Heights University Hospital

All Charges

Charge

Type

Setting

Price

ULTIPOR ******

Facility

$42.00

Hospital Charge Code	7000409
Hospital Revenue Code	279
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

ULTIPOR ******

Facility

$42.00

Hospital Charge Code	7000409
Hospital Revenue Code	279
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$12.60
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.46
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$21.00

ULTIVA 2MG VIAL

Facility

$610.64

Service Code	NDC 72078003502
Hospital Charge Code	6063943298
Hospital Revenue Code	250
Min. Negotiated Rate	$91.60
Max. Negotiated Rate	$91.60
Rate for Payer: Qualcare PPO/HMO/WC	$91.60

ULTIVA 2MG VIAL

Facility

$610.64

Service Code	NDC 72078003502
Hospital Charge Code	6063943298
Hospital Revenue Code	250
Min. Negotiated Rate	$79.38
Max. Negotiated Rate	$305.32
Rate for Payer: Aetna Commercial	$183.19
Rate for Payer: Aetna Medicare Advantage	$183.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.71
Rate for Payer: Cigna Commercial	$305.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.38
Rate for Payer: Oxford Commercial	$305.32
Rate for Payer: Qualcare PPO/HMO/WC	$91.60
Rate for Payer: UnitedHealthcare Commercial	$305.32

ULTRABRAID II2 BLUE SUTURE 38

Facility

$102.05

Hospital Charge Code	270681095
Hospital Revenue Code	272
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.31

ULTRABRAID II2 BLUE SUTURE 38

Facility

$102.05

Hospital Charge Code	270681095
Hospital Revenue Code	272
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$51.02
Rate for Payer: Aetna Commercial	$30.61
Rate for Payer: Aetna Medicare Advantage	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.02
Rate for Payer: Cigna Commercial	$51.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.27
Rate for Payer: Oxford Commercial	$51.02
Rate for Payer: Qualcare PPO/HMO/WC	$15.31
Rate for Payer: UnitedHealthcare Commercial	$51.02

ULTRA-COAT KERRISON MEDIUM 40D

Facility

$4,102.95

Hospital Charge Code	270691414
Hospital Revenue Code	272
Min. Negotiated Rate	$533.38
Max. Negotiated Rate	$2,051.47
Rate for Payer: Aetna Commercial	$1,230.88
Rate for Payer: Aetna Medicare Advantage	$1,230.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,046.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,046.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,046.25
Rate for Payer: Cigna Commercial	$2,051.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.38
Rate for Payer: Oxford Commercial	$2,051.47
Rate for Payer: Qualcare PPO/HMO/WC	$615.44
Rate for Payer: UnitedHealthcare Commercial	$2,051.47

ULTRA-COAT KERRISON MEDIUM 40D

Facility

$4,102.95

Hospital Charge Code	270691414
Hospital Revenue Code	272
Min. Negotiated Rate	$615.44
Max. Negotiated Rate	$615.44
Rate for Payer: Qualcare PPO/HMO/WC	$615.44

ULTRA FAST FIX AB CURVED

Facility

$1,715.00

Hospital Charge Code	270673674
Hospital Revenue Code	272
Min. Negotiated Rate	$257.25
Max. Negotiated Rate	$257.25
Rate for Payer: Qualcare PPO/HMO/WC	$257.25

ULTRA FAST FIX AB CURVED

Facility

$1,715.00

Hospital Charge Code	270673674
Hospital Revenue Code	272
Min. Negotiated Rate	$222.95
Max. Negotiated Rate	$857.50
Rate for Payer: Aetna Commercial	$514.50
Rate for Payer: Aetna Medicare Advantage	$514.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.32
Rate for Payer: Cigna Commercial	$857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.95
Rate for Payer: Oxford Commercial	$857.50
Rate for Payer: Qualcare PPO/HMO/WC	$257.25
Rate for Payer: UnitedHealthcare Commercial	$857.50

ULTRA FAST FIX AB REVERSE CURV

Facility

$1,765.00

Hospital Charge Code	270673672
Hospital Revenue Code	272
Min. Negotiated Rate	$229.45
Max. Negotiated Rate	$882.50
Rate for Payer: Aetna Commercial	$529.50
Rate for Payer: Aetna Medicare Advantage	$529.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.07
Rate for Payer: Cigna Commercial	$882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.45
Rate for Payer: Oxford Commercial	$882.50
Rate for Payer: Qualcare PPO/HMO/WC	$264.75
Rate for Payer: UnitedHealthcare Commercial	$882.50

ULTRA FAST FIX AB REVERSE CURV

Facility

$1,765.00

Hospital Charge Code	270673672
Hospital Revenue Code	272
Min. Negotiated Rate	$264.75
Max. Negotiated Rate	$264.75
Rate for Payer: Qualcare PPO/HMO/WC	$264.75

