Heights University Hospital

All Charges

Charge

Type

Setting

Price

BREAST RECONSTR W/ LAT FLAP

Facility

$21,668.55

Service Code	HCPCS 19361
Hospital Charge Code	1600000458
Hospital Revenue Code	360
Min. Negotiated Rate	$1,516.28
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$6,500.56
Rate for Payer: Aetna Medicare Advantage	$6,500.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,525.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,525.48
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	$5,525.48
Rate for Payer: Cigna Commercial	$1,516.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,816.91
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,250.28
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

BREAST RECONSTR W/ LAT FLAP

Facility

$21,668.55

Service Code	HCPCS 19361
Hospital Charge Code	1600000458
Hospital Revenue Code	360
Min. Negotiated Rate	$3,250.28
Max. Negotiated Rate	$3,250.28
Rate for Payer: Qualcare PPO/HMO/WC	$3,250.28

BREAST RECONST W TISS EXP

Facility

$57,566.30

Service Code	HCPCS 19357
Hospital Charge Code	16000467
Hospital Revenue Code	360
Min. Negotiated Rate	$8,634.94
Max. Negotiated Rate	$8,634.94
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94

BREAST RECONST W TISS EXP

Facility

$57,566.30

Service Code	HCPCS 19357
Hospital Charge Code	16000467
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$32,817.88
Rate for Payer: Aetna Commercial	$17,269.89
Rate for Payer: Aetna Medicare Advantage	$17,269.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,679.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,679.41
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	$14,679.41
Rate for Payer: Cigna Commercial	$32,817.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,483.62
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

BREAST-RT

Facility

$2,100.00

Service Code	HCPCS 76645RT
Hospital Charge Code	94061433
Hospital Revenue Code	402
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

BREAST-RT

Facility

$2,100.00

Service Code	HCPCS 76645RT
Hospital Charge Code	94061433
Hospital Revenue Code	402
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$630.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

BREAST SIZER 450CC

Facility

$1,500.00

Hospital Charge Code	270672833
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 450CC

Facility

$1,500.00

Hospital Charge Code	270672833
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 500CC

Facility

$1,500.00

Hospital Charge Code	270672834
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 500CC

Facility

$1,500.00

Hospital Charge Code	270672834
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 550CC

Facility

$1,500.00

Hospital Charge Code	270672835
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 550CC

Facility

$1,500.00

Hospital Charge Code	270672835
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 600CC

Facility

$1,500.00

Hospital Charge Code	270675851
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 600CC

Facility

$1,500.00

Hospital Charge Code	270675851
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 650CC

Facility

$1,500.00

Hospital Charge Code	270675850
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 650CC

Facility

$1,500.00

Hospital Charge Code	270675850
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 700CC

Facility

$1,500.00

Hospital Charge Code	270674070
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 700CC

Facility

$1,500.00

Hospital Charge Code	270674070
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 750CC

Facility

$1,500.00

Hospital Charge Code	270674071
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 750CC

Facility

$1,500.00

Hospital Charge Code	270674071
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 800CC

Facility

$1,500.00

Hospital Charge Code	270674072
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 800CC

Facility

$1,500.00

Hospital Charge Code	270674072
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SMOOTH ROUND UH 320CC

Facility

$0.01

Hospital Charge Code	270702699
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BREAST SMOOTH ROUND UH 320CC

Facility

$0.01

Hospital Charge Code	270702699
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BREATH ALCOHOL CONFIRMATION

Facility

$80.00

Service Code	HCPCS 82075
Hospital Charge Code	3000349
Hospital Revenue Code	307
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.92
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: Cigna Medicare Advantage	$15.00
Rate for Payer: Clover Medicare Advantage	$28.50
Rate for Payer: EmblemHealth Commercial	$90.00
Rate for Payer: Humana Medicare Advantage	$30.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31.80
Rate for Payer: Wellcare Medicare Advantage	$30.00

Know your out-of-pocket cost for care.

All Charges