SURGICAL EXTRA EXTRA LARGE

Facility

$132.50

Hospital Charge Code	270665572
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$19.88
Rate for Payer: Qualcare PPO/HMO/WC	$19.88

BRA SURGICAL EXTRA LARGE

Facility

$133.35

Hospital Charge Code	270665571
Hospital Revenue Code	272
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$66.67
Rate for Payer: Aetna Commercial	$40.01
Rate for Payer: Aetna Medicare Advantage	$40.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.00
Rate for Payer: Cigna Commercial	$66.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.34
Rate for Payer: Oxford Commercial	$66.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.00
Rate for Payer: UnitedHealthcare Commercial	$66.67

BRA SURGICAL EXTRA LARGE

Facility

$133.35

Hospital Charge Code	270665571
Hospital Revenue Code	272
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.00

BRA SURGICAL MED

Facility

$133.33

Hospital Charge Code	270665569
Hospital Revenue Code	270
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$66.67
Rate for Payer: Aetna Commercial	$40.00
Rate for Payer: Aetna Medicare Advantage	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.00
Rate for Payer: Cigna Commercial	$66.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.33
Rate for Payer: Oxford Commercial	$66.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.00
Rate for Payer: UnitedHealthcare Commercial	$66.67

BRA SURGICAL MED

Facility

$133.33

Hospital Charge Code	270665569
Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.00

BRA SURGICAL SUPPORT SURGI 3XL

Facility

$208.70

Hospital Charge Code	270676375
Hospital Revenue Code	272
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.30

BRA SURGICAL SUPPORT SURGI 3XL

Facility

$208.70

Hospital Charge Code	270676375
Hospital Revenue Code	272
Min. Negotiated Rate	$27.13
Max. Negotiated Rate	$104.35
Rate for Payer: Aetna Commercial	$62.61
Rate for Payer: Aetna Medicare Advantage	$62.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.22
Rate for Payer: Cigna Commercial	$104.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.13
Rate for Payer: Oxford Commercial	$104.35
Rate for Payer: Qualcare PPO/HMO/WC	$31.30
Rate for Payer: UnitedHealthcare Commercial	$104.35

BRA SURGICAL SUPPORT SURGI 4XL

Facility

$208.70

Hospital Charge Code	270676376
Hospital Revenue Code	272
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.30

BRA SURGICAL SUPPORT SURGI 4XL

Facility

$208.70

Hospital Charge Code	270676376
Hospital Revenue Code	272
Min. Negotiated Rate	$27.13
Max. Negotiated Rate	$104.35
Rate for Payer: Aetna Commercial	$62.61
Rate for Payer: Aetna Medicare Advantage	$62.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.22
Rate for Payer: Cigna Commercial	$104.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.13
Rate for Payer: Oxford Commercial	$104.35
Rate for Payer: Qualcare PPO/HMO/WC	$31.30
Rate for Payer: UnitedHealthcare Commercial	$104.35

BRA SURGICAL SUPPORT SURGI L38

Facility

$162.25

Hospital Charge Code	270655462
Hospital Revenue Code	270
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$81.12
Rate for Payer: Aetna Commercial	$48.67
Rate for Payer: Aetna Medicare Advantage	$48.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.37
Rate for Payer: Cigna Commercial	$81.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.09
Rate for Payer: Oxford Commercial	$81.12
Rate for Payer: Qualcare PPO/HMO/WC	$24.34
Rate for Payer: UnitedHealthcare Commercial	$81.12

BRA SURGICAL SUPPORT SURGI L38

Facility

$162.25

Hospital Charge Code	270655462
Hospital Revenue Code	270
Min. Negotiated Rate	$24.34
Max. Negotiated Rate	$24.34
Rate for Payer: Qualcare PPO/HMO/WC	$24.34

BRA SURGICAL SUPPORT SURGI MED

Facility

$209.10

Hospital Charge Code	270650798
Hospital Revenue Code	272
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$104.55
Rate for Payer: Aetna Commercial	$62.73
Rate for Payer: Aetna Medicare Advantage	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.32
Rate for Payer: Cigna Commercial	$104.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.18
Rate for Payer: Oxford Commercial	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$31.36
Rate for Payer: UnitedHealthcare Commercial	$104.55

BRA SURGICAL SUPPORT SURGI MED

Facility

$209.10

Hospital Charge Code	270650798
Hospital Revenue Code	272
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$31.36
Rate for Payer: Qualcare PPO/HMO/WC	$31.36

BRA SURGICAL SUPPORT SURGI SM.

