Heights University Hospital

All Charges

Charge

Type

Setting

Price

GENTAMYCIN PM 70MG/50ML

Facility

$34.00

Hospital Charge Code	60635035
Hospital Revenue Code	636
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$8.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

GENTAMYCIN PM 70MG/50ML

Facility

$34.00

Hospital Charge Code	60635035
Hospital Revenue Code	636
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.23
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

GENTAMYCIN PM 80MG/100ML

Facility

$48.00

Hospital Charge Code	60635036
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 80MG/100ML

Facility

$48.00

Hospital Charge Code	60635036
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 PREDNIS OPH SSP

Facility

$72.85

Hospital Charge Code	60628014
Hospital Revenue Code	250
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$21.86
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.47
Rate for Payer: Oxford Commercial	$36.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$36.42

GENTAMYCIN PREDNIS OPH SSP

Facility

$72.85

Hospital Charge Code	60628014
Hospital Revenue Code	250
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

GENTAMYCIN, RANDOM

Facility

$170.45

Service Code	HCPCS 80170
Hospital Charge Code	3004017
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	$22.16
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.57
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, RANDOM

Facility

$170.45

Service Code	HCPCS 80170
Hospital Charge Code	3004017
Hospital Revenue Code	301
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$25.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.57

GENTAMYCIN trough

Facility

$390.00

Service Code	HCPCS 80170
Hospital Charge Code	39900461
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GENTAMYCIN trough

Facility

$390.00

Service Code	HCPCS 80170
Hospital Charge Code	39900461
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	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
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 TROUGH

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479095
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 TROUGH

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479095
Hospital Revenue Code	301
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

GENTAMYCIN, TROUGH***

Facility

$123.60

Service Code	HCPCS 80170
Hospital Charge Code	3031382
Hospital Revenue Code	301
Min. Negotiated Rate	$18.54
Max. Negotiated Rate	$18.54
Rate for Payer: Qualcare PPO/HMO/WC	$18.54

GENTAMYCIN, TROUGH***

Facility

$123.60

Service Code	HCPCS 80170
Hospital Charge Code	3031382
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	$16.07
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.54
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

GENTIAN VIOLET 1%

Facility

$54.40

Service Code	NDC 395100592
Hospital Charge Code	60634492
Hospital Revenue Code	250
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna Commercial	$16.32
Rate for Payer: Aetna Medicare Advantage	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.87
Rate for Payer: Cigna Commercial	$27.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.07
Rate for Payer: Oxford Commercial	$27.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.16
Rate for Payer: UnitedHealthcare Commercial	$27.20

GENTIAN VIOLET 1%

Facility

$54.40

Service Code	NDC 395100592
Hospital Charge Code	60634492
Hospital Revenue Code	250
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$8.16
Rate for Payer: Qualcare PPO/HMO/WC	$8.16

GENTIAN VIOLET 2%

Facility

$13.00

Hospital Charge Code	60634493
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

GENTIAN VIOLET 2%

Facility

$13.00

Hospital Charge Code	60634493
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

GENTLE TOUCH SYSTEM 100MM LOOP

Facility

$116.20

Hospital Charge Code	270655989
Hospital Revenue Code	271
Min. Negotiated Rate	$17.43
Max. Negotiated Rate	$17.43
Rate for Payer: Qualcare PPO/HMO/WC	$17.43

GENTLE TOUCH SYSTEM 100MM LOOP

Facility

$116.20

Hospital Charge Code	270655989
Hospital Revenue Code	271
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$58.10
Rate for Payer: Aetna Commercial	$34.86
Rate for Payer: Aetna Medicare Advantage	$34.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.63
Rate for Payer: Cigna Commercial	$58.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.11
Rate for Payer: Oxford Commercial	$58.10
Rate for Payer: Qualcare PPO/HMO/WC	$17.43
Rate for Payer: UnitedHealthcare Commercial	$58.10

GEODON,40MG CAP

Facility

$102.64

Service Code	NDC 49005460
Hospital Charge Code	60635421
Hospital Revenue Code	250
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$51.32
Rate for Payer: Aetna Commercial	$30.79
Rate for Payer: Aetna Medicare Advantage	$30.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.17
Rate for Payer: Cigna Commercial	$51.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.34
Rate for Payer: Oxford Commercial	$51.32
Rate for Payer: Qualcare PPO/HMO/WC	$15.40
Rate for Payer: UnitedHealthcare Commercial	$51.32

GEODON,40MG CAP

Facility

$102.64

Service Code	NDC 49005460
Hospital Charge Code	60635421
Hospital Revenue Code	250
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$15.40

GERI PREV MED.COUNSLNG,INTERVW

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	83652497
Hospital Revenue Code	510
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

GERI PREV MED.COUNSLNG,INTERVW

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	83652497
Hospital Revenue Code	510
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

GERI PSYCH PRIVATE

Facility

$18,000.00

Hospital Charge Code	100824
Hospital Revenue Code	114
Min. Negotiated Rate	$1,109.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

Know your out-of-pocket cost for care.

All Charges