Heights University Hospital

All Charges

Charge

Type

Setting

Price

GENTAMICIN SULFATE 0.1%/1

Facility

$8.00

Hospital Charge Code	60633045
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$4.00

GENTAMICIN SULFATE 0.1%/1

Facility

$8.00

Hospital Charge Code	60633045
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

GENTAMICIN SULFATE 0.1 % CRE

Facility

$330.85

Service Code	NDC 45802005635
Hospital Charge Code	6002596
Hospital Revenue Code	251
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$49.63
Rate for Payer: Qualcare PPO/HMO/WC	$49.63

GENTAMICIN SULFATE 0.1 % CRE

Facility

$330.85

Service Code	NDC 45802005635
Hospital Charge Code	6002596
Hospital Revenue Code	251
Min. Negotiated Rate	$43.01
Max. Negotiated Rate	$165.43
Rate for Payer: Aetna Commercial	$99.25
Rate for Payer: Aetna Medicare Advantage	$99.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.37
Rate for Payer: Cigna Commercial	$165.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.01
Rate for Payer: Oxford Commercial	$165.43
Rate for Payer: Qualcare PPO/HMO/WC	$49.63
Rate for Payer: UnitedHealthcare Commercial	$165.43

GENTAMICIN SULFATE 0.1 % OIN

Facility

$330.78

Service Code	NDC 45802004635
Hospital Charge Code	6002604
Hospital Revenue Code	251
Min. Negotiated Rate	$43.00
Max. Negotiated Rate	$165.39
Rate for Payer: Aetna Commercial	$99.23
Rate for Payer: Aetna Medicare Advantage	$99.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.35
Rate for Payer: Cigna Commercial	$165.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.00
Rate for Payer: Oxford Commercial	$165.39
Rate for Payer: Qualcare PPO/HMO/WC	$49.62
Rate for Payer: UnitedHealthcare Commercial	$165.39

GENTAMICIN SULFATE 0.1 % OIN

Facility

$330.78

Service Code	NDC 45802004635
Hospital Charge Code	6002604
Hospital Revenue Code	251
Min. Negotiated Rate	$49.62
Max. Negotiated Rate	$49.62
Rate for Payer: Qualcare PPO/HMO/WC	$49.62

GENTAMICIN SULFATE/40MG/1

Facility

$7.00

Hospital Charge Code	60633042
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

GENTAMICIN SULFATE/40MG/1

Facility

$13.00

Hospital Charge Code	60633041
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

GENTAMICIN SULFATE/40MG/1

Facility

$7.00

Hospital Charge Code	60633042
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

GENTAMICIN SULFATE/40MG/1

Facility

$13.00

Hospital Charge Code	60633041
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

GENTAMICIN SULFATE PEDIAT

Facility

$3.00

Hospital Charge Code	60633043
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

GENTAMICIN SULFATE PEDIAT

Facility

$7.30

Service Code	NDC 63323017302
Hospital Charge Code	60633044
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.95
Rate for Payer: Oxford Commercial	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.65

GENTAMICIN SULFATE PEDIAT

Facility

$7.30

Service Code	NDC 63323017302
Hospital Charge Code	60633044
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

GENTAMICIN SULFATE PEDIAT

Facility

$3.00

Hospital Charge Code	60633043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GENTAMYCIN 120MG/100ML PREMIX

Facility

$27.34

Service Code	HCPCS J1580
Hospital Charge Code	606390499
Hospital Revenue Code	636
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$6.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.10

GENTAMYCIN 120MG/100ML PREMIX

Facility

$27.34

Service Code	HCPCS J1580
Hospital Charge Code	606390499
Hospital Revenue Code	636
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$8.20
Rate for Payer: Aetna Commercial	$8.20
Rate for Payer: Aetna Medicare Advantage	$8.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.97
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.10

GENTAMYCIN 90MG PM

Facility

$48.00

Hospital Charge Code	60635045
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$11.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

GENTAMYCIN 90MG PM

Facility

$48.00

Hospital Charge Code	60635045
Hospital Revenue Code	636
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$14.40
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

GENTAMYCIN ADDVANT/100MG

Facility

$6.00

Hospital Charge Code	60634290
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

GENTAMYCIN ADDVANT/100MG

Facility

$6.00

Hospital Charge Code	60634290
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

GENTAMYCIN INJ 20MG

Facility

$10.90

Hospital Charge Code	6009211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

GENTAMYCIN INJ 20MG

Facility

$10.90

Hospital Charge Code	6009211
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.45

GENTAMYCIN INJ 20MG/2ML

Facility

$5.65

Hospital Charge Code	60627235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$1.70
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$2.83

GENTAMYCIN INJ 20MG/2ML

Facility

$5.65

Hospital Charge Code	60627235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

GENTAMYCIN INJ 60MG MINIBAG

Facility

$19.85

Hospital Charge Code	6010151
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$9.93
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$9.93

Know your out-of-pocket cost for care.

All Charges