Heights University Hospital

All Charges

Charge

Type

Setting

Price

GANTRISIN 4% OPHTH/15ML

Facility

$49.00

Hospital Charge Code	60633033
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

GANTRISIN/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633032
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/500MG/TAB

Facility

$3.00

Hospital Charge Code	60633032
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GARAMYCIN/3.5GM

Facility

$112.96

Service Code	NDC 17478082735
Hospital Charge Code	60633034
Hospital Revenue Code	250
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$56.48
Rate for Payer: Aetna Commercial	$33.89
Rate for Payer: Aetna Medicare Advantage	$33.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.80
Rate for Payer: Cigna Commercial	$56.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.68
Rate for Payer: Oxford Commercial	$56.48
Rate for Payer: Qualcare PPO/HMO/WC	$16.94
Rate for Payer: UnitedHealthcare Commercial	$56.48

GARAMYCIN/3.5GM

Facility

$112.96

Service Code	NDC 17478082735
Hospital Charge Code	60633034
Hospital Revenue Code	250
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.94

GARAMYCIN OPHTH/5ML

Facility

$126.70

Service Code	NDC 24208058060
Hospital Charge Code	60635874
Hospital Revenue Code	259
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.00

GARAMYCIN OPHTH/5ML

Facility

$126.70

Service Code	NDC 24208058060
Hospital Charge Code	60635874
Hospital Revenue Code	259
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$63.35
Rate for Payer: Aetna Commercial	$38.01
Rate for Payer: Aetna Medicare Advantage	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.31
Rate for Payer: Cigna Commercial	$63.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.47
Rate for Payer: Oxford Commercial	$63.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.00
Rate for Payer: UnitedHealthcare Commercial	$63.35

GARDASIL 0.5ML VACCINE VIAL

Facility

$1,183.35

Service Code	HCPCS 90649
Hospital Charge Code	6000430
Hospital Revenue Code	636
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$286.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.37
Rate for Payer: Qualcare PPO/HMO/WC	$177.50

GARDASIL 0.5ML VACCINE VIAL

Facility

$1,183.35

Service Code	HCPCS 90649
Hospital Charge Code	6000430
Hospital Revenue Code	636
Min. Negotiated Rate	$146.33
Max. Negotiated Rate	$591.67
Rate for Payer: Aetna Commercial	$355.00
Rate for Payer: Aetna Medicare Advantage	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.75
Rate for Payer: Cigna Commercial	$591.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.37
Rate for Payer: Qualcare PPO/HMO/WC	$177.50

GARDASIL VIAL HPV

Facility

$273.00

Service Code	HCPCS 90713
Hospital Charge Code	83652563
Hospital Revenue Code	636
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$66.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

GARDASIL VIAL HPV

Facility

$273.00

Service Code	HCPCS 90713
Hospital Charge Code	83652563
Hospital Revenue Code	636
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$136.50
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Aetna Medicare Advantage	$81.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.61
Rate for Payer: Cigna Commercial	$136.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

GARDASIL VIAL HPV

Facility

$1,210.49

Service Code	HCPCS 90649
Hospital Charge Code	83652307
Hospital Revenue Code	636
Min. Negotiated Rate	$181.57
Max. Negotiated Rate	$292.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.94
Rate for Payer: Qualcare PPO/HMO/WC	$181.57

GARDASIL VIAL HPV

Facility

$1,210.49

Service Code	HCPCS 90649
Hospital Charge Code	83652307
Hospital Revenue Code	636
Min. Negotiated Rate	$146.33
Max. Negotiated Rate	$605.25
Rate for Payer: Aetna Commercial	$363.15
Rate for Payer: Aetna Medicare Advantage	$363.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.67
Rate for Payer: Cigna Commercial	$605.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.94
Rate for Payer: Qualcare PPO/HMO/WC	$181.57

