Heights University Hospital

All Charges

Charge

Type

Setting

Price

OXCARBAZEPINE 150 MG TAB

Facility

$9.65

Service Code	NDC 51991029201
Hospital Charge Code	60629111
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

OXCARBAZEPINE 150 MG TAB

Facility

$9.65

Service Code	NDC 51991029201
Hospital Charge Code	60629111
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$4.83

OXCARBAZEPINE 300 MG TAB

Facility

$17.62

Service Code	NDC 51991029301
Hospital Charge Code	60628978
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$2.64

OXCARBAZEPINE 300 MG TAB

Facility

$17.62

Service Code	NDC 51991029301
Hospital Charge Code	60628978
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$8.81
Rate for Payer: Aetna Commercial	$5.29
Rate for Payer: Aetna Medicare Advantage	$5.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.49
Rate for Payer: Cigna Commercial	$8.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.29
Rate for Payer: Oxford Commercial	$8.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.64
Rate for Payer: UnitedHealthcare Commercial	$8.81

OXCARBAZEPINE, DRUG QUANTITATI

Facility

$127.84

Service Code	HCPCS 83789
Hospital Charge Code	38472340
Hospital Revenue Code	301
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

OXCARBAZEPINE, DRUG QUANTITATI

Facility

$127.84

Service Code	HCPCS 83789
Hospital Charge Code	38472340
Hospital Revenue Code	301
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.12
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.34
Rate for Payer: Cigna Commercial	$24.11
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.56
Rate for Payer: Wellcare Medicare Advantage	$24.11

OXCARBAZEPINE METABOLITE SERUM

Facility

$667.59

Service Code	HCPCS 80183
Hospital Charge Code	3036033
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

OXCARBAZEPINE METABOLITE SERUM

Facility

$667.59

Service Code	HCPCS 80183
Hospital Charge Code	3036033
Hospital Revenue Code	301
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$42.93
Rate for Payer: Aetna Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.55
Rate for Payer: Cigna Commercial	$13.25
Rate for Payer: Cigna Medicare Advantage	$6.62
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.04
Rate for Payer: Wellcare Medicare Advantage	$13.25

OXCARBAZEPINE-TRILEPTAL SERUM

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3035046
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

OXCARBAZEPINE-TRILEPTAL SERUM

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3035046
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$78.05
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.27
Rate for Payer: Cigna Commercial	$24.09
Rate for Payer: Cigna Medicare Advantage	$12.04
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$25.54
Rate for Payer: Wellcare Medicare Advantage	$24.09

OXCARBEZEPINE 300 MG/5ML SUSPN

Facility

$36.58

Service Code	NDC 65162064978
Hospital Charge Code	606351007
Hospital Revenue Code	250
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$18.29
Rate for Payer: Aetna Commercial	$10.97
Rate for Payer: Aetna Medicare Advantage	$10.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.33
Rate for Payer: Cigna Commercial	$18.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.76
Rate for Payer: Oxford Commercial	$18.29
Rate for Payer: Qualcare PPO/HMO/WC	$5.49
Rate for Payer: UnitedHealthcare Commercial	$18.29

OXCARBEZEPINE 300 MG/5ML SUSPN

Facility

$36.58

Service Code	NDC 65162064978
Hospital Charge Code	606351007
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$5.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.49

OXEPA

Facility

$54.00

Hospital Charge Code	60635267
Hospital Revenue Code	250
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

OXEPA

Facility

$54.00

Hospital Charge Code	60635267
Hospital Revenue Code	250
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.02
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$27.00

OXF ANAT BRG LT MD SIZE 4 PMA

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270665189
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$2,160.00
Rate for Payer: Aetna Medicare Advantage	$2,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,836.00
Rate for Payer: Cigna Commercial	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00

OXF ANAT BRG LT MD SIZE 4 PMA

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270665189
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,742.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00

OXF SAWBLADE STRYKER CMNTD 3PK

Facility

$2,625.00

Hospital Charge Code	270684057
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

OXF SAWBLADE STRYKER CMNTD 3PK

Facility

$2,625.00

Hospital Charge Code	270684057
Hospital Revenue Code	272
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$787.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$341.25
Rate for Payer: Oxford Commercial	$1,312.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$1,312.50

OXF TWIN PEG CMNTD FEM MD PMA

Facility

$14,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270665188
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.00
Max. Negotiated Rate	$3,412.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,412.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.00

OXF TWIN PEG CMNTD FEM MD PMA

Facility

$14,100.00

Service Code	HCPCS C1776
Hospital Charge Code	270665188
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.00
Max. Negotiated Rate	$7,050.00
Rate for Payer: Aetna Commercial	$4,230.00
Rate for Payer: Aetna Medicare Advantage	$4,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,595.50
Rate for Payer: Cigna Commercial	$7,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,412.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.00

OXF UNI TIB TRAY SZA RM/LL PMA

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,395.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

OXF UNI TIB TRAY SZA RM/LL PMA

Facility

$9,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$2,970.00
Rate for Payer: Aetna Medicare Advantage	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,524.50
Rate for Payer: Cigna Commercial	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,395.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,485.00

OXICONAZOLE 190 CREAM 30GM

Facility

$142.75

Hospital Charge Code	6017842
Hospital Revenue Code	252
Min. Negotiated Rate	$21.41
Max. Negotiated Rate	$21.41
Rate for Payer: Qualcare PPO/HMO/WC	$21.41

OXICONAZOLE 190 CREAM 30GM

Facility

$142.75

Hospital Charge Code	6017842
Hospital Revenue Code	252
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$71.38
Rate for Payer: Aetna Commercial	$42.83
Rate for Payer: Aetna Medicare Advantage	$42.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.40
Rate for Payer: Cigna Commercial	$71.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.56
Rate for Payer: Oxford Commercial	$71.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.41
Rate for Payer: UnitedHealthcare Commercial	$71.38

OXIDIZED CELLULOSE ABSORB HEMS

Facility

$98.50

Hospital Charge Code	60628454R
Hospital Revenue Code	250
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$14.78
Rate for Payer: Qualcare PPO/HMO/WC	$14.78

Know your out-of-pocket cost for care.

All Charges