Heights University Hospital

All Charges

Charge

Type

Setting

Price

ULTRATOME 3 LUMEN 20 L 3591-05

Facility

$1,310.45

Hospital Charge Code	270612457
Hospital Revenue Code	272
Min. Negotiated Rate	$170.36
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$393.13
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.36
Rate for Payer: Oxford Commercial	$655.23
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$655.23

ULTRATOME 3 LUMEN 20 L 3591-05

Facility

$1,310.45

Hospital Charge Code	270612457
Hospital Revenue Code	272
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

ULTRATOME 3 LUMEN 30 L 3593-05

Facility

$1,310.45

Hospital Charge Code	270612459
Hospital Revenue Code	272
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

ULTRATOME 3 LUMEN 30 L 3593-05

Facility

$1,310.45

Hospital Charge Code	270612459
Hospital Revenue Code	272
Min. Negotiated Rate	$170.36
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$393.13
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.36
Rate for Payer: Oxford Commercial	$655.23
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$655.23

ULTRATOME MCV XL 30MM 3592

Facility

$1,584.00

Hospital Charge Code	270604765
Hospital Revenue Code	270
Min. Negotiated Rate	$205.92
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna Commercial	$475.20
Rate for Payer: Aetna Medicare Advantage	$475.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$403.92
Rate for Payer: Cigna Commercial	$792.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.92
Rate for Payer: Oxford Commercial	$792.00
Rate for Payer: Qualcare PPO/HMO/WC	$237.60
Rate for Payer: UnitedHealthcare Commercial	$792.00

ULTRATOME MCV XL 30MM 3592

Facility

$1,584.00

Hospital Charge Code	270604765
Hospital Revenue Code	270
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$237.60
Rate for Payer: Qualcare PPO/HMO/WC	$237.60

ULTRATOME SPHYNCTERO SHT

Facility

$1,482.45

Hospital Charge Code	270600940
Hospital Revenue Code	270
Min. Negotiated Rate	$222.37
Max. Negotiated Rate	$222.37
Rate for Payer: Qualcare PPO/HMO/WC	$222.37

ULTRATOME SPHYNCTERO SHT

Facility

$1,482.45

Hospital Charge Code	270600940
Hospital Revenue Code	270
Min. Negotiated Rate	$192.72
Max. Negotiated Rate	$741.23
Rate for Payer: Aetna Commercial	$444.74
Rate for Payer: Aetna Medicare Advantage	$444.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$378.02
Rate for Payer: Cigna Commercial	$741.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.72
Rate for Payer: Oxford Commercial	$741.23
Rate for Payer: Qualcare PPO/HMO/WC	$222.37
Rate for Payer: UnitedHealthcare Commercial	$741.23

ULTRATOME XL 0

Facility

$1,584.00

Hospital Charge Code	270604763
Hospital Revenue Code	270
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$237.60
Rate for Payer: Qualcare PPO/HMO/WC	$237.60

ULTRATOME XL 0

Facility

$1,584.00

Hospital Charge Code	270604763
Hospital Revenue Code	270
Min. Negotiated Rate	$205.92
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna Commercial	$475.20
Rate for Payer: Aetna Medicare Advantage	$475.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$403.92
Rate for Payer: Cigna Commercial	$792.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.92
Rate for Payer: Oxford Commercial	$792.00
Rate for Payer: Qualcare PPO/HMO/WC	$237.60
Rate for Payer: UnitedHealthcare Commercial	$792.00

ULTRATOME XL 1

Facility

$1,584.00

Hospital Charge Code	270604764
Hospital Revenue Code	270
Min. Negotiated Rate	$205.92
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna Commercial	$475.20
Rate for Payer: Aetna Medicare Advantage	$475.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$403.92
Rate for Payer: Cigna Commercial	$792.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.92
Rate for Payer: Oxford Commercial	$792.00
Rate for Payer: Qualcare PPO/HMO/WC	$237.60
Rate for Payer: UnitedHealthcare Commercial	$792.00

ULTRATOME XL 1

Facility

$1,584.00

Hospital Charge Code	270604764
Hospital Revenue Code	270
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$237.60
Rate for Payer: Qualcare PPO/HMO/WC	$237.60

ULTRATOME XL 3

Facility

$1,584.00

Hospital Charge Code	270604766
Hospital Revenue Code	270
Min. Negotiated Rate	$205.92
Max. Negotiated Rate	$792.00
Rate for Payer: Aetna Commercial	$475.20
Rate for Payer: Aetna Medicare Advantage	$475.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$403.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$403.92
Rate for Payer: Cigna Commercial	$792.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.92
Rate for Payer: Oxford Commercial	$792.00
Rate for Payer: Qualcare PPO/HMO/WC	$237.60
Rate for Payer: UnitedHealthcare Commercial	$792.00

ULTRATOME XL 3

Facility

$1,584.00

Hospital Charge Code	270604766
Hospital Revenue Code	270
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$237.60
Rate for Payer: Qualcare PPO/HMO/WC	$237.60

