Heights University Hospital

All Charges

Charge

Type

Setting

Price

ORUDIS/75MG/CAP

Facility

$6.00

Hospital Charge Code	60633588
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

ORUDIS/75MG/CAP

Facility

$3.00

Hospital Charge Code	60633590
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ORUDIS/75MG/CAP

Facility

$6.00

Hospital Charge Code	60633588
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

ORVIL DST DEVICE 21 MM

Facility

$451.40

Hospital Charge Code	270665495
Hospital Revenue Code	270
Min. Negotiated Rate	$58.68
Max. Negotiated Rate	$225.70
Rate for Payer: Aetna Commercial	$135.42
Rate for Payer: Aetna Medicare Advantage	$135.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.11
Rate for Payer: Cigna Commercial	$225.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.68
Rate for Payer: Oxford Commercial	$225.70
Rate for Payer: Qualcare PPO/HMO/WC	$67.71
Rate for Payer: UnitedHealthcare Commercial	$225.70

ORVIL DST DEVICE 21 MM

Facility

$451.40

Hospital Charge Code	270665495
Hospital Revenue Code	270
Min. Negotiated Rate	$67.71
Max. Negotiated Rate	$67.71
Rate for Payer: Qualcare PPO/HMO/WC	$67.71

ORVIL DST DEVICE 25 MM

Facility

$451.40

Hospital Charge Code	270665491
Hospital Revenue Code	270
Min. Negotiated Rate	$58.68
Max. Negotiated Rate	$225.70
Rate for Payer: Aetna Commercial	$135.42
Rate for Payer: Aetna Medicare Advantage	$135.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.11
Rate for Payer: Cigna Commercial	$225.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.68
Rate for Payer: Oxford Commercial	$225.70
Rate for Payer: Qualcare PPO/HMO/WC	$67.71
Rate for Payer: UnitedHealthcare Commercial	$225.70

ORVIL DST DEVICE 25 MM

Facility

$451.40

Hospital Charge Code	270665491
Hospital Revenue Code	270
Min. Negotiated Rate	$67.71
Max. Negotiated Rate	$67.71
Rate for Payer: Qualcare PPO/HMO/WC	$67.71

OSCAL/250MG + VITAMIN D

Facility

$1.00

Hospital Charge Code	60633598
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

OSCAL/250MG + VITAMIN D

Facility

$1.00

Hospital Charge Code	60633598
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

OS-CAL 500/1.25GM/TAB

Facility

$1.00

Hospital Charge Code	60633594
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

OS-CAL 500/1.25GM/TAB

Facility

$3.00

Hospital Charge Code	60633593
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

OS-CAL 500/1.25GM/TAB

Facility

$3.00

Hospital Charge Code	60633593
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

OS-CAL 500/1.25GM/TAB

Facility

$1.00

Hospital Charge Code	60633594
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

OSCAL 500+D

Facility

$4.00

Service Code	NDC 904546061
Hospital Charge Code	60635136
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

OSCAL 500+D

Facility

$4.00

Service Code	NDC 904546061
Hospital Charge Code	60635136
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

OS-CAL FORTE/TAB

Facility

$3.00

Hospital Charge Code	60633592
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

OS-CAL FORTE/TAB

Facility

$3.00

Hospital Charge Code	60633592
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

OS-CAL/TAB

Facility

$3.00

Hospital Charge Code	60633591
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

OS-CAL/TAB

Facility

$3.00

Hospital Charge Code	60633591
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

OSCAL W/ VIT D/250MG/TAB

Facility

$1.00

Hospital Charge Code	60634304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

OSCAL W/ VIT D/250MG/TAB

Facility

$1.00

Hospital Charge Code	60634304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

OSCILLATING SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674162
Hospital Revenue Code	272
Min. Negotiated Rate	$1,290.12
Max. Negotiated Rate	$4,962.00
Rate for Payer: Aetna Commercial	$2,977.20
Rate for Payer: Aetna Medicare Advantage	$2,977.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,530.62
Rate for Payer: Cigna Commercial	$4,962.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,290.12
Rate for Payer: Oxford Commercial	$4,962.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60
Rate for Payer: UnitedHealthcare Commercial	$4,962.00

OSCILLATING SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674162
Hospital Revenue Code	272
Min. Negotiated Rate	$1,488.60
Max. Negotiated Rate	$1,488.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60

OSELTAMAVIR COMPOUNDED 15MG/ML

Facility

$19.36

Service Code	NDC 93818064
Hospital Charge Code	606390534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

OSELTAMAVIR COMPOUNDED 15MG/ML

Facility

$19.36

Service Code	NDC 93818064
Hospital Charge Code	606390534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$9.68
Rate for Payer: Aetna Commercial	$5.81
Rate for Payer: Aetna Medicare Advantage	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.94
Rate for Payer: Cigna Commercial	$9.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.52
Rate for Payer: Oxford Commercial	$9.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$9.68

Know your out-of-pocket cost for care.

All Charges