Heights University Hospital

All Charges

Charge

Type

Setting

Price

GAMIMUNE N 5%/0.5GM/10ML

Facility

$270.00

Hospital Charge Code	60633031
Hospital Revenue Code	250
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$81.00
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$135.00

GAMIMUNE N 5%/0.5GM/10ML

Facility

$270.00

Hospital Charge Code	60633031
Hospital Revenue Code	250
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

GAMMA 125DGRE 420mm 3370-6-425

Facility

$4,677.65

Hospital Charge Code	270615322
Hospital Revenue Code	272
Min. Negotiated Rate	$608.09
Max. Negotiated Rate	$2,338.82
Rate for Payer: Aetna Commercial	$1,403.30
Rate for Payer: Aetna Medicare Advantage	$1,403.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,192.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,192.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,192.80
Rate for Payer: Cigna Commercial	$2,338.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$608.09
Rate for Payer: Oxford Commercial	$2,338.82
Rate for Payer: Qualcare PPO/HMO/WC	$701.65
Rate for Payer: UnitedHealthcare Commercial	$2,338.82

GAMMA 125DGRE 420mm 3370-6-425

Facility

$4,677.65

Hospital Charge Code	270615322
Hospital Revenue Code	272
Min. Negotiated Rate	$701.65
Max. Negotiated Rate	$701.65
Rate for Payer: Qualcare PPO/HMO/WC	$701.65

GAMMA 3 S NAIL RIGHT

Facility

$16,175.00

Hospital Charge Code	270656504
Hospital Revenue Code	278
Min. Negotiated Rate	$2,426.25
Max. Negotiated Rate	$8,087.50
Rate for Payer: Aetna Commercial	$4,852.50
Rate for Payer: Aetna Medicare Advantage	$4,852.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,124.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,124.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,124.62
Rate for Payer: Cigna Commercial	$8,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,914.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,426.25

GAMMA 3 S NAIL RIGHT

Facility

$16,175.00

Hospital Charge Code	270656504
Hospital Revenue Code	278
Min. Negotiated Rate	$2,426.25
Max. Negotiated Rate	$3,914.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,914.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,426.25

GAMMA 4 LAG SCREW 10.5X80MM

Facility

$3,780.00

Service Code	HCPCS C1713
Hospital Charge Code	270705041
Hospital Revenue Code	278
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$914.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$756.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$914.76
Rate for Payer: Qualcare PPO/HMO/WC	$567.00

GAMMA 4 LAG SCREW 10.5X80MM

Facility

$3,780.00

Service Code	HCPCS C1713
Hospital Charge Code	270705041
Hospital Revenue Code	278
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna Commercial	$1,134.00
Rate for Payer: Aetna Medicare Advantage	$1,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$963.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$963.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$756.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$963.90
Rate for Payer: Cigna Commercial	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$914.76
Rate for Payer: Qualcare PPO/HMO/WC	$567.00

Gammaglobulin; IgA, IgD, IgG,

Facility

$362.00

Service Code	HCPCS 82784
Hospital Charge Code	3035001F
Hospital Revenue Code	301
Min. Negotiated Rate	$54.30
Max. Negotiated Rate	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$54.30

Gammaglobulin; IgA, IgD, IgG,

Facility

$362.00

Service Code	HCPCS 82784
Hospital Charge Code	3035001F
Hospital Revenue Code	301
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$30.13
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.08
Rate for Payer: Cigna Commercial	$9.30
Rate for Payer: Cigna Medicare Advantage	$4.65
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.86
Rate for Payer: Wellcare Medicare Advantage	$9.30

GAMMA GLUTAMYLTRANSFERASE

Facility

$336.00

Service Code	HCPCS 82977
Hospital Charge Code	38472290
Hospital Revenue Code	301
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$23.33
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.38
Rate for Payer: Cigna Commercial	$7.20
Rate for Payer: Cigna Medicare Advantage	$3.60
Rate for Payer: Clover Medicare Advantage	$6.84
Rate for Payer: EmblemHealth Commercial	$21.60
Rate for Payer: Humana Medicare Advantage	$7.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.68
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$7.63
Rate for Payer: Wellcare Medicare Advantage	$7.20

