Heights University Hospital

All Charges

Charge

Type

Setting

Price

UGI

Facility

$1,066.95

Service Code	HCPCS 74240
Hospital Charge Code	94061137
Hospital Revenue Code	320
Min. Negotiated Rate	$160.04
Max. Negotiated Rate	$160.04
Rate for Payer: Qualcare PPO/HMO/WC	$160.04

UGI 2X W/O KUB W/W/O DELA

Facility

$460.00

Hospital Charge Code	2009030
Hospital Revenue Code	320
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$138.00
Rate for Payer: Aetna Medicare Advantage	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.30
Rate for Payer: Cigna Commercial	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.80
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

UGI 2X W/O KUB W/W/O DELA

Facility

$460.00

Hospital Charge Code	2009030
Hospital Revenue Code	320
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

UGI,DIAGNOSTIC-

Facility

$7,963.40

Service Code	HCPCS 43235
Hospital Charge Code	16000196
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

UGI,DIAGNOSTIC-

Facility

$7,963.40

Service Code	HCPCS 43235
Hospital Charge Code	16000196
Hospital Revenue Code	360
Min. Negotiated Rate	$1,035.24
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$2,389.02
Rate for Payer: Aetna Medicare Advantage	$2,389.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,030.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,030.67
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	$2,030.67
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.24
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

UGI PLACEM GASTROSTOMY TUBE

Facility

$12,032.40

Service Code	HCPCS 43246
Hospital Charge Code	16000962
Hospital Revenue Code	360
Min. Negotiated Rate	$1,564.21
Max. Negotiated Rate	$4,829.61
Rate for Payer: Aetna Better Health Medicaid	$4,734.91
Rate for Payer: Aetna Commercial	$3,609.72
Rate for Payer: Aetna Medicare Advantage	$3,609.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,068.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,068.26
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	$3,068.26
Rate for Payer: Cigna Commercial	$4,569.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,564.21
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.86
Rate for Payer: UnitedHealthcare Commercial	$3,687.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,829.61
Rate for Payer: Wellpoint Medicaid Managed Care	$4,734.91

UGI PLACEM GASTROSTOMY TUBE

Facility

$12,032.40

Service Code	HCPCS 43246
Hospital Charge Code	16000962
Hospital Revenue Code	360
Min. Negotiated Rate	$1,804.86
Max. Negotiated Rate	$1,804.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.86

UGI W BX. SGL/MULTIPLE

Facility

$8,280.20

Service Code	HCPCS 27268
Hospital Charge Code	16000874
Hospital Revenue Code	360
Min. Negotiated Rate	$1,076.43
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$2,484.06
Rate for Payer: Aetna Medicare Advantage	$2,484.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,111.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,111.45
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	$2,111.45
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.43
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,242.03
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

UGI W BX. SGL/MULTIPLE

Facility

$8,280.20

Service Code	HCPCS 27268
Hospital Charge Code	16000874
Hospital Revenue Code	360
Min. Negotiated Rate	$1,242.03
Max. Negotiated Rate	$1,242.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,242.03

UGI W BX_SGL/MULTIPLE

Facility

$7,963.40

Service Code	HCPCS 43239
Hospital Charge Code	16000175
Hospital Revenue Code	360
Min. Negotiated Rate	$1,035.24
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$2,389.02
Rate for Payer: Aetna Medicare Advantage	$2,389.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,030.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,030.67
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	$2,030.67
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.24
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

UGI W BX_SGL/MULTIPLE

Facility

$7,963.40

Service Code	HCPCS 43239
Hospital Charge Code	16000175
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

UGI W REMOVAL OF FB

Facility

$7,963.40

Service Code	HCPCS 43247
Hospital Charge Code	16000200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,035.24
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$2,389.02
Rate for Payer: Aetna Medicare Advantage	$2,389.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,030.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,030.67
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	$2,030.67
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.24
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

UGI W REMOVAL OF FB

Facility

$7,963.40

Service Code	HCPCS 43247
Hospital Charge Code	16000200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

UGI W SUBMUCOS INJ

Facility

$7,963.40

Service Code	HCPCS 43236
Hospital Charge Code	16000961
Hospital Revenue Code	360
Min. Negotiated Rate	$1,035.24
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Better Health Medicaid	$2,482.30
Rate for Payer: Aetna Commercial	$2,389.02
Rate for Payer: Aetna Medicare Advantage	$2,389.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,030.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,030.67
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	$2,030.67
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.24
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51
Rate for Payer: UnitedHealthcare Commercial	$3,687.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,531.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2,482.30

