Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

OXALIC ACD,24HR W/O CREAT

Facility

$88.45

Service Code	HCPCS 83945
Hospital Charge Code	39900115
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

OXALIC ACD,24HR W/O CREAT

Facility

$88.45

Service Code	HCPCS 83945
Hospital Charge Code	39900115
Hospital Revenue Code	301
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$13.27
Rate for Payer: Qualcare PPO/HMO/WC	$13.27

OXALIC ACID,24HR UR(W/CR) I

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39990064A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OXALIC ACID,24HR UR(W/CR) I

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	3990129A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$5.18
Rate for Payer: Cigna Medicare Advantage	$2.59
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
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	$5.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.18

OXALIC ACID,24HR UR(W/CR) I

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39990064A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$5.18
Rate for Payer: Cigna Medicare Advantage	$2.59
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
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	$5.18
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$5.49
Rate for Payer: Wellcare Medicare Advantage	$5.18

OXALIC ACID,24HR UR(W/CR) I

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	3990129A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OXALIC ACID,24HR UR(W/CR) II

Facility

$390.00

Service Code	HCPCS 83945
Hospital Charge Code	39990064B
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

OXALIC ACID,24HR UR(W/CR) II

Facility

$390.00

Service Code	HCPCS 83945
Hospital Charge Code	39990064B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OXALIC ACID,24HR UR(W/CR) II

Facility

$390.00

Service Code	HCPCS 83945
Hospital Charge Code	3990129B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

OXALIC ACID,24HR UR(W/CR) II

Facility

$390.00

Service Code	HCPCS 83945
Hospital Charge Code	3990129B
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

OXALIPLATIN 50 MG INJECTION

Facility

$3,945.00

Hospital Charge Code	60629257
Hospital Revenue Code	636
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$954.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

OXALIPLATIN 50 MG INJECTION

Facility

$3,945.00

Hospital Charge Code	60629257
Hospital Revenue Code	636
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,183.50
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

OXALIPLATIN 50 MG VIAL

Facility

$503.00

Hospital Charge Code	60631873
Hospital Revenue Code	636
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$251.50
Rate for Payer: Aetna Commercial	$150.90
Rate for Payer: Aetna Medicare Advantage	$150.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.26
Rate for Payer: Cigna Commercial	$251.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.73
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

OXALIPLATIN 50 MG VIAL

Facility

$503.00

Hospital Charge Code	60631873
Hospital Revenue Code	636
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$121.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.73
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

OXANDRIN 10MG TAB

Facility

$25.00

Hospital Charge Code	60635479
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

OXANDRIN 10MG TAB

Facility

$25.00

Hospital Charge Code	60635479
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

OXANDROLONE 2.5MG TABLET

Facility

$46.43

Service Code	NDC 68084042421
Hospital Charge Code	60632260
Hospital Revenue Code	250
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$6.96
Rate for Payer: Qualcare PPO/HMO/WC	$6.96

OXANDROLONE 2.5MG TABLET

Facility

$46.43

Service Code	NDC 68084042421
Hospital Charge Code	60632260
Hospital Revenue Code	250
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$23.21
Rate for Payer: Aetna Commercial	$13.93
Rate for Payer: Aetna Medicare Advantage	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.04
Rate for Payer: Oxford Commercial	$23.21
Rate for Payer: Qualcare PPO/HMO/WC	$6.96
Rate for Payer: UnitedHealthcare Commercial	$23.21

OXAPROZIN 600 MG TAB

Facility

$15.05

Hospital Charge Code	60628671
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$7.53
Rate for Payer: Aetna Commercial	$4.51
Rate for Payer: Aetna Medicare Advantage	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.84
Rate for Payer: Cigna Commercial	$7.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.96
Rate for Payer: Oxford Commercial	$7.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.26
Rate for Payer: UnitedHealthcare Commercial	$7.53

OXAPROZIN 600 MG TAB

Facility

$15.05

Hospital Charge Code	60628671
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$2.26
Rate for Payer: Qualcare PPO/HMO/WC	$2.26

OXAZEPAM

Facility

$127.15

Service Code	HCPCS 80346
Hospital Charge Code	39900445
Hospital Revenue Code	301
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$19.07
Rate for Payer: Qualcare PPO/HMO/WC	$19.07

OXAZEPAM

Facility

$127.15

Service Code	HCPCS 80346
Hospital Charge Code	39900445
Hospital Revenue Code	301
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.15
Rate for Payer: Aetna Medicare Advantage	$38.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.42
Rate for Payer: Cigna Commercial	$63.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.07
Rate for Payer: UnitedHealthcare Commercial	$114.00

OXAZEPAM 10MG CAPSULE

Facility

$7.25

Hospital Charge Code	60629039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

OXAZEPAM 10MG CAPSULE

Facility

$7.25

Hospital Charge Code	60629039
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

Know your out-of-pocket cost for care.

All Charges