Heights University Hospital

All Charges

Charge

Type

Setting

Price

UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	421029580
Hospital Revenue Code	761
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

UNNA BOOT PRIMER 4 MODIFIED

Facility

$11.50

Hospital Charge Code	60629869
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$5.75
Rate for Payer: Aetna Commercial	$3.45
Rate for Payer: Aetna Medicare Advantage	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.93
Rate for Payer: Cigna Commercial	$5.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.73
Rate for Payer: UnitedHealthcare Commercial	$5.75

UNNA BOOT PRIMER 4 MODIFIED

Facility

$11.50

Hospital Charge Code	60629869
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.73

UNSCHED DIALYSIS ESRD PT HOS

Facility

$3,624.15

Service Code	HCPCS G0257
Hospital Charge Code	93626001
Hospital Revenue Code	829
Min. Negotiated Rate	$543.62
Max. Negotiated Rate	$543.62
Rate for Payer: Qualcare PPO/HMO/WC	$543.62

UNSCHED DIALYSIS ESRD PT HOS

Facility

$3,624.15

Service Code	HCPCS G0257
Hospital Charge Code	93626001
Hospital Revenue Code	829
Min. Negotiated Rate	$471.14
Max. Negotiated Rate	$2,892.00
Rate for Payer: Aetna Commercial	$1,087.24
Rate for Payer: Aetna Medicare Advantage	$1,087.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.16
Rate for Payer: Cigna Commercial	$1,634.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.14
Rate for Payer: Oxford Commercial	$2,546.00
Rate for Payer: Qualcare PPO/HMO/WC	$543.62
Rate for Payer: UnitedHealthcare Commercial	$2,892.00

UNSTERILE 8X7 DOZ****

Facility

$20.00

Hospital Charge Code	8000556
Hospital Revenue Code	279
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$10.00

UNSTERILE 8X7 DOZ****

Facility

$20.00

Hospital Charge Code	8000556
Hospital Revenue Code	279
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

UNSUCCSSFL PTCA INTERVENT

Facility

$23,778.00

Service Code	HCPCS 9298074
Hospital Charge Code	7411185
Hospital Revenue Code	481
Min. Negotiated Rate	$3,091.14
Max. Negotiated Rate	$11,889.00
Rate for Payer: Aetna Commercial	$7,133.40
Rate for Payer: Aetna Medicare Advantage	$7,133.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,063.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,063.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,063.39
Rate for Payer: Cigna Commercial	$11,889.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,091.14
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.70

UNSUCCSSFL PTCA INTERVENT

Facility

$23,778.00

Service Code	HCPCS 9298074
Hospital Charge Code	7411185
Hospital Revenue Code	481
Min. Negotiated Rate	$3,566.70
Max. Negotiated Rate	$3,566.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.70

UNSUCCSSFL PTCA INTERVENT

Facility

$23,778.00

Hospital Charge Code	7411275
Hospital Revenue Code	481
Min. Negotiated Rate	$3,091.14
Max. Negotiated Rate	$11,889.00
Rate for Payer: Aetna Commercial	$7,133.40
Rate for Payer: Aetna Medicare Advantage	$7,133.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,063.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,063.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,063.39
Rate for Payer: Cigna Commercial	$11,889.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,091.14
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.70

UNSUCCSSFL PTCA INTERVENT

Facility

$23,778.00

Hospital Charge Code	7411275
Hospital Revenue Code	481
Min. Negotiated Rate	$3,566.70
Max. Negotiated Rate	$3,566.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,566.70

UPEPU

Facility

$107.00

Service Code	HCPCS 82570
Hospital Charge Code	3000370A
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

UPEPU

Facility

$107.00

Service Code	HCPCS 82570
Hospital Charge Code	3000370A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$5.18
Rate for Payer: Cigna Medicare Advantage	$2.59
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.18

UPEPU

Facility

$75.00

Service Code	HCPCS 84156
Hospital Charge Code	3000370B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

UPEPU

Facility

$113.00

Service Code	HCPCS 84166
Hospital Charge Code	3000370C
Hospital Revenue Code	301
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.77
Rate for Payer: Aetna Medicare Advantage	$17.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.33
Rate for Payer: Cigna Commercial	$17.83
Rate for Payer: Cigna Medicare Advantage	$8.91
Rate for Payer: Clover Medicare Advantage	$16.94
Rate for Payer: EmblemHealth Commercial	$53.49
Rate for Payer: Humana Medicare Advantage	$18.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.69
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.83
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.90
Rate for Payer: Wellcare Medicare Advantage	$17.83

UPEPU

Facility

$113.00

Service Code	HCPCS 84166
Hospital Charge Code	3000370C
Hospital Revenue Code	301
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

