Heights University Hospital

All Charges

Charge

Type

Setting

Price

OPHTHALMIC IRRIGATION, SOLN

Facility

$27.60

Service Code	NDC 10119000738
Hospital Charge Code	60628092
Hospital Revenue Code	250
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

OPHTHALMIC IRRIGATION, SOLN

Facility

$27.60

Service Code	NDC 10119000738
Hospital Charge Code	60628092
Hospital Revenue Code	250
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$8.28
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.59
Rate for Payer: Oxford Commercial	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$13.80

OPHTHALMIC IRRIG SOL 15ML

Facility

$32.65

Hospital Charge Code	60628093
Hospital Revenue Code	250
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.90

OPHTHALMIC IRRIG SOL 15ML

Facility

$32.65

Hospital Charge Code	60628093
Hospital Revenue Code	250
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$16.32
Rate for Payer: Aetna Commercial	$9.79
Rate for Payer: Aetna Medicare Advantage	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.33
Rate for Payer: Cigna Commercial	$16.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.24
Rate for Payer: Oxford Commercial	$16.32
Rate for Payer: Qualcare PPO/HMO/WC	$4.90
Rate for Payer: UnitedHealthcare Commercial	$16.32

OPHTHALMIC MEDICATION

Facility

$21.15

Hospital Charge Code	6027214
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

OPHTHALMIC MEDICATION

Facility

$21.15

Hospital Charge Code	6027214
Hospital Revenue Code	251
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

OPHTHALMICS 500MG

Facility

$203.55

Hospital Charge Code	6012140
Hospital Revenue Code	251
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$101.78
Rate for Payer: Aetna Commercial	$61.06
Rate for Payer: Aetna Medicare Advantage	$61.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.91
Rate for Payer: Cigna Commercial	$101.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.46
Rate for Payer: Oxford Commercial	$101.78
Rate for Payer: Qualcare PPO/HMO/WC	$30.53
Rate for Payer: UnitedHealthcare Commercial	$101.78

OPHTHALMICS 500MG

Facility

$203.55

Hospital Charge Code	6012140
Hospital Revenue Code	251
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$30.53
Rate for Payer: Qualcare PPO/HMO/WC	$30.53

OPHTHETIC 0.5% OPHTH/15ML

Facility

$90.00

Hospital Charge Code	60633577
Hospital Revenue Code	250
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

OPHTHETIC 0.5% OPHTH/15ML

Facility

$90.00

Hospital Charge Code	60633577
Hospital Revenue Code	250
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$45.00

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	3039030
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	38430030
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	3039030
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	39990230
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	38430030
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIATES 1 OR MORE

Facility

$190.45

Service Code	HCPCS 80361
Hospital Charge Code	39990230
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

OPIATES,URINE

Facility

$190.00

Service Code	HCPCS 80300
Hospital Charge Code	38479112
Hospital Revenue Code	301
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

OPIATES,URINE

Facility

$190.45

Service Code	HCPCS 80300
Hospital Charge Code	3006997
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

OPIATES,URINE

Facility

$190.45

Service Code	HCPCS 80300
Hospital Charge Code	3006997
Hospital Revenue Code	301
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.13
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$114.00

OPIATES,URINE

Facility

$190.00

Service Code	HCPCS 80300
Hospital Charge Code	38479112
Hospital Revenue Code	301
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$114.00

OPIATES, URINE

Facility

$137.79

Service Code	HCPCS 80361
Hospital Charge Code	38472502
Hospital Revenue Code	301
Min. Negotiated Rate	$17.91
Max. Negotiated Rate	$114.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Aetna Commercial	$41.34
Rate for Payer: Aetna Medicare Advantage	$41.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.14
Rate for Payer: Cigna Commercial	$68.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.91
Rate for Payer: Qualcare PPO/HMO/WC	$20.67
Rate for Payer: UnitedHealthcare Commercial	$114.00

OPIATES, URINE

Facility

$137.79

Service Code	HCPCS 80361
Hospital Charge Code	38472502
Hospital Revenue Code	301
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$20.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.67

OP INC FINGER FLEXOR

Facility

$6,353.16

Service Code	HCPCS 26455
Hospital Charge Code	16000446
Hospital Revenue Code	360
Min. Negotiated Rate	$825.91
Max. Negotiated Rate	$3,829.26
Rate for Payer: Aetna Commercial	$1,905.95
Rate for Payer: Aetna Medicare Advantage	$1,905.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.06
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	$1,620.06
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.91
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$952.97
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

OP INC FINGER FLEXOR

Facility

$6,353.16

Service Code	HCPCS 26455
Hospital Charge Code	16000446
Hospital Revenue Code	360
Min. Negotiated Rate	$952.97
Max. Negotiated Rate	$952.97
Rate for Payer: Qualcare PPO/HMO/WC	$952.97

OP INC FOOT/TOE EXTENSOR TENDN

Facility

$19,998.60

Service Code	HCPCS 28234
Hospital Charge Code	16000481
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

Know your out-of-pocket cost for care.

All Charges