Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

OMNIFLOX TABS/400MG

Facility

$18.00

Hospital Charge Code	60634734
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

OMNIFLOX TABS/400MG

Facility

$18.00

Hospital Charge Code	60634734
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$5.40
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$9.00

OMNIFLOX TABS/600MG

Facility

$21.00

Hospital Charge Code	60634735
Hospital Revenue Code	250
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$10.50

OMNIFLOX TABS/600MG

Facility

$21.00

Hospital Charge Code	60634735
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

OMNIPAQIE 350 50ML VIAL

Facility

$65.65

Hospital Charge Code	601304
Hospital Revenue Code	636
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$19.70
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

OMNIPAQIE 350 50ML VIAL

Facility

$65.65

Hospital Charge Code	601304
Hospital Revenue Code	636
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$15.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.89
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

OMNIPAQUE 180MG PER 20ML VIAL

Facility

$426.80

Hospital Charge Code	609386
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$213.40
Rate for Payer: Aetna Commercial	$128.04
Rate for Payer: Aetna Medicare Advantage	$128.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.83
Rate for Payer: Cigna Commercial	$213.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 180MG PER 20ML VIAL

Facility

$426.80

Hospital Charge Code	609386
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$103.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 240 50ml Y250

Facility

$426.80

Hospital Charge Code	601176
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$213.40
Rate for Payer: Aetna Commercial	$128.04
Rate for Payer: Aetna Medicare Advantage	$128.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.83
Rate for Payer: Cigna Commercial	$213.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 240 50ml Y250

Facility

$426.80

Hospital Charge Code	601176
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$103.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 240MGI/ML 10ML

Facility

$104.12

Service Code	NDC 407141210
Hospital Charge Code	606390113
Hospital Revenue Code	255
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$15.62
Rate for Payer: Qualcare PPO/HMO/WC	$15.62

OMNIPAQUE 240MGI/ML 10ML

Facility

$104.12

Service Code	NDC 407141210
Hospital Charge Code	606390113
Hospital Revenue Code	255
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$52.06
Rate for Payer: Aetna Commercial	$31.24
Rate for Payer: Aetna Medicare Advantage	$31.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.55
Rate for Payer: Cigna Commercial	$52.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.54
Rate for Payer: Oxford Commercial	$52.06
Rate for Payer: Qualcare PPO/HMO/WC	$15.62
Rate for Payer: UnitedHealthcare Commercial	$52.06

OMNIPAQUE 240MG PER 20 ML VIAL

Facility

$426.80

Hospital Charge Code	601305
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$103.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 240MG PER 20 ML VIAL

Facility

$426.80

Hospital Charge Code	601305
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$213.40
Rate for Payer: Aetna Commercial	$128.04
Rate for Payer: Aetna Medicare Advantage	$128.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.83
Rate for Payer: Cigna Commercial	$213.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 300 10 ML

Facility

$426.80

Hospital Charge Code	60639492
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$213.40
Rate for Payer: Aetna Commercial	$128.04
Rate for Payer: Aetna Medicare Advantage	$128.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.83
Rate for Payer: Cigna Commercial	$213.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 300 10 ML

Facility

$426.80

Hospital Charge Code	60639492
Hospital Revenue Code	636
Min. Negotiated Rate	$64.02
Max. Negotiated Rate	$103.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Qualcare PPO/HMO/WC	$64.02

OMNIPAQUE 320MG/ML 170ML

Facility

$3.75

Hospital Charge Code	270605515C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.88
Rate for Payer: Cigna Commercial	$1.88
Rate for Payer: Aetna Commercial	$1.12
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.49
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Commercial	$1.88

OMNIPAQUE 320MG/ML 170ML

Facility

$3.75

Hospital Charge Code	270605515C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

OMNIPAQUE 350 150M FLEXPK Y495

Facility

$184.85

Hospital Charge Code	270601302
Hospital Revenue Code	250
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$27.73
Rate for Payer: Qualcare PPO/HMO/WC	$27.73

OMNIPAQUE 350 150M FLEXPK Y495

Facility

$184.85

Hospital Charge Code	270601302
Hospital Revenue Code	250
Min. Negotiated Rate	$24.03
Max. Negotiated Rate	$92.42
Rate for Payer: Aetna Commercial	$55.45
Rate for Payer: Aetna Medicare Advantage	$55.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.14
Rate for Payer: Cigna Commercial	$92.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.03
Rate for Payer: Oxford Commercial	$92.42
Rate for Payer: Qualcare PPO/HMO/WC	$27.73
Rate for Payer: UnitedHealthcare Commercial	$92.42

OMNIPAQUE 350MG/150ML

Facility

$835.00

Hospital Charge Code	60630247
Hospital Revenue Code	255
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$125.25
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

OMNIPAQUE 350MG/150ML

Facility

$1,047.34

Service Code	HCPCS Q9967
Hospital Charge Code	60630241
Hospital Revenue Code	255
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$523.67
Rate for Payer: Aetna Commercial	$314.20
Rate for Payer: Aetna Medicare Advantage	$314.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.07
Rate for Payer: Cigna Commercial	$0.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.15
Rate for Payer: Oxford Commercial	$523.67
Rate for Payer: Qualcare PPO/HMO/WC	$157.10
Rate for Payer: UnitedHealthcare Commercial	$523.67

OMNIPAQUE 350MG/150ML

Facility

$1,047.34

Service Code	HCPCS Q9967
Hospital Charge Code	60630241
Hospital Revenue Code	255
Min. Negotiated Rate	$157.10
Max. Negotiated Rate	$157.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.10

OMNIPAQUE 350MG/150ML

Facility

$835.00

Hospital Charge Code	60630247
Hospital Revenue Code	255
Min. Negotiated Rate	$108.55
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$250.50
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.55
Rate for Payer: Oxford Commercial	$417.50
Rate for Payer: Qualcare PPO/HMO/WC	$125.25
Rate for Payer: UnitedHealthcare Commercial	$417.50

Know your out-of-pocket cost for care.

All Charges