Facility

$209.10

Hospital Charge Code	270655494
Hospital Revenue Code	272
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$104.55
Rate for Payer: Aetna Commercial	$62.73
Rate for Payer: Aetna Medicare Advantage	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.32
Rate for Payer: Cigna Commercial	$104.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.18
Rate for Payer: Oxford Commercial	$104.55
Rate for Payer: Qualcare PPO/HMO/WC	$31.36
Rate for Payer: UnitedHealthcare Commercial	$104.55

BRA SURGICAL SUPPORT SURGI SM.

Facility

$209.10

Hospital Charge Code	270655494
Hospital Revenue Code	272
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$31.36
Rate for Payer: Qualcare PPO/HMO/WC	$31.36

BRA SURGICAL SUPPORT SURGI XL

Facility

$183.65

Hospital Charge Code	270655491
Hospital Revenue Code	270
Min. Negotiated Rate	$27.55
Max. Negotiated Rate	$27.55
Rate for Payer: Qualcare PPO/HMO/WC	$27.55

BRA SURGICAL SUPPORT SURGI XL

Facility

$183.65

Hospital Charge Code	270655491
Hospital Revenue Code	270
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$91.83
Rate for Payer: Aetna Commercial	$55.09
Rate for Payer: Aetna Medicare Advantage	$55.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.83
Rate for Payer: Cigna Commercial	$91.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.87
Rate for Payer: Oxford Commercial	$91.83
Rate for Payer: Qualcare PPO/HMO/WC	$27.55
Rate for Payer: UnitedHealthcare Commercial	$91.83

BRA SURGI SUPPORT QUEEN 958

Facility

$173.65

Hospital Charge Code	270615326
Hospital Revenue Code	272
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$52.09
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.57
Rate for Payer: Oxford Commercial	$86.83
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$86.83

BRA SURGI SUPPORT QUEEN 958

Facility

$173.65

Hospital Charge Code	270615326
Hospital Revenue Code	272
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

BRA SURGI SUPP W VEL SZ XL 958

Facility

$215.80

Hospital Charge Code	270616011
Hospital Revenue Code	272
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$107.90
Rate for Payer: Aetna Commercial	$64.74
Rate for Payer: Aetna Medicare Advantage	$64.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.03
Rate for Payer: Cigna Commercial	$107.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.05
Rate for Payer: Oxford Commercial	$107.90
Rate for Payer: Qualcare PPO/HMO/WC	$32.37
Rate for Payer: UnitedHealthcare Commercial	$107.90

BRA SURGI SUPP W VEL SZ XL 958

Facility

$215.80

Hospital Charge Code	270616011
Hospital Revenue Code	272
Min. Negotiated Rate	$32.37
Max. Negotiated Rate	$32.37
Rate for Payer: Qualcare PPO/HMO/WC	$32.37

BRA SURGI SZ 2X

Facility

$503.25

Hospital Charge Code	270600427
Hospital Revenue Code	272
Min. Negotiated Rate	$65.42
Max. Negotiated Rate	$251.62
Rate for Payer: Aetna Commercial	$150.97
Rate for Payer: Aetna Medicare Advantage	$150.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.33
Rate for Payer: Cigna Commercial	$251.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.42
Rate for Payer: Oxford Commercial	$251.62
Rate for Payer: Qualcare PPO/HMO/WC	$75.49
Rate for Payer: UnitedHealthcare Commercial	$251.62

BRA SURGI SZ 2X

Facility

$503.25

Hospital Charge Code	270600427
Hospital Revenue Code	272
Min. Negotiated Rate	$75.49
Max. Negotiated Rate	$75.49
Rate for Payer: Qualcare PPO/HMO/WC	$75.49

BRA SURGI SZ 3X

Facility

$420.00

Hospital Charge Code	270600428
Hospital Revenue Code	272
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Commercial	$210.00

Know your out-of-pocket cost for care.

All Charges