Heights University Hospital

All Charges

Charge

Type

Setting

Price

OLIVE PIN 1.4 MM

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270690335
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

OLIVE PIN 1.4 MM

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270690335
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$255.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

OLIVEWIRE

Facility

$3,885.00

Hospital Charge Code	270703513
Hospital Revenue Code	278
Min. Negotiated Rate	$582.75
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,165.50
Rate for Payer: Aetna Medicare Advantage	$1,165.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$990.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$990.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$777.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$990.67
Rate for Payer: Cigna Commercial	$1,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$940.17
Rate for Payer: Qualcare PPO/HMO/WC	$582.75

OLIVEWIRE

Facility

$3,885.00

Hospital Charge Code	270703513
Hospital Revenue Code	278
Min. Negotiated Rate	$582.75
Max. Negotiated Rate	$940.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$777.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$940.17
Rate for Payer: Qualcare PPO/HMO/WC	$582.75

OLIVE WIRE 0.062

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270702089
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

OLIVE WIRE 0.062

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270702089
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703620
Hospital Revenue Code	279
Min. Negotiated Rate	$675.35
Max. Negotiated Rate	$2,597.50
Rate for Payer: Aetna Commercial	$1,558.50
Rate for Payer: Aetna Medicare Advantage	$1,558.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,324.72
Rate for Payer: Cigna Commercial	$2,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.35
Rate for Payer: Oxford Commercial	$2,597.50
Rate for Payer: Qualcare PPO/HMO/WC	$779.25
Rate for Payer: UnitedHealthcare Commercial	$2,597.50

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703260
Hospital Revenue Code	279
Min. Negotiated Rate	$675.35
Max. Negotiated Rate	$2,597.50
Rate for Payer: Aetna Commercial	$1,558.50
Rate for Payer: Aetna Medicare Advantage	$1,558.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,324.72
Rate for Payer: Cigna Commercial	$2,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.35
Rate for Payer: Oxford Commercial	$2,597.50
Rate for Payer: Qualcare PPO/HMO/WC	$779.25
Rate for Payer: UnitedHealthcare Commercial	$2,597.50

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703620
Hospital Revenue Code	279
Min. Negotiated Rate	$779.25
Max. Negotiated Rate	$779.25
Rate for Payer: Qualcare PPO/HMO/WC	$779.25

OLIVE WIRE 15MM

Facility

$5,195.00

Hospital Charge Code	270703260
Hospital Revenue Code	279
Min. Negotiated Rate	$779.25
Max. Negotiated Rate	$779.25
Rate for Payer: Qualcare PPO/HMO/WC	$779.25

OLIVE WIRE, 2.0X450MM

Facility

$780.50

Hospital Charge Code	270656540
Hospital Revenue Code	271
Min. Negotiated Rate	$117.08
Max. Negotiated Rate	$117.08
Rate for Payer: Qualcare PPO/HMO/WC	$117.08

OLIVE WIRE, 2.0X450MM

Facility

$780.50

Hospital Charge Code	270656540
Hospital Revenue Code	271
Min. Negotiated Rate	$101.47
Max. Negotiated Rate	$390.25
Rate for Payer: Aetna Commercial	$234.15
Rate for Payer: Aetna Medicare Advantage	$234.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.03
Rate for Payer: Cigna Commercial	$390.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.47
Rate for Payer: Oxford Commercial	$390.25
Rate for Payer: Qualcare PPO/HMO/WC	$117.08
Rate for Payer: UnitedHealthcare Commercial	$390.25

OLOPATADINE OPTHALMIC 0.1% SOL

Facility

$1,909.50

Service Code	NDC 65027105
Hospital Charge Code	60629908
Hospital Revenue Code	250
Min. Negotiated Rate	$248.24
Max. Negotiated Rate	$954.75
Rate for Payer: Aetna Commercial	$572.85
Rate for Payer: Aetna Medicare Advantage	$572.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$486.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$486.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$486.92
Rate for Payer: Cigna Commercial	$954.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.24
Rate for Payer: Oxford Commercial	$954.75
Rate for Payer: Qualcare PPO/HMO/WC	$286.43
Rate for Payer: UnitedHealthcare Commercial	$954.75

OLOPATADINE OPTHALMIC 0.1% SOL

Facility

$1,909.50

Service Code	NDC 65027105
Hospital Charge Code	60629908
Hospital Revenue Code	250
Min. Negotiated Rate	$286.43
Max. Negotiated Rate	$286.43
Rate for Payer: Qualcare PPO/HMO/WC	$286.43

OMENTECTOMY EPIPLOECTOMY

Facility

$13,267.95

Service Code	HCPCS 49255
Hospital Charge Code	1600000496
Hospital Revenue Code	360
Min. Negotiated Rate	$1,724.83
Max. Negotiated Rate	$15,416.72
Rate for Payer: Aetna Commercial	$3,980.39
Rate for Payer: Aetna Medicare Advantage	$3,980.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,383.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,383.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,383.33
Rate for Payer: Cigna Commercial	$15,416.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.83
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,990.19
Rate for Payer: UnitedHealthcare Commercial	$5,529.00

OMENTECTOMY EPIPLOECTOMY

Facility

$13,267.95

Service Code	HCPCS 49255
Hospital Charge Code	1600000496
Hospital Revenue Code	360
Min. Negotiated Rate	$1,990.19
Max. Negotiated Rate	$1,990.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,990.19

OMEPRAZOLE 40 MG SR CAP

Facility

$47.25

Hospital Charge Code	60629095
Hospital Revenue Code	250
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

OMEPRAZOLE 40 MG SR CAP

Facility

$47.25

Hospital Charge Code	60629095
Hospital Revenue Code	250
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.14
Rate for Payer: Oxford Commercial	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$23.62

OMEPRAZOLE CAP 20MG

Facility

$34.60

Hospital Charge Code	6008858
Hospital Revenue Code	252
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

OMEPRAZOLE CAP 20MG

Facility

$34.60

Hospital Charge Code	6008858
Hospital Revenue Code	252
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$17.30

OMEPRAZOLE CAP SR 10MG

Facility

$26.45

Hospital Charge Code	60628171
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

OMEPRAZOLE CAP SR 10MG

Facility

$26.45

Hospital Charge Code	60628171
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$7.93
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.44
Rate for Payer: Oxford Commercial	$13.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$13.22

OMEPRAZOLE CAP SR 20MG

Facility

$29.65

Hospital Charge Code	60628172
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

OMEPRAZOLE CAP SR 20MG

Facility

$29.65

Hospital Charge Code	60628172
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$8.89
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$14.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$14.82

OMNIA VARIABLE SELF DRILL

Facility

$6,750.00

Hospital Charge Code	270693192
Hospital Revenue Code	272
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

Know your out-of-pocket cost for care.

All Charges