Heights University Hospital

All Charges

Charge

Type

Setting

Price

OCCULT BLOOD, STOOL DIAGNOSTIC

Facility

$41.25

Service Code	HCPCS 82270
Hospital Charge Code	3002987
Hospital Revenue Code	301
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

OCCULT BLOOD, STOOL DIAGNOSTIC

Facility

$41.25

Service Code	HCPCS 82270
Hospital Charge Code	3002987
Hospital Revenue Code	301
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$14.19
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.05
Rate for Payer: Cigna Commercial	$4.38
Rate for Payer: Cigna Medicare Advantage	$2.19
Rate for Payer: Clover Medicare Advantage	$4.16
Rate for Payer: EmblemHealth Commercial	$13.14
Rate for Payer: Humana Medicare Advantage	$4.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.36
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.64
Rate for Payer: Wellcare Medicare Advantage	$4.38

OCCULT BLOOD, STOOL SCREENING

Facility

$269.60

Service Code	HCPCS G0328
Hospital Charge Code	3002988
Hospital Revenue Code	305
Min. Negotiated Rate	$40.44
Max. Negotiated Rate	$40.44
Rate for Payer: Qualcare PPO/HMO/WC	$40.44

OCCULT BLOOD, STOOL SCREENING

Facility

$269.60

Service Code	HCPCS G0328
Hospital Charge Code	3002988
Hospital Revenue Code	305
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.48
Rate for Payer: Aetna Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.14
Rate for Payer: Cigna Commercial	$18.05
Rate for Payer: Cigna Medicare Advantage	$9.03
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.44
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.13
Rate for Payer: Wellcare Medicare Advantage	$18.05

OCCULT BLOOD VOMITUS

Facility

$390.00

Service Code	HCPCS 82270
Hospital Charge Code	3002989
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OCCULT BLOOD VOMITUS

Facility

$390.00

Service Code	HCPCS 82270
Hospital Charge Code	3002989
Hospital Revenue Code	301
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$14.19
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.05
Rate for Payer: Cigna Commercial	$4.38
Rate for Payer: Cigna Medicare Advantage	$2.19
Rate for Payer: Clover Medicare Advantage	$4.16
Rate for Payer: EmblemHealth Commercial	$13.14
Rate for Payer: Humana Medicare Advantage	$4.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.64
Rate for Payer: Wellcare Medicare Advantage	$4.38

OC DRILL

Facility

$2,375.00

Hospital Charge Code	270663781
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

OC DRILL

Facility

$2,375.00

Hospital Charge Code	270663781
Hospital Revenue Code	272
Min. Negotiated Rate	$308.75
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.75
Rate for Payer: Oxford Commercial	$1,187.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$1,187.50

OC SET SCREWS

Facility

$665.00

Service Code	HCPCS C1713
Hospital Charge Code	270687818
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

OC SET SCREWS

Facility

$665.00

Service Code	HCPCS C1713
Hospital Charge Code	270687818
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$160.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

OCTAGAM 10% 20GM/200ML

Facility

$10,004.78

Service Code	HCPCS J1568
Hospital Charge Code	606390174
Hospital Revenue Code	636
Min. Negotiated Rate	$1,500.72
Max. Negotiated Rate	$2,421.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,421.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.72

OCTAGAM 10% 20GM/200ML

Facility

$10,004.78

Service Code	HCPCS J1568
Hospital Charge Code	606390174
Hospital Revenue Code	636
Min. Negotiated Rate	$1,500.72
Max. Negotiated Rate	$3,001.43
Rate for Payer: Aetna Commercial	$3,001.43
Rate for Payer: Aetna Medicare Advantage	$3,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,551.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,551.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,551.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,421.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.72

OCTAGAM 2.5GM 5%/50ML

Facility

$3,471.27

Service Code	HCPCS J1568JW
Hospital Charge Code	606390486
Hospital Revenue Code	636
Min. Negotiated Rate	$520.69
Max. Negotiated Rate	$1,735.63
Rate for Payer: Aetna Commercial	$1,041.38
Rate for Payer: Aetna Medicare Advantage	$1,041.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.17
Rate for Payer: Cigna Commercial	$1,735.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.05
Rate for Payer: Qualcare PPO/HMO/WC	$520.69