ULTRA FAST FIX AB STRAIGHT

Facility

$1,765.00

Hospital Charge Code	270673676
Hospital Revenue Code	272
Min. Negotiated Rate	$264.75
Max. Negotiated Rate	$264.75
Rate for Payer: Qualcare PPO/HMO/WC	$264.75

ULTRA FAST FIX AB STRAIGHT

Facility

$1,765.00

Hospital Charge Code	270673676
Hospital Revenue Code	272
Min. Negotiated Rate	$229.45
Max. Negotiated Rate	$882.50
Rate for Payer: Aetna Commercial	$529.50
Rate for Payer: Aetna Medicare Advantage	$529.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.07
Rate for Payer: Cigna Commercial	$882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.45
Rate for Payer: Oxford Commercial	$882.50
Rate for Payer: Qualcare PPO/HMO/WC	$264.75
Rate for Payer: UnitedHealthcare Commercial	$882.50

ULTRAFLEX DIAMOND 4 1544

Facility

$5,250.00

Hospital Charge Code	270604777
Hospital Revenue Code	270
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

ULTRAFLEX DIAMOND 4 1544

Facility

$5,250.00

Hospital Charge Code	270604777
Hospital Revenue Code	270
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$2,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$2,625.00

ULTRAFLEX DIAMOND 6 1546

Facility

$5,250.00

Hospital Charge Code	270604778
Hospital Revenue Code	270
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

ULTRAFLEX DIAMOND 6 1546

Facility

$5,250.00

Hospital Charge Code	270604778
Hospital Revenue Code	270
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$2,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$2,625.00

ULTRAFLEX DIAMOND 8 1548

Facility

$5,250.00

Hospital Charge Code	270604779
Hospital Revenue Code	270
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

ULTRAFLEX DIAMOND 8 1548

Facility

$5,250.00

Hospital Charge Code	270604779
Hospital Revenue Code	270
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,575.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$2,625.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$2,625.00

ULTRAFLEX ESOPHAGEAL 5

Facility

$6,625.00

Hospital Charge Code	270604780
Hospital Revenue Code	270
Min. Negotiated Rate	$993.75
Max. Negotiated Rate	$993.75
Rate for Payer: Qualcare PPO/HMO/WC	$993.75

ULTRAFLEX ESOPHAGEAL 5

Facility

$6,625.00

Hospital Charge Code	270604780
Hospital Revenue Code	270
Min. Negotiated Rate	$861.25
Max. Negotiated Rate	$3,312.50
Rate for Payer: Aetna Commercial	$1,987.50
Rate for Payer: Aetna Medicare Advantage	$1,987.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.38
Rate for Payer: Cigna Commercial	$3,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$861.25
Rate for Payer: Oxford Commercial	$3,312.50
Rate for Payer: Qualcare PPO/HMO/WC	$993.75
Rate for Payer: UnitedHealthcare Commercial	$3,312.50

ULTRAFLEX ESOPHAGEAL 5

Facility

$4,274.45

Hospital Charge Code	270604782
Hospital Revenue Code	270
Min. Negotiated Rate	$641.17
Max. Negotiated Rate	$641.17
Rate for Payer: Qualcare PPO/HMO/WC	$641.17

ULTRAFLEX ESOPHAGEAL 5

Facility

$4,274.45

Hospital Charge Code	270604782
Hospital Revenue Code	270
Min. Negotiated Rate	$555.68
Max. Negotiated Rate	$2,137.22
Rate for Payer: Aetna Commercial	$1,282.34
Rate for Payer: Aetna Medicare Advantage	$1,282.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,089.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,089.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,089.98
Rate for Payer: Cigna Commercial	$2,137.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.68
Rate for Payer: Oxford Commercial	$2,137.22
Rate for Payer: Qualcare PPO/HMO/WC	$641.17
Rate for Payer: UnitedHealthcare Commercial	$2,137.22

ULTRAFLEX ESOPHAGEAL 6

Facility

$6,625.00

Hospital Charge Code	270604781
Hospital Revenue Code	270
Min. Negotiated Rate	$861.25
Max. Negotiated Rate	$3,312.50
Rate for Payer: Aetna Commercial	$1,987.50
Rate for Payer: Aetna Medicare Advantage	$1,987.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.38
Rate for Payer: Cigna Commercial	$3,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$861.25
Rate for Payer: Oxford Commercial	$3,312.50
Rate for Payer: Qualcare PPO/HMO/WC	$993.75
Rate for Payer: UnitedHealthcare Commercial	$3,312.50

Know your out-of-pocket cost for care.

All Charges