Heights University Hospital

All Charges

Charge

Type

Setting

Price

ULTRASOUND ECHOENCEPHALGRAPHY

Facility

$6,700.00

Service Code	HCPCS 76506
Hospital Charge Code	2100106
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

ULTRASOUND GEL .25 LTR

Facility

$10.23

Hospital Charge Code	270653056
Hospital Revenue Code	270
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$5.12
Rate for Payer: Aetna Commercial	$3.07
Rate for Payer: Aetna Medicare Advantage	$3.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.61
Rate for Payer: Cigna Commercial	$5.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.53
Rate for Payer: UnitedHealthcare Commercial	$5.12

ULTRASOUND GEL .25 LTR

Facility

$10.23

Hospital Charge Code	270653056
Hospital Revenue Code	270
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.53

ULTRASOUND PREG UTERUS LIMITED

Facility

$650.00

Service Code	HCPCS 76815
Hospital Charge Code	1800069
Hospital Revenue Code	402
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

ULTRASOUND PREG UTERUS LIMITED

Facility

$650.00

Service Code	HCPCS 76815
Hospital Charge Code	1800069
Hospital Revenue Code	402
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	83653115
Hospital Revenue Code	402
Min. Negotiated Rate	$137.82
Max. Negotiated Rate	$1,981.00
Rate for Payer: Aetna Commercial	$689.64
Rate for Payer: Aetna Medicare Advantage	$689.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.19
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.84
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.82
Rate for Payer: UnitedHealthcare Commercial	$1,981.00

ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	83653115
Hospital Revenue Code	402
Min. Negotiated Rate	$344.82
Max. Negotiated Rate	$344.82
Rate for Payer: Qualcare PPO/HMO/WC	$344.82

ULTRASOUND TRI TRAREC PROBE

Facility

$1,500.00

Hospital Charge Code	270688357
Hospital Revenue Code	272
Min. Negotiated Rate	$195.00
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) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

ULTRASOUND TRI TRAREC PROBE

Facility

$1,500.00

Hospital Charge Code	270688357
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Ultratag RBC Vial Kit

Facility

$471.56

Hospital Charge Code	4509091
Hospital Revenue Code	272
Min. Negotiated Rate	$61.30
Max. Negotiated Rate	$235.78
Rate for Payer: Aetna Commercial	$141.47
Rate for Payer: Aetna Medicare Advantage	$141.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.25
Rate for Payer: Cigna Commercial	$235.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.30
Rate for Payer: Oxford Commercial	$235.78
Rate for Payer: Qualcare PPO/HMO/WC	$70.73
Rate for Payer: UnitedHealthcare Commercial	$235.78

Ultratag RBC Vial Kit

Facility

$471.56

Hospital Charge Code	4509091
Hospital Revenue Code	272
Min. Negotiated Rate	$70.73
Max. Negotiated Rate	$70.73
Rate for Payer: Qualcare PPO/HMO/WC	$70.73

UL TRATAPE 2MM CORD BLUE

Facility

$667.50

Hospital Charge Code	270679417
Hospital Revenue Code	272
Min. Negotiated Rate	$100.12
Max. Negotiated Rate	$100.12
Rate for Payer: Qualcare PPO/HMO/WC	$100.12

UL TRATAPE 2MM CORD BLUE

Facility

$667.50

Hospital Charge Code	270679417
Hospital Revenue Code	272
Min. Negotiated Rate	$86.78
Max. Negotiated Rate	$333.75
Rate for Payer: Aetna Commercial	$200.25
Rate for Payer: Aetna Medicare Advantage	$200.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.21
Rate for Payer: Cigna Commercial	$333.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.78
Rate for Payer: Oxford Commercial	$333.75
Rate for Payer: Qualcare PPO/HMO/WC	$100.12
Rate for Payer: UnitedHealthcare Commercial	$333.75

ULTRA THIN BLADES

Facility

$191.00

Hospital Charge Code	270332553
Hospital Revenue Code	272
Min. Negotiated Rate	$24.83
Max. Negotiated Rate	$95.50
Rate for Payer: Aetna Commercial	$57.30
Rate for Payer: Aetna Medicare Advantage	$57.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.70
Rate for Payer: Cigna Commercial	$95.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.83
Rate for Payer: Oxford Commercial	$95.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.65
Rate for Payer: UnitedHealthcare Commercial	$95.50

ULTRA THIN BLADES

Facility

$191.00

Hospital Charge Code	270332553
Hospital Revenue Code	272
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$28.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

ULTRATOME 2 LUMEN 0

Facility

$1,276.85

Hospital Charge Code	270604767
Hospital Revenue Code	270
Min. Negotiated Rate	$165.99
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$383.06
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.99
Rate for Payer: Oxford Commercial	$638.42
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$638.42

ULTRATOME 2 LUMEN 0

Facility

$1,276.85

Hospital Charge Code	270604767
Hospital Revenue Code	270
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ULTRATOME 2 LUMEN 1

Facility

$1,276.85

Hospital Charge Code	270604768
Hospital Revenue Code	270
Min. Negotiated Rate	$165.99
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$383.06
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.99
Rate for Payer: Oxford Commercial	$638.42
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$638.42

ULTRATOME 2 LUMEN 1

Facility

$1,276.85

Hospital Charge Code	270604768
Hospital Revenue Code	270
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ULTRATOME 2 LUMEN 2

Facility

$1,276.85

Hospital Charge Code	270604769
Hospital Revenue Code	270
Min. Negotiated Rate	$165.99
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$383.06
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.99
Rate for Payer: Oxford Commercial	$638.42
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$638.42

ULTRATOME 2 LUMEN 2

Facility

$1,276.85

Hospital Charge Code	270604769
Hospital Revenue Code	270
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ULTRATOME 2 LUMEN 3

Facility

$1,276.85

Hospital Charge Code	270604770
Hospital Revenue Code	270
Min. Negotiated Rate	$165.99
Max. Negotiated Rate	$638.42
Rate for Payer: Aetna Commercial	$383.06
Rate for Payer: Aetna Medicare Advantage	$383.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.60
Rate for Payer: Cigna Commercial	$638.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.99
Rate for Payer: Oxford Commercial	$638.42
Rate for Payer: Qualcare PPO/HMO/WC	$191.53
Rate for Payer: UnitedHealthcare Commercial	$638.42

ULTRATOME 2 LUMEN 3

Facility

$1,276.85

Hospital Charge Code	270604770
Hospital Revenue Code	270
Min. Negotiated Rate	$191.53
Max. Negotiated Rate	$191.53
Rate for Payer: Qualcare PPO/HMO/WC	$191.53

ULTRATOME 3 LUMEN 20 3590-05

Facility

$1,747.25

Hospital Charge Code	270608084
Hospital Revenue Code	272
Min. Negotiated Rate	$227.14
Max. Negotiated Rate	$873.62
Rate for Payer: Aetna Commercial	$524.17
Rate for Payer: Aetna Medicare Advantage	$524.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$445.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$445.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$445.55
Rate for Payer: Cigna Commercial	$873.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.14
Rate for Payer: Oxford Commercial	$873.62
Rate for Payer: Qualcare PPO/HMO/WC	$262.09
Rate for Payer: UnitedHealthcare Commercial	$873.62

ULTRATOME 3 LUMEN 20 3590-05

Facility

$1,747.25

Hospital Charge Code	270608084
Hospital Revenue Code	272
Min. Negotiated Rate	$262.09
Max. Negotiated Rate	$262.09
Rate for Payer: Qualcare PPO/HMO/WC	$262.09

Know your out-of-pocket cost for care.

All Charges