Heights University Hospital

All Charges

Charge

Type

Setting

Price

GADOXETATE 181.43MG/ML 10ML

Facility

$109.75

Service Code	NDC 50419032005
Hospital Charge Code	606390437
Hospital Revenue Code	255
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$54.88
Rate for Payer: Aetna Commercial	$32.92
Rate for Payer: Aetna Medicare Advantage	$32.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.99
Rate for Payer: Cigna Commercial	$54.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.27
Rate for Payer: Oxford Commercial	$54.88
Rate for Payer: Qualcare PPO/HMO/WC	$16.46
Rate for Payer: UnitedHealthcare Commercial	$54.88

GAIRDIA ANTIGEN

Facility

$178.00

Service Code	HCPCS 87328
Hospital Charge Code	38479084
Hospital Revenue Code	306
Min. Negotiated Rate	$26.70
Max. Negotiated Rate	$26.70
Rate for Payer: Qualcare PPO/HMO/WC	$26.70

GAIRDIA ANTIGEN

Facility

$178.00

Service Code	HCPCS 87328
Hospital Charge Code	38479084
Hospital Revenue Code	306
Min. Negotiated Rate	$6.91
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$44.78
Rate for Payer: Aetna Medicare Advantage	$13.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.64
Rate for Payer: Cigna Commercial	$13.82
Rate for Payer: Cigna Medicare Advantage	$6.91
Rate for Payer: Clover Medicare Advantage	$13.13
Rate for Payer: EmblemHealth Commercial	$41.46
Rate for Payer: Humana Medicare Advantage	$14.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.14
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.82
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$14.65
Rate for Payer: Wellcare Medicare Advantage	$13.82

GAIT TRAINING EA 15 MIN CQ

Facility

$412.61

Service Code	HCPCS 97116GP
Hospital Charge Code	409197116Q
Hospital Revenue Code	420
Min. Negotiated Rate	$61.89
Max. Negotiated Rate	$61.89
Rate for Payer: Qualcare PPO/HMO/WC	$61.89

GAIT TRAINING EA 15 MIN CQ

Facility

$412.61

Service Code	HCPCS 97116GP
Hospital Charge Code	409197116Q
Hospital Revenue Code	420
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$123.78
Rate for Payer: Aetna Medicare Advantage	$123.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.22
Rate for Payer: Cigna Commercial	$206.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.64
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.89
Rate for Payer: UnitedHealthcare Commercial	$686.00

GALACTOMAN

Facility

$110.55

Service Code	HCPCS 87305
Hospital Charge Code	3036010
Hospital Revenue Code	300
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$16.58
Rate for Payer: Qualcare PPO/HMO/WC	$16.58

GALACTOMAN

Facility

$110.55

Service Code	HCPCS 87305
Hospital Charge Code	3036010
Hospital Revenue Code	300
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$38.82
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.89
Rate for Payer: Cigna Commercial	$11.98
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.58
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.70
Rate for Payer: Wellcare Medicare Advantage	$11.98

GALANTAMINE 4 MG TAB

Facility

$18.36

Service Code	NDC 10147088106
Hospital Charge Code	60629188
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.75

GALANTAMINE 4 MG TAB

Facility

$18.36

Service Code	NDC 10147088106
Hospital Charge Code	60629188
Hospital Revenue Code	250
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.68
Rate for Payer: Cigna Commercial	$9.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.39
Rate for Payer: Oxford Commercial	$9.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.75
Rate for Payer: UnitedHealthcare Commercial	$9.18

GALANTAMINE 8MG TAB

Facility

$10.45

Service Code	NDC 63739070833
Hospital Charge Code	606390065
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

GALANTAMINE 8MG TAB

Facility

$10.45

Service Code	NDC 63739070833
Hospital Charge Code	606390065
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$5.22

GALLACTOSE

Facility

$79.00

Service Code	HCPCS 82760
Hospital Charge Code	38477101
Hospital Revenue Code	301
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