GAMMA GLUTAMYLTRANSFERASE

Facility

$336.00

Service Code	HCPCS 82977
Hospital Charge Code	38472290
Hospital Revenue Code	301
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

GAMMA NAIL SYSTEM 10X320MMX125

Facility

$17,580.00

Hospital Charge Code	270662863
Hospital Revenue Code	270
Min. Negotiated Rate	$2,285.40
Max. Negotiated Rate	$8,790.00
Rate for Payer: Aetna Commercial	$5,274.00
Rate for Payer: Aetna Medicare Advantage	$5,274.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,482.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,482.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,482.90
Rate for Payer: Cigna Commercial	$8,790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,285.40
Rate for Payer: Oxford Commercial	$8,790.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,637.00
Rate for Payer: UnitedHealthcare Commercial	$8,790.00

GAMMA NAIL SYSTEM 10X320MMX125

Facility

$17,580.00

Hospital Charge Code	270662863
Hospital Revenue Code	270
Min. Negotiated Rate	$2,637.00
Max. Negotiated Rate	$2,637.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,637.00

GAMMAR-P IV 10GMS

Facility

$2,980.00

Hospital Charge Code	60635106
Hospital Revenue Code	636
Min. Negotiated Rate	$447.00
Max. Negotiated Rate	$1,490.00
Rate for Payer: Aetna Commercial	$894.00
Rate for Payer: Aetna Medicare Advantage	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$759.90
Rate for Payer: Cigna Commercial	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.16
Rate for Payer: Qualcare PPO/HMO/WC	$447.00

GAMMAR-P IV 10GMS

Facility

$2,980.00

Hospital Charge Code	60635106
Hospital Revenue Code	636
Min. Negotiated Rate	$447.00
Max. Negotiated Rate	$721.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.16
Rate for Payer: Qualcare PPO/HMO/WC	$447.00

GAMMAR-P IV 5GMS

Facility

$1,823.00

Hospital Charge Code	60635105
Hospital Revenue Code	636
Min. Negotiated Rate	$273.45
Max. Negotiated Rate	$911.50
Rate for Payer: Aetna Commercial	$546.90
Rate for Payer: Aetna Medicare Advantage	$546.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$464.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$464.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$464.87
Rate for Payer: Cigna Commercial	$911.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.17
Rate for Payer: Qualcare PPO/HMO/WC	$273.45

GAMMAR-P IV 5GMS

Facility

$1,823.00

Hospital Charge Code	60635105
Hospital Revenue Code	636
Min. Negotiated Rate	$273.45
Max. Negotiated Rate	$441.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.17
Rate for Payer: Qualcare PPO/HMO/WC	$273.45

GANCICLOVIR 500 MG

Facility

$152.00

Hospital Charge Code	60632770
Hospital Revenue Code	250
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

GANCICLOVIR 500 MG

Facility

$152.00

Hospital Charge Code	60632770
Hospital Revenue Code	250
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.76
Rate for Payer: Oxford Commercial	$76.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$76.00

GANGLIOSDEGQ1BANTI(IGG)EIA(SE)

Facility

$159.73

Service Code	HCPCS 83520
Hospital Charge Code	4013835209
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.76
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.96
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

GANGLIOSDEGQ1BANTI(IGG)EIA(SE)

Facility

$159.73

Service Code	HCPCS 83520
Hospital Charge Code	4013835209
Hospital Revenue Code	301
Min. Negotiated Rate	$23.96
Max. Negotiated Rate	$23.96
Rate for Payer: Qualcare PPO/HMO/WC	$23.96

GANTANOL/0.5G/TAB

Facility

$3.00

Hospital Charge Code	60634377
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GANTANOL/0.5G/TAB

Facility

$3.00

Hospital Charge Code	60634377
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.90
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.39
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$1.50

GANTRISIN 4% OPHTH/15ML

Facility

$49.00

Hospital Charge Code	60633033
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$14.70
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$24.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$24.50

Know your out-of-pocket cost for care.

All Charges