Heights University Hospital

All Charges

Charge

Type

Setting

Price

GENTAMYCIN INJ 60MG MINIBAG

Facility

$19.85

Hospital Charge Code	6010151
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

GENTAMYCIN INJ 80MG

Facility

$10.90

Hospital Charge Code	6009229
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 80MG

Facility

$10.90

Hospital Charge Code	6009229
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 IVPB 60MG/50ML NS

Facility

$25.19

Service Code	HCPCS J1580
Hospital Charge Code	60627236
Hospital Revenue Code	636
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$7.56
Rate for Payer: Aetna Commercial	$7.56
Rate for Payer: Aetna Medicare Advantage	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.42
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

GENTAMYCIN IVPB 60MG/50ML NS

Facility

$25.19

Service Code	HCPCS J1580
Hospital Charge Code	60627236
Hospital Revenue Code	636
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$6.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

GENTAMYCIN IVPB 80MG/50ML NS

Facility

$26.67

Service Code	HCPCS J1580
Hospital Charge Code	60627239
Hospital Revenue Code	636
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$8.00
Rate for Payer: Aetna Medicare Advantage	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.80
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.00

GENTAMYCIN IVPB 80MG/50ML NS

Facility

$26.67

Service Code	HCPCS J1580
Hospital Charge Code	60627239
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.00

GENTAMYCIN IVPB ODD DOSE <80MG

Facility

$58.25

Hospital Charge Code	60627240
Hospital Revenue Code	250
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$29.12
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$17.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.85
Rate for Payer: Cigna Commercial	$29.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.57
Rate for Payer: Oxford Commercial	$29.12
Rate for Payer: Qualcare PPO/HMO/WC	$8.74
Rate for Payer: UnitedHealthcare Commercial	$29.12

GENTAMYCIN IVPB ODD DOSE <80MG

Facility

$58.25

Hospital Charge Code	60627240
Hospital Revenue Code	250
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$8.74
Rate for Payer: Qualcare PPO/HMO/WC	$8.74

GENTAMYCIN MDV/20ML

Facility

$101.00

Hospital Charge Code	60634673
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

GENTAMYCIN MDV/20ML

Facility

$101.00

Hospital Charge Code	60634673
Hospital Revenue Code	250
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$30.30
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.13
Rate for Payer: Oxford Commercial	$50.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$50.50

GENTAMYCIN ODD DOSE >80MG IVPB

Facility

$58.25

Hospital Charge Code	60627241
Hospital Revenue Code	250
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$29.12
Rate for Payer: Oxford Commercial	$29.12
Rate for Payer: Qualcare PPO/HMO/WC	$8.74
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$17.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.85
Rate for Payer: Cigna Commercial	$29.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$29.12

GENTAMYCIN ODD DOSE >80MG IVPB

Facility

$58.25

Hospital Charge Code	60627241
Hospital Revenue Code	250
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$8.74
Rate for Payer: Qualcare PPO/HMO/WC	$8.74

GENTAMYCIN OPH DROP

Facility

$64.00

Hospital Charge Code	6002588
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

GENTAMYCIN OPH DROP

Facility

$64.00

Hospital Charge Code	6002588
Hospital Revenue Code	251
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$19.20
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$32.00

GENTAMYCIN OPH IV 1MG

Facility

$53.80

Hospital Charge Code	6002570
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

GENTAMYCIN OPH IV 1MG

Facility

$53.80

Hospital Charge Code	6002570
Hospital Revenue Code	251
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.99
Rate for Payer: Oxford Commercial	$26.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$26.90

GENTAMYCIN OPH SOL .3% 5ML

Facility

$43.55

Hospital Charge Code	6002554
Hospital Revenue Code	251
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$21.77
Rate for Payer: Aetna Commercial	$13.06
Rate for Payer: Aetna Medicare Advantage	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.11
Rate for Payer: Cigna Commercial	$21.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$21.77
Rate for Payer: Qualcare PPO/HMO/WC	$6.53
Rate for Payer: UnitedHealthcare Commercial	$21.77

GENTAMYCIN OPH SOL .3% 5ML

Facility

$43.55

Hospital Charge Code	6002554
Hospital Revenue Code	251
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$6.53

GENTAMYCIN PEAK

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479093
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.07
Rate for Payer: Aetna Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.02
Rate for Payer: Cigna Commercial	$16.38
Rate for Payer: Cigna Medicare Advantage	$8.19
Rate for Payer: Clover Medicare Advantage	$15.56
Rate for Payer: EmblemHealth Commercial	$49.14
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.27
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.36
Rate for Payer: Wellcare Medicare Advantage	$16.38

GENTAMYCIN PEAK

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479093
Hospital Revenue Code	301
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

GENTAMYCIN, PEAK***

Facility

$124.00

Service Code	HCPCS 80170
Hospital Charge Code	3031390
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.07
Rate for Payer: Aetna Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.02
Rate for Payer: Cigna Commercial	$16.38
Rate for Payer: Cigna Medicare Advantage	$8.19
Rate for Payer: Clover Medicare Advantage	$15.56
Rate for Payer: EmblemHealth Commercial	$49.14
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.38
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.36
Rate for Payer: Wellcare Medicare Advantage	$16.38

GENTAMYCIN, PEAK***

Facility

$124.00

Service Code	HCPCS 80170
Hospital Charge Code	3031390
Hospital Revenue Code	301
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

GENTAMYCIN PM 60MG/50ML

Facility

$48.00

Hospital Charge Code	60635034
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 PM 60MG/50ML

Facility

$48.00

Hospital Charge Code	60635034
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

Know your out-of-pocket cost for care.

All Charges