UPEPU

Facility

$75.00

Service Code	HCPCS 84156
Hospital Charge Code	3000370B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.89
Rate for Payer: Aetna Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.45
Rate for Payer: Cigna Commercial	$3.67
Rate for Payer: Cigna Medicare Advantage	$1.83
Rate for Payer: Clover Medicare Advantage	$3.49
Rate for Payer: EmblemHealth Commercial	$11.01
Rate for Payer: Humana Medicare Advantage	$3.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.67
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.89
Rate for Payer: Wellcare Medicare Advantage	$3.67

UPGRADE PG & LEAD SNGL

Facility

$39,837.00

Service Code	HCPCS 33214
Hospital Charge Code	7411021
Hospital Revenue Code	480
Min. Negotiated Rate	$267.38
Max. Negotiated Rate	$24,890.32
Rate for Payer: Aetna Commercial	$11,951.10
Rate for Payer: Aetna Medicare Advantage	$11,951.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,158.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,158.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$267.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,158.43
Rate for Payer: Cigna Commercial	$24,890.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,178.81
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,975.55
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

UPGRADE PG & LEAD SNGL

Facility

$39,837.00

Service Code	HCPCS 33214
Hospital Charge Code	7411021
Hospital Revenue Code	480
Min. Negotiated Rate	$5,975.55
Max. Negotiated Rate	$5,975.55
Rate for Payer: Qualcare PPO/HMO/WC	$5,975.55

UPPER GI W/SMALL BOWEL

Facility

$825.00

Service Code	HCPCS 74245
Hospital Charge Code	94061141
Hospital Revenue Code	320
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

UPPER GI W/SMALL BOWEL

Facility

$825.00

Service Code	HCPCS 74245
Hospital Charge Code	94061141
Hospital Revenue Code	320
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$247.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$61,105.02

Service Code	MSDRG 256
Min. Negotiated Rate	$18,528.47
Max. Negotiated Rate	$61,105.02
Rate for Payer: Aetna Commercial	$57,252.97
Rate for Payer: Aetna Medicare Advantage	$18,528.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,209.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,209.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,368.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,209.88
Rate for Payer: Cigna Commercial	$36,540.51
Rate for Payer: Cigna Medicare Advantage	$20,368.34
Rate for Payer: Clover Medicare Advantage	$19,349.92
Rate for Payer: EmblemHealth Commercial	$61,105.02
Rate for Payer: Humana Medicare Advantage	$20,979.39
Rate for Payer: Oxford Commercial	$22,836.76
Rate for Payer: UnitedHealthcare Commercial	$25,921.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,368.34
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$21,590.44
Rate for Payer: Wellcare Medicare Advantage	$20,368.34

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$90,956.00

Service Code	MSDRG 255
Min. Negotiated Rate	$28,536.81
Max. Negotiated Rate	$90,956.00
Rate for Payer: Aetna Commercial	$90,956.00
Rate for Payer: Aetna Medicare Advantage	$29,435.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,809.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,809.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30,038.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75,809.25
Rate for Payer: Cigna Commercial	$58,050.75
Rate for Payer: Cigna Medicare Advantage	$30,038.75
Rate for Payer: Clover Medicare Advantage	$28,536.81
Rate for Payer: EmblemHealth Commercial	$90,116.25
Rate for Payer: Humana Medicare Advantage	$30,939.91
Rate for Payer: Oxford Commercial	$36,280.03
Rate for Payer: UnitedHealthcare Commercial	$41,181.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$30,038.75
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$31,841.08
Rate for Payer: Wellcare Medicare Advantage	$30,038.75

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$43,524.12

Service Code	MSDRG 257
Min. Negotiated Rate	$11,918.72
Max. Negotiated Rate	$43,524.12
Rate for Payer: Aetna Commercial	$36,828.84
Rate for Payer: Aetna Medicare Advantage	$11,918.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,291.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,291.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,508.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,291.33
Rate for Payer: Cigna Commercial	$23,505.24
Rate for Payer: Cigna Medicare Advantage	$14,508.04
Rate for Payer: Clover Medicare Advantage	$13,782.64
Rate for Payer: EmblemHealth Commercial	$43,524.12
Rate for Payer: Humana Medicare Advantage	$14,943.28
Rate for Payer: Oxford Commercial	$14,690.09
Rate for Payer: UnitedHealthcare Commercial	$16,674.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,508.04
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15,378.52
Rate for Payer: Wellcare Medicare Advantage	$14,508.04

UPPER MINOR KIT

Facility

$145.00

Hospital Charge Code	270338758
Hospital Revenue Code	272
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$43.50
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.85
Rate for Payer: Oxford Commercial	$72.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$72.50

Know your out-of-pocket cost for care.

All Charges