Heights University Hospital

All Charges

Charge

Type

Setting

Price

OV NEW PATIENT LOW COMPLEXITY

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84506100
Hospital Revenue Code	510
Min. Negotiated Rate	$77.24
Max. Negotiated Rate	$248.64
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV NEW PATIENT LOW COMPLEXITY

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84506100
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV NEW PATIENT MODERATE COMPLX

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84506105
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$320.46
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

OV NEW PATIENT MODERATE COMPLX

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	84506105
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

OV NEW PT EXPANDED PROBL FOCUS

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84506095
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OV NEW PT EXPANDED PROBL FOCUS

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84506095
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$133.80
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OV NEW PT STRAIGHT FORWARD

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	84506090
Hospital Revenue Code	510
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$159.82
Rate for Payer: Aetna Commercial	$95.89
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$159.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OV NEW PT STRAIGHT FORWARD

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	84506090
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OVVAN CYSTECTOMY UL/BL

Facility

$6,544.55

Service Code	HCPCS 58925
Hospital Charge Code	1600000356
Hospital Revenue Code	360
Min. Negotiated Rate	$850.79
Max. Negotiated Rate	$11,912.81
Rate for Payer: Aetna Commercial	$1,963.37
Rate for Payer: Aetna Medicare Advantage	$1,963.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,668.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,668.86
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	$1,668.86
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$850.79
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$981.68
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

OVVAN CYSTECTOMY UL/BL

Facility

$6,544.55

Service Code	HCPCS 58925
Hospital Charge Code	1600000356
Hospital Revenue Code	360
Min. Negotiated Rate	$981.68
Max. Negotiated Rate	$981.68
Rate for Payer: Qualcare PPO/HMO/WC	$981.68

OXACILLIN 1 GM VIAL

Facility

$66.40

Hospital Charge Code	60630055
Hospital Revenue Code	250
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$33.20
Rate for Payer: Aetna Commercial	$19.92
Rate for Payer: Aetna Medicare Advantage	$19.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.93
Rate for Payer: Cigna Commercial	$33.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.63
Rate for Payer: Oxford Commercial	$33.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.96
Rate for Payer: UnitedHealthcare Commercial	$33.20

OXACILLIN 1 GM VIAL

Facility

$66.40

Hospital Charge Code	60630055
Hospital Revenue Code	250
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$9.96
Rate for Payer: Qualcare PPO/HMO/WC	$9.96

OXACILLIN 2GM VIAL

Facility

$128.61

Hospital Charge Code	60630056
Hospital Revenue Code	250
Min. Negotiated Rate	$19.29
Max. Negotiated Rate	$19.29
Rate for Payer: Qualcare PPO/HMO/WC	$19.29

OXACILLIN 2GM VIAL

Facility

$128.61

Hospital Charge Code	60630056
Hospital Revenue Code	250
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$64.31
Rate for Payer: Aetna Commercial	$38.58
Rate for Payer: Aetna Medicare Advantage	$38.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.80
Rate for Payer: Cigna Commercial	$64.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.72
Rate for Payer: Oxford Commercial	$64.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.29
Rate for Payer: UnitedHealthcare Commercial	$64.31

OXACILLIN VL 1GM

Facility

$171.00

Hospital Charge Code	6006548
Hospital Revenue Code	250
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$25.65

OXACILLIN VL 1GM

Facility

$171.00

Hospital Charge Code	6006548
Hospital Revenue Code	250
Min. Negotiated Rate	$22.23
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$51.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.60
Rate for Payer: Cigna Commercial	$85.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.23
Rate for Payer: Oxford Commercial	$85.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.65
Rate for Payer: UnitedHealthcare Commercial	$85.50

OXACILLIN VL 2GM

Facility

$324.00

Hospital Charge Code	6006555
Hospital Revenue Code	250
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

OXACILLIN VL 2GM

Facility

$324.00

Hospital Charge Code	6006555
Hospital Revenue Code	250
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$97.20
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: Oxford Commercial	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$162.00

OXALATE

Facility

$390.00

Service Code	HCPCS 83945
Hospital Charge Code	39990241F
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OXALATE

Facility

$517.00

Service Code	HCPCS 83945
Hospital Charge Code	38472427
Hospital Revenue Code	301
Min. Negotiated Rate	$77.55
Max. Negotiated Rate	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$77.55

OXALATE

Facility

$517.00

Service Code	HCPCS 83945
Hospital Charge Code	38472427
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: Aetna Medicare Advantage	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.94
Rate for Payer: Cigna Commercial	$14.45
Rate for Payer: Cigna Medicare Advantage	$7.22
Rate for Payer: Clover Medicare Advantage	$13.73
Rate for Payer: EmblemHealth Commercial	$43.35
Rate for Payer: Humana Medicare Advantage	$14.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.55
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.32
Rate for Payer: Wellcare Medicare Advantage	$14.45

OXALATE

Facility

$390.00

Service Code	HCPCS 83945
Hospital Charge Code	39990241F
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: Aetna Medicare Advantage	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.94
Rate for Payer: Cigna Commercial	$14.45
Rate for Payer: Cigna Medicare Advantage	$7.22
Rate for Payer: Clover Medicare Advantage	$13.73
Rate for Payer: EmblemHealth Commercial	$43.35
Rate for Payer: Humana Medicare Advantage	$14.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.32
Rate for Payer: Wellcare Medicare Advantage	$14.45

OXALATE,SERUM/PLASMA

Facility

$88.45

Service Code	HCPCS 83945
Hospital Charge Code	401384445
Hospital Revenue Code	301
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$13.27
Rate for Payer: Qualcare PPO/HMO/WC	$13.27

OXALATE,SERUM/PLASMA

Facility

$88.45

Service Code	HCPCS 83945
Hospital Charge Code	401384445
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$46.82
Rate for Payer: Aetna Medicare Advantage	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.94
Rate for Payer: Cigna Commercial	$14.45
Rate for Payer: Cigna Medicare Advantage	$7.22
Rate for Payer: Clover Medicare Advantage	$13.73
Rate for Payer: EmblemHealth Commercial	$43.35
Rate for Payer: Humana Medicare Advantage	$14.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.27
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.45
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$15.32
Rate for Payer: Wellcare Medicare Advantage	$14.45

OXALATE (URINE)

Facility

$160.85

Service Code	HCPCS 83945
Hospital Charge Code	3009149
Hospital Revenue Code	301
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$24.13
Rate for Payer: Qualcare PPO/HMO/WC	$24.13

Know your out-of-pocket cost for care.

All Charges