Heights University Hospital

All Charges

Charge

Type

Setting

Price

BREASTIMPSIENTRASMTHRNDMOD+355

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699945
Hospital Revenue Code	278
Min. Negotiated Rate	$458.68
Max. Negotiated Rate	$1,158.00
Rate for Payer: Aetna Commercial	$1,158.00
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$764.47
Rate for Payer: Cigna Medicare Advantage	$458.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+385

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699946
Hospital Revenue Code	278
Min. Negotiated Rate	$458.68
Max. Negotiated Rate	$1,158.00
Rate for Payer: Aetna Commercial	$1,158.00
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$764.47
Rate for Payer: Cigna Medicare Advantage	$458.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+385

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699946
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+415

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699947
Hospital Revenue Code	278
Min. Negotiated Rate	$458.68
Max. Negotiated Rate	$1,158.00
Rate for Payer: Aetna Commercial	$1,158.00
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$764.47
Rate for Payer: Cigna Medicare Advantage	$458.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+415

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699947
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+435

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699948
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+435

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699948
Hospital Revenue Code	278
Min. Negotiated Rate	$458.68
Max. Negotiated Rate	$1,158.00
Rate for Payer: Aetna Commercial	$1,158.00
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$764.47
Rate for Payer: Cigna Medicare Advantage	$458.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREAST LOCALIZATION MR GUIDE

Facility

$5,102.50

Service Code	HCPCS 19287
Hospital Charge Code	2409035
Hospital Revenue Code	361
Min. Negotiated Rate	$765.38
Max. Negotiated Rate	$765.38
Rate for Payer: Qualcare PPO/HMO/WC	$765.38

BREAST LOCALIZATION MR GUIDE

Facility

$5,102.50

Service Code	HCPCS 19287
Hospital Charge Code	2409035
Hospital Revenue Code	361
Min. Negotiated Rate	$663.33
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,530.75
Rate for Payer: Aetna Medicare Advantage	$1,530.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,301.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,301.14
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	$1,301.14
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.33
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.38
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

BREAST LOCALIZATION US GUIDE

Facility

$2,748.55

Service Code	HCPCS 19285
Hospital Charge Code	2309085
Hospital Revenue Code	361
Min. Negotiated Rate	$357.31
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$824.57
Rate for Payer: Aetna Medicare Advantage	$824.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.88
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	$700.88
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$357.31
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.28
Rate for Payer: UnitedHealthcare Commercial	$2,575.00

BREAST LOCALIZATION US GUIDE

Facility

$2,748.55

Service Code	HCPCS 19285
Hospital Charge Code	2309085
Hospital Revenue Code	361
Min. Negotiated Rate	$412.28
Max. Negotiated Rate	$412.28
Rate for Payer: Qualcare PPO/HMO/WC	$412.28

BREAST LOCAL MR GUIDE EA ADD L

Facility

$983.40

Service Code	HCPCS 19288
Hospital Charge Code	2409040
Hospital Revenue Code	361
Min. Negotiated Rate	$57.57
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$295.02
Rate for Payer: Aetna Medicare Advantage	$295.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.77
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	$250.77
Rate for Payer: Cigna Commercial	$57.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.84
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.51
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

BREAST LOCAL MR GUIDE EA ADD L

Facility

$983.40

Service Code	HCPCS 19288
Hospital Charge Code	2409040
Hospital Revenue Code	361
Min. Negotiated Rate	$147.51
Max. Negotiated Rate	$147.51
Rate for Payer: Qualcare PPO/HMO/WC	$147.51

BREAST LOCALUS GUIDE EA ADD LE

Facility

$2,321.15

Service Code	HCPCS 19286
Hospital Charge Code	2309090
Hospital Revenue Code	361
Min. Negotiated Rate	$348.17
Max. Negotiated Rate	$348.17
Rate for Payer: Qualcare PPO/HMO/WC	$348.17