GALLACTOSE

Facility

$79.00

Service Code	HCPCS 82760
Hospital Charge Code	38477101
Hospital Revenue Code	301
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$36.29
Rate for Payer: Aetna Medicare Advantage	$11.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.04
Rate for Payer: Cigna Commercial	$11.20
Rate for Payer: Cigna Medicare Advantage	$5.60
Rate for Payer: Clover Medicare Advantage	$10.64
Rate for Payer: EmblemHealth Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$11.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11.87
Rate for Payer: Wellcare Medicare Advantage	$11.20

GALLIUM GA-67 CITRATE

Facility

$750.00

Hospital Charge Code	270653758
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$375.00

GALLIUM GA-67 CITRATE

Facility

$750.00

Hospital Charge Code	270653758
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GALLIUM GA-68 DOTATATE 0.1MCI

Facility

$277.77

Service Code	HCPCS A9587
Hospital Charge Code	80000055
Hospital Revenue Code	343
Min. Negotiated Rate	$41.67
Max. Negotiated Rate	$41.67
Rate for Payer: Qualcare PPO/HMO/WC	$41.67

GALLIUM GA-68 DOTATATE 0.1MCI

Facility

$277.77

Service Code	HCPCS A9587
Hospital Charge Code	80000055
Hospital Revenue Code	343
Min. Negotiated Rate	$36.11
Max. Negotiated Rate	$83.33
Rate for Payer: Aetna Commercial	$83.33
Rate for Payer: Aetna Medicare Advantage	$83.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.11
Rate for Payer: Qualcare PPO/HMO/WC	$41.67

GALLIUM GA68 ILLUCCIX PER 1MCI

Facility

$4,712.86

Service Code	HCPCS A9596
Hospital Charge Code	80000054
Hospital Revenue Code	343
Min. Negotiated Rate	$706.93
Max. Negotiated Rate	$706.93
Rate for Payer: Qualcare PPO/HMO/WC	$706.93

GALLIUM GA68 ILLUCCIX PER 1MCI

Facility

$4,712.86

Service Code	HCPCS A9596
Hospital Charge Code	80000054
Hospital Revenue Code	343
Min. Negotiated Rate	$382.64
Max. Negotiated Rate	$1,413.86
Rate for Payer: Aetna Commercial	$1,413.86
Rate for Payer: Aetna Medicare Advantage	$1,413.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$382.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,201.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.67
Rate for Payer: Qualcare PPO/HMO/WC	$706.93

GALLIUM NITRATE INJ 500MG/20ML

Facility

$965.15

Hospital Charge Code	6009625
Hospital Revenue Code	250
Min. Negotiated Rate	$125.47
Max. Negotiated Rate	$482.57
Rate for Payer: Aetna Commercial	$289.55
Rate for Payer: Aetna Medicare Advantage	$289.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.11
Rate for Payer: Cigna Commercial	$482.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.47
Rate for Payer: Oxford Commercial	$482.57
Rate for Payer: Qualcare PPO/HMO/WC	$144.77
Rate for Payer: UnitedHealthcare Commercial	$482.57

GALLIUM NITRATE INJ 500MG/20ML

Facility

$965.15

Hospital Charge Code	6009625
Hospital Revenue Code	250
Min. Negotiated Rate	$144.77
Max. Negotiated Rate	$144.77
Rate for Payer: Qualcare PPO/HMO/WC	$144.77

GAMAR/2ML

Facility

$75.00

Hospital Charge Code	60634238
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GAMAR/2ML

Facility

$75.00

Hospital Charge Code	60634238
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

GAMASTAN/10ML

Facility

$324.00

Hospital Charge Code	60635881
Hospital Revenue Code	259
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

GAMASTAN/10ML

Facility

$324.00

Hospital Charge Code	60635881
Hospital Revenue Code	259
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

Know your out-of-pocket cost for care.

All Charges