Heights University Hospital

All Charges

Charge

Type

Setting

Price

OXYCONTIN 10 MG TAB

Facility

$5.00

Hospital Charge Code	60635327
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

OXYCONTIN 10 MG TAB

Facility

$5.00

Hospital Charge Code	60635327
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

OXYCONTIN 160 MG TAB U/D

Facility

$45.00

Hospital Charge Code	60635328
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

OXYCONTIN 160 MG TAB U/D

Facility

$45.00

Hospital Charge Code	60635328
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$22.50

OXYCONTIN 20 MG TAB U/D

Facility

$14.00

Hospital Charge Code	60635313
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$4.20
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$7.00

OXYCONTIN 20 MG TAB U/D

Facility

$14.00

Hospital Charge Code	60635313
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

OXYCONTIN 40 MG TAB U/D

Facility

$70.89

Service Code	NDC 59011044020
Hospital Charge Code	60635312
Hospital Revenue Code	250
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$35.45
Rate for Payer: Aetna Commercial	$21.27
Rate for Payer: Aetna Medicare Advantage	$21.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.08
Rate for Payer: Cigna Commercial	$35.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.22
Rate for Payer: Oxford Commercial	$35.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.63
Rate for Payer: UnitedHealthcare Commercial	$35.45

OXYCONTIN 40 MG TAB U/D

Facility

$70.89

Service Code	NDC 59011044020
Hospital Charge Code	60635312
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$10.63
Rate for Payer: Qualcare PPO/HMO/WC	$10.63

OXYDIZED CELLU HEM 3X3

Facility

$21.15

Hospital Charge Code	6004055
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$10.57

OXYDIZED CELLU HEM 3X3

Facility

$21.15

Hospital Charge Code	6004055
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

OXYGEN 100% E TANK 2.3 CU. FT.

Facility

$135.65

Hospital Charge Code	270653642
Hospital Revenue Code	272
Min. Negotiated Rate	$20.35
Max. Negotiated Rate	$20.35
Rate for Payer: Qualcare PPO/HMO/WC	$20.35

OXYGEN 100% E TANK 2.3 CU. FT.

Facility

$135.65

Hospital Charge Code	270653642
Hospital Revenue Code	272
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$67.83
Rate for Payer: Aetna Commercial	$40.70
Rate for Payer: Aetna Medicare Advantage	$40.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.59
Rate for Payer: Cigna Commercial	$67.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.63
Rate for Payer: Oxford Commercial	$67.83
Rate for Payer: Qualcare PPO/HMO/WC	$20.35
Rate for Payer: UnitedHealthcare Commercial	$67.83

OXYGEN SAT-EA ADD PER DAY

Facility

$105.00

Service Code	HCPCS 82810
Hospital Charge Code	7411173
Hospital Revenue Code	300
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

OXYGEN SAT-EA ADD PER DAY

Facility

$105.00

Service Code	HCPCS 82810
Hospital Charge Code	7411173
Hospital Revenue Code	300
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.65
Rate for Payer: Aetna Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.80
Rate for Payer: Cigna Commercial	$9.77
Rate for Payer: Cigna Medicare Advantage	$4.88
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.36
Rate for Payer: Wellcare Medicare Advantage	$9.77

OXYGEN SAT-INIT PER DAY

Facility

$105.00

Service Code	HCPCS 82810
Hospital Charge Code	7411171
Hospital Revenue Code	300
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.65
Rate for Payer: Aetna Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.80
Rate for Payer: Cigna Commercial	$9.77
Rate for Payer: Cigna Medicare Advantage	$4.88
Rate for Payer: Clover Medicare Advantage	$9.28
Rate for Payer: EmblemHealth Commercial	$29.31
Rate for Payer: Humana Medicare Advantage	$10.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.77
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.36
Rate for Payer: Wellcare Medicare Advantage	$9.77

OXYGEN SAT-INIT PER DAY

Facility

$105.00

Service Code	HCPCS 82810
Hospital Charge Code	7411171
Hospital Revenue Code	300
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

OXYGEN STAND-BY*****

Facility

$27.00

Hospital Charge Code	9500257
Hospital Revenue Code	279
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

OXYGEN STAND-BY*****

Facility

$27.00

Hospital Charge Code	9500257
Hospital Revenue Code	279
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$13.50

OXYGEN SUPPLY

Facility

$450.00

Hospital Charge Code	270339090
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

OXYGEN SUPPLY

Facility

$450.00

Hospital Charge Code	270339090
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$225.00

OXYGEN U.S.P.

Facility

$3,429.11

Hospital Charge Code	270616668
Hospital Revenue Code	270
Min. Negotiated Rate	$445.78
Max. Negotiated Rate	$1,714.56
Rate for Payer: Aetna Commercial	$1,028.73
Rate for Payer: Aetna Medicare Advantage	$1,028.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$874.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$874.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$874.42
Rate for Payer: Cigna Commercial	$1,714.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$445.78
Rate for Payer: Oxford Commercial	$1,714.56
Rate for Payer: Qualcare PPO/HMO/WC	$514.37
Rate for Payer: UnitedHealthcare Commercial	$1,714.56

OXYGEN U.S.P.

Facility

$3,429.11

Hospital Charge Code	270616668
Hospital Revenue Code	270
Min. Negotiated Rate	$514.37
Max. Negotiated Rate	$514.37
Rate for Payer: Qualcare PPO/HMO/WC	$514.37

OXYHOOD DISP INFANT

Facility

$52.00

Hospital Charge Code	1801109
Hospital Revenue Code	272
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$15.60
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.76
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$26.00

OXYHOOD DISP INFANT

Facility

$52.00

Hospital Charge Code	1801109
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

OXYHOOD LARGE DISP

Facility

$682.45

Hospital Charge Code	270614394
Hospital Revenue Code	272
Min. Negotiated Rate	$88.72
Max. Negotiated Rate	$341.23
Rate for Payer: Aetna Commercial	$204.74
Rate for Payer: Aetna Medicare Advantage	$204.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.02
Rate for Payer: Cigna Commercial	$341.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.72
Rate for Payer: Oxford Commercial	$341.23
Rate for Payer: Qualcare PPO/HMO/WC	$102.37
Rate for Payer: UnitedHealthcare Commercial	$341.23

Know your out-of-pocket cost for care.

All Charges