UGI W SUBMUCOS INJ

Facility

$7,963.40

Service Code	HCPCS 43236
Hospital Charge Code	16000961
Hospital Revenue Code	360
Min. Negotiated Rate	$1,194.51
Max. Negotiated Rate	$1,194.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.51

UGT1AI GENE POLYMORPHISM

Facility

$478.88

Service Code	HCPCS 81350
Hospital Charge Code	397080009
Hospital Revenue Code	306
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$857.38
Rate for Payer: Aetna Commercial	$758.16
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$857.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$857.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$857.38
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: Cigna Medicare Advantage	$117.00
Rate for Payer: Clover Medicare Advantage	$222.30
Rate for Payer: EmblemHealth Commercial	$702.00
Rate for Payer: Humana Medicare Advantage	$241.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.25
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.83
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$234.00
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$248.04
Rate for Payer: Wellcare Medicare Advantage	$234.00

UGT1AI GENE POLYMORPHISM

Facility

$478.88

Service Code	HCPCS 81350
Hospital Charge Code	397080009
Hospital Revenue Code	306
Min. Negotiated Rate	$71.83
Max. Negotiated Rate	$71.83
Rate for Payer: Qualcare PPO/HMO/WC	$71.83

UHR UNIV BIPOLAR HEAD OD 53X26

Facility

$3,669.90

Service Code	HCPCS C1776
Hospital Charge Code	270691243
Hospital Revenue Code	278
Min. Negotiated Rate	$550.49
Max. Negotiated Rate	$888.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$733.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$888.12
Rate for Payer: Qualcare PPO/HMO/WC	$550.49

UHR UNIV BIPOLAR HEAD OD 53X26

Facility

$3,669.90

Service Code	HCPCS C1776
Hospital Charge Code	270691243
Hospital Revenue Code	278
Min. Negotiated Rate	$550.49
Max. Negotiated Rate	$1,834.95
Rate for Payer: Aetna Commercial	$1,100.97
Rate for Payer: Aetna Medicare Advantage	$1,100.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$935.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$935.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$733.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$935.82
Rate for Payer: Cigna Commercial	$1,834.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$888.12
Rate for Payer: Qualcare PPO/HMO/WC	$550.49

ULNAR PRECOAT REG RI32-8105-12

Facility

$11,006.45

Hospital Charge Code	270609043
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.97
Max. Negotiated Rate	$2,663.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,201.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,663.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.97

ULNAR PRECOAT REG RI32-8105-12

Facility

$11,006.45

Hospital Charge Code	270609043
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.97
Max. Negotiated Rate	$5,503.23
Rate for Payer: Aetna Commercial	$3,301.93
Rate for Payer: Aetna Medicare Advantage	$3,301.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,806.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,806.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,201.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,806.64
Rate for Payer: Cigna Commercial	$5,503.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,663.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.97

ULS CORTICAL SCREW 3.5MM X 22M

Facility

$12.15

Hospital Charge Code	270657744
Hospital Revenue Code	278
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$6.08
Rate for Payer: Aetna Commercial	$3.65
Rate for Payer: Aetna Medicare Advantage	$3.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.10
Rate for Payer: Cigna Commercial	$6.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.82

ULS CORTICAL SCREW 3.5MM X 22M

Facility

$12.15

Hospital Charge Code	270657744
Hospital Revenue Code	278
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$2.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.82

ULTANE SEVOFLURANE 250ML

Facility

$1,043.00

Hospital Charge Code	60635038
Hospital Revenue Code	250
Min. Negotiated Rate	$135.59
Max. Negotiated Rate	$521.50
Rate for Payer: Aetna Commercial	$312.90
Rate for Payer: Aetna Medicare Advantage	$312.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$265.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$265.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$265.96
Rate for Payer: Cigna Commercial	$521.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.59
Rate for Payer: Oxford Commercial	$521.50
Rate for Payer: Qualcare PPO/HMO/WC	$156.45
Rate for Payer: UnitedHealthcare Commercial	$521.50

ULTANE SEVOFLURANE 250ML

Facility

$1,043.00

Hospital Charge Code	60635038
Hospital Revenue Code	250
Min. Negotiated Rate	$156.45
Max. Negotiated Rate	$156.45
Rate for Payer: Qualcare PPO/HMO/WC	$156.45

Know your out-of-pocket cost for care.

All Charges