OCTAGAM 2.5GM 5%/50ML

Facility

$3,471.27

Service Code	HCPCS J1568JW
Hospital Charge Code	606390486
Hospital Revenue Code	636
Min. Negotiated Rate	$520.69
Max. Negotiated Rate	$840.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.05
Rate for Payer: Qualcare PPO/HMO/WC	$520.69

OCTAGAM 5% 5GM/100ML

Facility

$4,755.66

Service Code	HCPCS J1568
Hospital Charge Code	60628294
Hospital Revenue Code	636
Min. Negotiated Rate	$713.35
Max. Negotiated Rate	$1,150.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,150.87
Rate for Payer: Qualcare PPO/HMO/WC	$713.35

OCTAGAM 5% 5GM/100ML

Facility

$4,755.66

Service Code	HCPCS J1568
Hospital Charge Code	60628294
Hospital Revenue Code	636
Min. Negotiated Rate	$713.35
Max. Negotiated Rate	$1,426.70
Rate for Payer: Aetna Commercial	$1,426.70
Rate for Payer: Aetna Medicare Advantage	$1,426.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,212.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,212.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,212.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,150.87
Rate for Payer: Qualcare PPO/HMO/WC	$713.35

OC TAP

Facility

$2,700.00

Hospital Charge Code	270683739
Hospital Revenue Code	272
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

OC TAP

Facility

$2,700.00

Hospital Charge Code	270683739
Hospital Revenue Code	272
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$810.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$1,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,350.00

OCTREASCAN (TROPOLONE) IN-111

Facility

$10,344.40

Hospital Charge Code	270658216
Hospital Revenue Code	272
Min. Negotiated Rate	$1,344.77
Max. Negotiated Rate	$5,172.20
Rate for Payer: Aetna Commercial	$3,103.32
Rate for Payer: Aetna Medicare Advantage	$3,103.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,637.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,637.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,637.82
Rate for Payer: Cigna Commercial	$5,172.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.77
Rate for Payer: Oxford Commercial	$5,172.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,551.66
Rate for Payer: UnitedHealthcare Commercial	$5,172.20

OCTREASCAN (TROPOLONE) IN-111

Facility

$10,344.40

Hospital Charge Code	270658216
Hospital Revenue Code	272
Min. Negotiated Rate	$1,551.66
Max. Negotiated Rate	$1,551.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,551.66

OCTREOSCAN UD

Facility

$7,577.65

Hospital Charge Code	270626959
Hospital Revenue Code	272
Min. Negotiated Rate	$985.09
Max. Negotiated Rate	$3,788.82
Rate for Payer: Aetna Commercial	$2,273.30
Rate for Payer: Aetna Medicare Advantage	$2,273.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,932.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,932.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,932.30
Rate for Payer: Cigna Commercial	$3,788.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$985.09
Rate for Payer: Oxford Commercial	$3,788.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.65
Rate for Payer: UnitedHealthcare Commercial	$3,788.82

OCTREOSCAN UD

Facility

$7,577.65

Hospital Charge Code	270626959
Hospital Revenue Code	272
Min. Negotiated Rate	$1,136.65
Max. Negotiated Rate	$1,136.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.65

OCTREOTIDE 100MCG/ML

Facility

$106.00

Hospital Charge Code	60635669
Hospital Revenue Code	250
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.78
Rate for Payer: Oxford Commercial	$53.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$53.00

OCTREOTIDE 100MCG/ML

Facility

$106.00

Hospital Charge Code	60635669
Hospital Revenue Code	250
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

OCTREOTIDE 100 MCG/ML INJ

Facility

$205.56

Service Code	HCPCS J2354
Hospital Charge Code	60628540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$61.67
Rate for Payer: Aetna Commercial	$61.67
Rate for Payer: Aetna Medicare Advantage	$61.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.42
Rate for Payer: Cigna Commercial	$0.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.75
Rate for Payer: Qualcare PPO/HMO/WC	$30.83

Know your out-of-pocket cost for care.

All Charges