BREAST LOCALUS GUIDE EA ADD LE

Facility

$2,321.15

Service Code	HCPCS 19286
Hospital Charge Code	2309090
Hospital Revenue Code	361
Min. Negotiated Rate	$38.88
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Commercial	$696.35
Rate for Payer: Aetna Medicare Advantage	$696.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.89
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	$591.89
Rate for Payer: Cigna Commercial	$38.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.75
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.17
Rate for Payer: UnitedHealthcare Commercial	$1,686.00

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$26,882.63

Service Code	APR-DRG 3632
Min. Negotiated Rate	$16,404.21
Max. Negotiated Rate	$26,882.63
Rate for Payer: Aetna Better Health Medicaid	$26,355.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,882.63
Rate for Payer: Wellpoint Medicaid Managed Care	$16,404.21

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$14,111.22

Service Code	APR-DRG 3631
Min. Negotiated Rate	$9,722.00
Max. Negotiated Rate	$14,111.22
Rate for Payer: Aetna Better Health Medicaid	$13,834.53
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,111.22
Rate for Payer: Wellpoint Medicaid Managed Care	$9,722.00

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$48,848.62

Service Code	APR-DRG 3634
Min. Negotiated Rate	$40,337.72
Max. Negotiated Rate	$48,848.62
Rate for Payer: Aetna Better Health Medicaid	$47,890.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$48,848.62
Rate for Payer: Wellpoint Medicaid Managed Care	$40,337.72

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$33,333.02

Service Code	APR-DRG 3633
Min. Negotiated Rate	$20,943.15
Max. Negotiated Rate	$33,333.02
Rate for Payer: Aetna Better Health Medicaid	$32,679.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$33,333.02
Rate for Payer: Wellpoint Medicaid Managed Care	$20,943.15

BREAST PUMP AMEDA SGL HYGIE

Facility

$96.39

Hospital Charge Code	270657026
Hospital Revenue Code	270
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$14.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.46

BREAST PUMP AMEDA SGL HYGIE

Facility

$96.39

Hospital Charge Code	270657026
Hospital Revenue Code	270
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$48.20
Rate for Payer: Aetna Commercial	$28.92
Rate for Payer: Aetna Medicare Advantage	$28.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.58
Rate for Payer: Cigna Commercial	$48.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.53
Rate for Payer: Oxford Commercial	$48.20
Rate for Payer: Qualcare PPO/HMO/WC	$14.46
Rate for Payer: UnitedHealthcare Commercial	$48.20

BREAST PUMP MANUALELECTRIC

Facility

$109.27

Hospital Charge Code	270650206
Hospital Revenue Code	270
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$16.39
Rate for Payer: Qualcare PPO/HMO/WC	$16.39

BREAST PUMP MANUALELECTRIC

Facility

$109.27

Hospital Charge Code	270650206
Hospital Revenue Code	270
Min. Negotiated Rate	$14.21
Max. Negotiated Rate	$54.63
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$32.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.86
Rate for Payer: Cigna Commercial	$54.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$54.63
Rate for Payer: Qualcare PPO/HMO/WC	$16.39
Rate for Payer: UnitedHealthcare Commercial	$54.63

BREAST RECONSTR W FF

Facility

$31,390.90

Service Code	HCPCS 19364
Hospital Charge Code	16000537
Hospital Revenue Code	360
Min. Negotiated Rate	$4,708.64
Max. Negotiated Rate	$4,708.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,708.64

BREAST RECONSTR W FF

Facility

$31,390.90

Service Code	HCPCS 19364
Hospital Charge Code	16000537
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$9,417.27
Rate for Payer: Aetna Commercial	$9,417.27
Rate for Payer: Aetna Medicare Advantage	$9,417.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,004.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,004.68
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	$8,004.68
Rate for Payer: Cigna Commercial	$2,589.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,080.82
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,708.64
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

Know your out-of-pocket cost for care.

All Charges