GAS CRYOSURGICAL HISTOFREEZ

Facility

$1,935.00

Hospital Charge Code	270658830
Hospital Revenue Code	272
Min. Negotiated Rate	$290.25
Max. Negotiated Rate	$290.25
Rate for Payer: Qualcare PPO/HMO/WC	$290.25

GAS CRYOSURGICAL HISTOFREEZ

Facility

$1,935.00

Hospital Charge Code	270658830
Hospital Revenue Code	272
Min. Negotiated Rate	$251.55
Max. Negotiated Rate	$967.50
Rate for Payer: Aetna Commercial	$580.50
Rate for Payer: Aetna Medicare Advantage	$580.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$493.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$493.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$493.43
Rate for Payer: Cigna Commercial	$967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.55
Rate for Payer: Oxford Commercial	$967.50
Rate for Payer: Qualcare PPO/HMO/WC	$290.25
Rate for Payer: UnitedHealthcare Commercial	$967.50

GASE NITRUS OXIDE 20 POUNDS

Facility

$240.00

Hospital Charge Code	270663700
Hospital Revenue Code	279
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$120.00

GASE NITRUS OXIDE 20 POUNDS

Facility

$240.00

Hospital Charge Code	270663700
Hospital Revenue Code	279
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

GAS RESTRICT PROC WO GAS BYPAS

Facility

$112,126.91

Service Code	HCPCS 43843
Hospital Charge Code	1600182
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

GAS RESTRICT PROC WO GAS BYPAS

Facility

$112,126.91

Service Code	HCPCS 43843
Hospital Charge Code	1600182
Hospital Revenue Code	361
Min. Negotiated Rate	$1,315.48
Max. Negotiated Rate	$33,638.07
Rate for Payer: Aetna Commercial	$33,638.07
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,592.36
Rate for Payer: Cigna Commercial	$1,315.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,576.50
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Commercial	$8,580.00

GASRESTRPROCWSHORTLIMBROUXENY

Facility

$112,126.91

Service Code	HCPCS 43846
Hospital Charge Code	1600183
Hospital Revenue Code	361
Min. Negotiated Rate	$1,686.49
Max. Negotiated Rate	$33,638.07
Rate for Payer: Aetna Commercial	$33,638.07
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,592.36
Rate for Payer: Cigna Commercial	$1,686.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,576.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

GASRESTRPROCWSHORTLIMBROUXENY

Facility

$112,126.91

Service Code	HCPCS 43846
Hospital Charge Code	1600183
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

GASRESTR PROCWSMALLINTESTRECON

Facility

$112,126.91

Service Code	HCPCS 43847
Hospital Charge Code	1600184
Hospital Revenue Code	361
Min. Negotiated Rate	$1,838.26
Max. Negotiated Rate	$33,638.07
Rate for Payer: Aetna Commercial	$33,638.07
Rate for Payer: Aetna Medicare Advantage	$33,638.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,592.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,592.36
Rate for Payer: Cigna Commercial	$1,838.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,576.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

GASRESTR PROCWSMALLINTESTRECON

Facility

$112,126.91

Service Code	HCPCS 43847
Hospital Charge Code	1600184
Hospital Revenue Code	361
Min. Negotiated Rate	$16,819.04
Max. Negotiated Rate	$16,819.04
Rate for Payer: Qualcare PPO/HMO/WC	$16,819.04

GASTRECTOMY P DIST; W ROUX-EN

Facility

$23,535.00

Service Code	HCPCS 43633
Hospital Charge Code	1600000636
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,060.50
Rate for Payer: Aetna Commercial	$7,060.50
Rate for Payer: Aetna Medicare Advantage	$7,060.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,001.43
Rate for Payer: Cigna Commercial	$1,930.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,059.55
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

GASTRECTOMY P DIST; W ROUX-EN

Facility

$23,535.00

Service Code	HCPCS 43633
Hospital Charge Code	1600000636
Hospital Revenue Code	360
Min. Negotiated Rate	$3,530.25
Max. Negotiated Rate	$3,530.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25

Know your out-of-pocket cost for care.

All Charges