Heights University Hospital

All Charges

Charge

Type

Setting

Price

OK TO USE

Facility

$620.00

Hospital Charge Code	270634621
Hospital Revenue Code	278
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$150.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.04
Rate for Payer: Qualcare PPO/HMO/WC	$93.00

OK TO USE- USED IN ERROR

Facility

$942.40

Hospital Charge Code	270634631
Hospital Revenue Code	278
Min. Negotiated Rate	$141.36
Max. Negotiated Rate	$228.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.06
Rate for Payer: Qualcare PPO/HMO/WC	$141.36

OK TO USE- USED IN ERROR

Facility

$942.40

Hospital Charge Code	270634631
Hospital Revenue Code	278
Min. Negotiated Rate	$141.36
Max. Negotiated Rate	$471.20
Rate for Payer: Aetna Commercial	$282.72
Rate for Payer: Aetna Medicare Advantage	$282.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.31
Rate for Payer: Cigna Commercial	$471.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.06
Rate for Payer: Qualcare PPO/HMO/WC	$141.36

OLA CYSTIC

Facility

$134.58

Hospital Charge Code	3036006B
Hospital Revenue Code	301
Min. Negotiated Rate	$20.19
Max. Negotiated Rate	$20.19
Rate for Payer: Qualcare PPO/HMO/WC	$20.19

OLA CYSTIC

Facility

$134.58

Hospital Charge Code	3036006B
Hospital Revenue Code	301
Min. Negotiated Rate	$17.50
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$40.37
Rate for Payer: Aetna Medicare Advantage	$40.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.32
Rate for Payer: Cigna Commercial	$67.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.19
Rate for Payer: UnitedHealthcare Commercial	$114.00

OLANZAPINE 10 MG PDS

Facility

$314.03

Service Code	NDC 2759701
Hospital Charge Code	6063943222
Hospital Revenue Code	250
Min. Negotiated Rate	$40.82
Max. Negotiated Rate	$157.01
Rate for Payer: Aetna Commercial	$94.21
Rate for Payer: Aetna Medicare Advantage	$94.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.08
Rate for Payer: Cigna Commercial	$157.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.82
Rate for Payer: Oxford Commercial	$157.01
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$157.01

OLANZAPINE 10 MG PDS

Facility

$314.03

Service Code	NDC 2759701
Hospital Charge Code	6063943222
Hospital Revenue Code	250
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

OLANZAPINE 10 MG TAB

Facility

$148.27

Service Code	NDC 2411730
Hospital Charge Code	60627812
Hospital Revenue Code	250
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$74.14
Rate for Payer: Aetna Commercial	$44.48
Rate for Payer: Aetna Medicare Advantage	$44.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.81
Rate for Payer: Cigna Commercial	$74.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.28
Rate for Payer: Oxford Commercial	$74.14
Rate for Payer: Qualcare PPO/HMO/WC	$22.24
Rate for Payer: UnitedHealthcare Commercial	$74.14

OLANZAPINE 10 MG TAB

Facility

$148.27

Service Code	NDC 2411730
Hospital Charge Code	60627812
Hospital Revenue Code	250
Min. Negotiated Rate	$22.24
Max. Negotiated Rate	$22.24
Rate for Payer: Qualcare PPO/HMO/WC	$22.24

OLANZAPINE 2.5 MG TAB

Facility

$75.04

Service Code	NDC 904628361
Hospital Charge Code	60627813
Hospital Revenue Code	250
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$11.26
Rate for Payer: Qualcare PPO/HMO/WC	$11.26

OLANZAPINE 2.5 MG TAB

Facility

$75.04

Service Code	NDC 904628361
Hospital Charge Code	60627813
Hospital Revenue Code	250
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$37.52
Rate for Payer: Aetna Commercial	$22.51
Rate for Payer: Aetna Medicare Advantage	$22.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.14
Rate for Payer: Cigna Commercial	$37.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.76
Rate for Payer: Oxford Commercial	$37.52
Rate for Payer: Qualcare PPO/HMO/WC	$11.26
Rate for Payer: UnitedHealthcare Commercial	$37.52

OLANZAPINE 5MG

Facility

$25.60

Hospital Charge Code	6017305
Hospital Revenue Code	252
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$7.68
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.33
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$12.80