ULTRA VAC SMOKE PENCIL

Facility

$154.50

Hospital Charge Code	270664807
Hospital Revenue Code	270
Min. Negotiated Rate	$20.09
Max. Negotiated Rate	$77.25
Rate for Payer: Aetna Commercial	$46.35
Rate for Payer: Aetna Medicare Advantage	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.40
Rate for Payer: Cigna Commercial	$77.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.09
Rate for Payer: Oxford Commercial	$77.25
Rate for Payer: Qualcare PPO/HMO/WC	$23.18
Rate for Payer: UnitedHealthcare Commercial	$77.25

ULTRA VAC SMOKE PENCIL

Facility

$154.50

Hospital Charge Code	270664807
Hospital Revenue Code	270
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$23.18
Rate for Payer: Qualcare PPO/HMO/WC	$23.18

UNBOUND IRON BINDING

Facility

$91.25

Service Code	HCPCS 83550
Hospital Charge Code	8200317RS
Hospital Revenue Code	301
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

UNBOUND IRON BINDING

Facility

$91.25

Service Code	HCPCS 83550
Hospital Charge Code	8200317RS
Hospital Revenue Code	301
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$28.32
Rate for Payer: Aetna Medicare Advantage	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.02
Rate for Payer: Cigna Commercial	$8.74
Rate for Payer: Cigna Medicare Advantage	$4.37
Rate for Payer: Clover Medicare Advantage	$8.30
Rate for Payer: EmblemHealth Commercial	$26.22
Rate for Payer: Humana Medicare Advantage	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.74
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.26
Rate for Payer: Wellcare Medicare Advantage	$8.74

UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$51,898.05

Service Code	MSDRG 383
Min. Negotiated Rate	$15,067.00
Max. Negotiated Rate	$51,898.05
Rate for Payer: Aetna Commercial	$46,557.03
Rate for Payer: Aetna Medicare Advantage	$15,067.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38,593.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38,593.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,299.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38,593.80
Rate for Payer: Cigna Commercial	$29,714.04
Rate for Payer: Cigna Medicare Advantage	$17,299.35
Rate for Payer: Clover Medicare Advantage	$16,434.38
Rate for Payer: EmblemHealth Commercial	$51,898.05
Rate for Payer: Humana Medicare Advantage	$17,818.33
Rate for Payer: Oxford Commercial	$18,570.42
Rate for Payer: UnitedHealthcare Commercial	$21,079.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,299.35
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18,337.31
Rate for Payer: Wellcare Medicare Advantage	$17,299.35

UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$36,633.42

Service Code	MSDRG 384
Min. Negotiated Rate	$9,328.08
Max. Negotiated Rate	$36,633.42
Rate for Payer: Aetna Commercial	$28,823.77
Rate for Payer: Aetna Medicare Advantage	$9,328.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,258.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,258.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,211.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,258.96
Rate for Payer: Cigna Commercial	$18,396.15
Rate for Payer: Cigna Medicare Advantage	$12,211.14
Rate for Payer: Clover Medicare Advantage	$11,600.58
Rate for Payer: EmblemHealth Commercial	$36,633.42
Rate for Payer: Humana Medicare Advantage	$12,577.47
Rate for Payer: Oxford Commercial	$11,497.06
Rate for Payer: UnitedHealthcare Commercial	$13,050.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,211.14
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12,943.81
Rate for Payer: Wellcare Medicare Advantage	$12,211.14

UNDERGAURD FOR PLASMA

Facility

$309.05

Hospital Charge Code	270665038
Hospital Revenue Code	270
Min. Negotiated Rate	$46.36
Max. Negotiated Rate	$46.36
Rate for Payer: Qualcare PPO/HMO/WC	$46.36

UNDERGAURD FOR PLASMA

Facility

$309.05

Hospital Charge Code	270665038
Hospital Revenue Code	270
Min. Negotiated Rate	$40.18
Max. Negotiated Rate	$154.53
Rate for Payer: Aetna Commercial	$92.72
Rate for Payer: Aetna Medicare Advantage	$92.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.81
Rate for Payer: Cigna Commercial	$154.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.18
Rate for Payer: Oxford Commercial	$154.53
Rate for Payer: Qualcare PPO/HMO/WC	$46.36
Rate for Payer: UnitedHealthcare Commercial	$154.53

UNDERPAD 30X36

Facility

$5.65

Hospital Charge Code	270303310
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

UNDERPAD 30X36

Facility

$5.65

Hospital Charge Code	270303310
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

UNDERPAD ULTRASORB 31x36

Facility

$9.61

Hospital Charge Code	270644336
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna Commercial	$2.88
Rate for Payer: Aetna Medicare Advantage	$2.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.45
Rate for Payer: Cigna Commercial	$4.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$4.80

Know your out-of-pocket cost for care.

All Charges