Heights University Hospital

All Charges

Charge

Type

Setting

Price

OXISENSOR OXIMAX ADULT

Facility

$39.80

Hospital Charge Code	270649182N
Hospital Revenue Code	270
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$19.90
Rate for Payer: Aetna Commercial	$11.94
Rate for Payer: Aetna Medicare Advantage	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.15
Rate for Payer: Cigna Commercial	$19.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.17
Rate for Payer: Oxford Commercial	$19.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.97
Rate for Payer: UnitedHealthcare Commercial	$19.90

OXISENSOR OXIMAX ADULT

Facility

$28.75

Hospital Charge Code	270649182S
Hospital Revenue Code	270
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$4.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.31

OXISENSOR OXIMAX PED

Facility

$47.90

Hospital Charge Code	270649183
Hospital Revenue Code	272
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$7.18
Rate for Payer: Qualcare PPO/HMO/WC	$7.18

OXISENSOR OXIMAX PED

Facility

$47.90

Hospital Charge Code	270649183
Hospital Revenue Code	272
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$23.95
Rate for Payer: Aetna Commercial	$14.37
Rate for Payer: Aetna Medicare Advantage	$14.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.21
Rate for Payer: Cigna Commercial	$23.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.23
Rate for Payer: Oxford Commercial	$23.95
Rate for Payer: Qualcare PPO/HMO/WC	$7.18
Rate for Payer: UnitedHealthcare Commercial	$23.95

OXISENSOR PEDIATRIC DIGIT DISP

Facility

$70.54

Hospital Charge Code	270649676
Hospital Revenue Code	270
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$35.27
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.99
Rate for Payer: Cigna Commercial	$35.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.17
Rate for Payer: Oxford Commercial	$35.27
Rate for Payer: Qualcare PPO/HMO/WC	$10.58
Rate for Payer: UnitedHealthcare Commercial	$35.27

OXISENSOR PEDIATRIC DIGIT DISP

Facility

$70.54

Hospital Charge Code	270649676
Hospital Revenue Code	270
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$10.58
Rate for Payer: Qualcare PPO/HMO/WC	$10.58

OXISENSOR PULSE PEDIATRIC

Facility

$6.55

Hospital Charge Code	270600746
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna Commercial	$1.97
Rate for Payer: Aetna Medicare Advantage	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.67
Rate for Payer: Cigna Commercial	$3.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.85
Rate for Payer: Oxford Commercial	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$3.27

OXISENSOR PULSE PEDIATRIC

Facility

$6.55

Hospital Charge Code	270600746
Hospital Revenue Code	270
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

OXISENSORS***

Facility

$69.00

Hospital Charge Code	2300721
Hospital Revenue Code	279
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.97
Rate for Payer: Oxford Commercial	$34.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$34.50

OXISENSORS***

Facility

$69.00

Hospital Charge Code	2300721
Hospital Revenue Code	279
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

OXYBUTYNIN 2.5 MG/0.5 TAB

Facility

$3.20

Hospital Charge Code	60628924
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

OXYBUTYNIN 2.5 MG/0.5 TAB

Facility

$3.20

Hospital Charge Code	60628924
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

OXYBUTYNIN 5 MG TAB

Facility

$5.09

Service Code	NDC 60687067001
Hospital Charge Code	60628468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare Advantage	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.66
Rate for Payer: Oxford Commercial	$2.54
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$2.54

OXYBUTYNIN 5 MG TAB

Facility

$5.09

Service Code	NDC 60687067001
Hospital Charge Code	60628468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

OXYBUTYNIN SOL 5MG/5ML 16 OZ

Facility

$299.55

Hospital Charge Code	6004048
Hospital Revenue Code	251
Min. Negotiated Rate	$38.94
Max. Negotiated Rate	$149.78
Rate for Payer: Aetna Commercial	$89.86
Rate for Payer: Aetna Medicare Advantage	$89.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.39
Rate for Payer: Cigna Commercial	$149.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.94
Rate for Payer: Oxford Commercial	$149.78
Rate for Payer: Qualcare PPO/HMO/WC	$44.93
Rate for Payer: UnitedHealthcare Commercial	$149.78

OXYBUTYNIN SOL 5MG/5ML 16 OZ

Facility

$299.55

Hospital Charge Code	6004048
Hospital Revenue Code	251
Min. Negotiated Rate	$44.93
Max. Negotiated Rate	$44.93
Rate for Payer: Qualcare PPO/HMO/WC	$44.93

OXYBUTYNIN SYRP 5MG/5ML

Facility

$4.00

Service Code	NDC 60432009216
Hospital Charge Code	60628469
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

OXYBUTYNIN SYRP 5MG/5ML

Facility

$4.00

Service Code	NDC 60432009216
Hospital Charge Code	60628469
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

OXYBUTYNIN SYRP 5MG/5ML 480ML

Facility

$419.85

Hospital Charge Code	6010318
Hospital Revenue Code	251
Min. Negotiated Rate	$54.58
Max. Negotiated Rate	$209.93
Rate for Payer: Aetna Commercial	$125.95
Rate for Payer: Aetna Medicare Advantage	$125.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.06
Rate for Payer: Cigna Commercial	$209.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.58
Rate for Payer: Oxford Commercial	$209.93
Rate for Payer: Qualcare PPO/HMO/WC	$62.98
Rate for Payer: UnitedHealthcare Commercial	$209.93

OXYBUTYNIN SYRP 5MG/5ML 480ML

Facility

$419.85

Hospital Charge Code	6010318
Hospital Revenue Code	251
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

OXYBUTYNIN XL 5MG TAB

Facility

$21.98

Service Code	NDC 378660501
Hospital Charge Code	606361015
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

OXYBUTYNIN XL 5MG TAB

Facility

$21.98

Service Code	NDC 378660501
Hospital Charge Code	606361015
Hospital Revenue Code	250
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$10.99
Rate for Payer: Aetna Commercial	$6.59
Rate for Payer: Aetna Medicare Advantage	$6.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.60
Rate for Payer: Cigna Commercial	$10.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$10.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$10.99

OXYCODONE

Facility

$138.45

Service Code	HCPCS 80361
Hospital Charge Code	3009150
Hospital Revenue Code	301
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.53
Rate for Payer: Aetna Medicare Advantage	$41.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.30
Rate for Payer: Cigna Commercial	$69.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.77
Rate for Payer: UnitedHealthcare Commercial	$114.00

OXYCODONE

Facility

$138.45

Service Code	HCPCS 80361
Hospital Charge Code	3009150
Hospital Revenue Code	301
Min. Negotiated Rate	$20.77
Max. Negotiated Rate	$20.77
Rate for Payer: Qualcare PPO/HMO/WC	$20.77

OXYCODONE 10 MG IR TAB

Facility

$4.22

Service Code	NDC 10702005601
Hospital Charge Code	60630058
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

Know your out-of-pocket cost for care.

All Charges