OLANZAPINE 5MG

Facility

$25.60

Hospital Charge Code	6017305
Hospital Revenue Code	252
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

OLANZAPINE 5 MG TAB

Facility

$98.36

Service Code	NDC 62756055283
Hospital Charge Code	6017800
Hospital Revenue Code	250
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$14.75
Rate for Payer: Qualcare PPO/HMO/WC	$14.75

OLANZAPINE 5 MG TAB

Facility

$98.36

Service Code	NDC 62756055283
Hospital Charge Code	6017800
Hospital Revenue Code	250
Min. Negotiated Rate	$12.79
Max. Negotiated Rate	$49.18
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$29.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.08
Rate for Payer: Cigna Commercial	$49.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.79
Rate for Payer: Oxford Commercial	$49.18
Rate for Payer: Qualcare PPO/HMO/WC	$14.75
Rate for Payer: UnitedHealthcare Commercial	$49.18

OLANZAPINE DISINTEG TAB 5MG

Facility

$106.26

Service Code	NDC 2445385
Hospital Charge Code	60629274
Hospital Revenue Code	250
Min. Negotiated Rate	$15.94
Max. Negotiated Rate	$15.94
Rate for Payer: Qualcare PPO/HMO/WC	$15.94

OLANZAPINE DISINTEG TAB 5MG

Facility

$106.26

Service Code	NDC 2445385
Hospital Charge Code	60629274
Hospital Revenue Code	250
Min. Negotiated Rate	$13.81
Max. Negotiated Rate	$53.13
Rate for Payer: Aetna Commercial	$31.88
Rate for Payer: Aetna Medicare Advantage	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.10
Rate for Payer: Cigna Commercial	$53.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.81
Rate for Payer: Oxford Commercial	$53.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.94
Rate for Payer: UnitedHealthcare Commercial	$53.13

OLANZAPINE TAB 10MG

Facility

$53.80

Hospital Charge Code	6017818
Hospital Revenue Code	252
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

OLANZAPINE TAB 10MG

Facility

$53.80

Hospital Charge Code	6017818
Hospital Revenue Code	252
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

OLIGOCLONAL BANDING

Facility

$227.00

Service Code	HCPCS 83916
Hospital Charge Code	38472678
Hospital Revenue Code	301
Min. Negotiated Rate	$13.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$88.74
Rate for Payer: Aetna Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.36
Rate for Payer: Cigna Commercial	$27.39
Rate for Payer: Cigna Medicare Advantage	$13.70
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.05
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.03
Rate for Payer: Wellcare Medicare Advantage	$27.39

OLIGOCLONAL BANDING

Facility

$227.00

Service Code	HCPCS 83916
Hospital Charge Code	38472678
Hospital Revenue Code	301
Min. Negotiated Rate	$34.05
Max. Negotiated Rate	$34.05
Rate for Payer: Qualcare PPO/HMO/WC	$34.05

OLIGOCLONAL BANDS,CSF

Facility

$138.20

Service Code	HCPCS 83916
Hospital Charge Code	39900113
Hospital Revenue Code	301
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$20.73
Rate for Payer: Qualcare PPO/HMO/WC	$20.73

OLIGOCLONAL BANDS,CSF

Facility

$138.20

Service Code	HCPCS 83916
Hospital Charge Code	39900113
Hospital Revenue Code	301
Min. Negotiated Rate	$13.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$88.74
Rate for Payer: Aetna Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.36
Rate for Payer: Cigna Commercial	$27.39
Rate for Payer: Cigna Medicare Advantage	$13.70
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.73
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.03
Rate for Payer: Wellcare Medicare Advantage	$27.39

OLIGOCLONAL BANDS, SERUM & CSF

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	3004348
Hospital Revenue Code	301
Min. Negotiated Rate	$13.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$88.74
Rate for Payer: Aetna Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.36
Rate for Payer: Cigna Commercial	$27.39
Rate for Payer: Cigna Medicare Advantage	$13.70
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
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	$27.39
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$29.03
Rate for Payer: Wellcare Medicare Advantage	$27.39

OLIGOCLONAL BANDS, SERUM & CSF

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	3004348
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges