Heights University Hospital

All Charges

Charge

Type

Setting

Price

OMNIPEN-N/1GM

Facility

$24.00

Hospital Charge Code	60633570
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

OMNIPEN-N/2GM

Facility

$48.00

Hospital Charge Code	60633571
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

OMNIPEN-N/2GM

Facility

$48.00

Hospital Charge Code	60633571
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

OMNIPEN-N/500MG

Facility

$21.00

Hospital Charge Code	60633569
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

OMNIPEN-N/500MG

Facility

$21.00

Hospital Charge Code	60633569
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

OMNISCAN 10ml

Facility

$123.00

Service Code	HCPCS A9579
Hospital Charge Code	601529
Hospital Revenue Code	255
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$18.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

OMNISCAN 10ml

Facility

$123.00

Service Code	HCPCS A9579
Hospital Charge Code	601529
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna Commercial	$36.90
Rate for Payer: Aetna Medicare Advantage	$36.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.36
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.99
Rate for Payer: Oxford Commercial	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Commercial	$61.50

OMNISCAN 15ML

Facility

$496.60

Service Code	HCPCS A9579
Hospital Charge Code	2680405
Hospital Revenue Code	255
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$74.49
Rate for Payer: Qualcare PPO/HMO/WC	$74.49

OMNISCAN 15ML

Facility

$496.60

Service Code	HCPCS A9579
Hospital Charge Code	2680405
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$248.30
Rate for Payer: Aetna Commercial	$148.98
Rate for Payer: Aetna Medicare Advantage	$148.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.63
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.56
Rate for Payer: Oxford Commercial	$248.30
Rate for Payer: Qualcare PPO/HMO/WC	$74.49
Rate for Payer: UnitedHealthcare Commercial	$248.30

OMNISCAN 15ML

Facility

$496.60

Hospital Charge Code	7412028
Hospital Revenue Code	636
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$248.30
Rate for Payer: Aetna Commercial	$148.98
Rate for Payer: Aetna Medicare Advantage	$148.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.63
Rate for Payer: Cigna Commercial	$248.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.18
Rate for Payer: Qualcare PPO/HMO/WC	$74.49

OMNISCAN 15ML

Facility

$496.60

Hospital Charge Code	7412028
Hospital Revenue Code	636
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$120.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.18
Rate for Payer: Qualcare PPO/HMO/WC	$74.49

OMNISCAN 15 ML

Facility

$131.25

Service Code	HCPCS A9579
Hospital Charge Code	2011540
Hospital Revenue Code	255
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

OMNISCAN 15 ML

Facility

$131.25

Service Code	HCPCS A9579
Hospital Charge Code	2011540
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$65.62
Rate for Payer: Aetna Commercial	$39.38
Rate for Payer: Aetna Medicare Advantage	$39.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.47
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Oxford Commercial	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$65.62

OMNISCAN 15ml NO SAFEPAK

Facility

$184.50

Service Code	HCPCS A9579
Hospital Charge Code	602913
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$92.25
Rate for Payer: Aetna Commercial	$55.35
Rate for Payer: Aetna Medicare Advantage	$55.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.05
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.98
Rate for Payer: Oxford Commercial	$92.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.68
Rate for Payer: UnitedHealthcare Commercial	$92.25

OMNISCAN 15ml NO SAFEPAK

Facility

$184.50

Service Code	HCPCS A9579
Hospital Charge Code	602913
Hospital Revenue Code	255
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$27.68
Rate for Payer: Qualcare PPO/HMO/WC	$27.68

OMNISCAN 20ml

Facility

$246.00

Service Code	HCPCS A9579
Hospital Charge Code	635147
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$123.00
Rate for Payer: Aetna Commercial	$73.80
Rate for Payer: Aetna Medicare Advantage	$73.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.73
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.98
Rate for Payer: Oxford Commercial	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.90
Rate for Payer: UnitedHealthcare Commercial	$123.00

OMNISCAN 20ml

Facility

$246.00

Service Code	HCPCS A9579
Hospital Charge Code	635147
Hospital Revenue Code	255
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$36.90
Rate for Payer: Qualcare PPO/HMO/WC	$36.90

OMNISCAN 20 ML

Facility

$150.00

Service Code	HCPCS A9579
Hospital Charge Code	2011545
Hospital Revenue Code	255
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

OMNISCAN 20 ML

Facility

$150.00

Service Code	HCPCS A9579
Hospital Charge Code	2011545
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$75.00

OMNISCAN 287MG INJ 20ML VIAL

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	60630198
Hospital Revenue Code	255
Min. Negotiated Rate	$105.53
Max. Negotiated Rate	$105.53
Rate for Payer: Qualcare PPO/HMO/WC	$105.53

OMNISCAN 287MG INJ 20ML VIAL

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	60630198
Hospital Revenue Code	255
Min. Negotiated Rate	$91.45
Max. Negotiated Rate	$351.75
Rate for Payer: Aetna Commercial	$211.05
Rate for Payer: Aetna Medicare Advantage	$211.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.39
Rate for Payer: Cigna Commercial	$351.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.45
Rate for Payer: Oxford Commercial	$351.75
Rate for Payer: Qualcare PPO/HMO/WC	$105.53
Rate for Payer: UnitedHealthcare Commercial	$351.75

OMNISCAN 5ml

Facility

$69.50

Service Code	HCPCS A9579
Hospital Charge Code	601530
Hospital Revenue Code	255
Min. Negotiated Rate	$10.43
Max. Negotiated Rate	$10.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.43

OMNISCAN 5ml

Facility

$69.50

Service Code	HCPCS A9579
Hospital Charge Code	601530
Hospital Revenue Code	255
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$34.75
Rate for Payer: Aetna Commercial	$20.85
Rate for Payer: Aetna Medicare Advantage	$20.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.72
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: Oxford Commercial	$34.75
Rate for Payer: Qualcare PPO/HMO/WC	$10.43
Rate for Payer: UnitedHealthcare Commercial	$34.75

OMNI SPAN 0 DEG

Facility

$1,750.00

Hospital Charge Code	270664472
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

OMNI SPAN 0 DEG

Facility

$1,750.00

Hospital Charge Code	270664472
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$525.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

Know your out-of-pocket cost for care.

All Charges