Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLIMEPIRIDE 4 MG TAB

Facility

$8.24

Service Code	NDC 51079042620
Hospital Charge Code	60628622
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.07
Rate for Payer: Oxford Commercial	$4.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$4.12

GLIPIZIDE 10 MG SR TAB

Facility

$5.43

Service Code	NDC 591084501
Hospital Charge Code	60628232
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

GLIPIZIDE 10 MG SR TAB

Facility

$5.43

Service Code	NDC 591084501
Hospital Charge Code	60628232
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.71
Rate for Payer: Oxford Commercial	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$2.71

GLIPIZIDE 10 MG TAB UD

Facility

$4.49

Service Code	NDC 60505014200
Hospital Charge Code	60629856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.14
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.58
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.67
Rate for Payer: UnitedHealthcare Commercial	$2.25

GLIPIZIDE 10 MG TAB UD

Facility

$4.49

Service Code	NDC 60505014200
Hospital Charge Code	60629856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.67

GLIPIZIDE 2.5 MG SR TAB

Facility

$7.77

Service Code	NDC 49017001
Hospital Charge Code	60628936
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$1.17

GLIPIZIDE 2.5 MG SR TAB

Facility

$7.77

Service Code	NDC 49017001
Hospital Charge Code	60628936
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna Medicare Advantage	$2.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.98
Rate for Payer: Cigna Commercial	$3.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.01
Rate for Payer: Oxford Commercial	$3.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.17
Rate for Payer: UnitedHealthcare Commercial	$3.88

GLIPIZIDE 5 MG SR TAB

Facility

$7.77

Service Code	NDC 49017402
Hospital Charge Code	60628233
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna Medicare Advantage	$2.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.98
Rate for Payer: Cigna Commercial	$3.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.01
Rate for Payer: Oxford Commercial	$3.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.17
Rate for Payer: UnitedHealthcare Commercial	$3.88

GLIPIZIDE 5 MG SR TAB

Facility

$7.77

Service Code	NDC 49017402
Hospital Charge Code	60628233
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$1.17

GLIPIZIDE 5 MG TAB UD

Facility

$4.00

Service Code	NDC 51079081020
Hospital Charge Code	60628234
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLIPIZIDE 5 MG TAB UD

Facility

$4.00

Service Code	NDC 51079081020
Hospital Charge Code	60628234
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

GLIPIZIDE TAB 5MG

Facility

$3.20

Hospital Charge Code	6023030
Hospital Revenue Code	251
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$1.60

GLIPIZIDE TAB 5MG

Facility

$3.20

Hospital Charge Code	6023030
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

GLOBULIN

Facility

$10.08

Service Code	HCPCS 82977CF
Hospital Charge Code	8200313RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna Medicare Advantage	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.57
Rate for Payer: Cigna Commercial	$5.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Commercial	$114.00

GLOBULIN

Facility

$10.08

Service Code	HCPCS 82977CF
Hospital Charge Code	8200313RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

GLOBULIN, IMMUNE 1M 2ML

Facility

$113.30

Hospital Charge Code	6009237
Hospital Revenue Code	636
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$33.99
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.42
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

GLOBULIN, IMMUNE 1M 2ML

Facility

$113.30

Hospital Charge Code	6009237
Hospital Revenue Code	636
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$27.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.42
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

GLOCOSE 1/2 HR

Facility

$203.00

Service Code	HCPCS 82952
Hospital Charge Code	38479022
Hospital Revenue Code	301
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

GLOCOSE 1/2 HR

Facility

$203.00

Service Code	HCPCS 82952
Hospital Charge Code	38479022
Hospital Revenue Code	301
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

GLOCOSE,5HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479026
Hospital Revenue Code	301
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

GLOCOSE,5HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479026
Hospital Revenue Code	301
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

GLOCOSE,6HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479027
Hospital Revenue Code	301
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.36
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: Cigna Medicare Advantage	$1.96
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.39
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.16
Rate for Payer: Wellcare Medicare Advantage	$3.92

GLOCOSE,6HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479027
Hospital Revenue Code	301
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

G-LOK 25MM LOOP

Facility

$1,781.25

Hospital Charge Code	270676528
Hospital Revenue Code	272
Min. Negotiated Rate	$231.56
Max. Negotiated Rate	$890.62
Rate for Payer: Aetna Commercial	$534.38
Rate for Payer: Aetna Medicare Advantage	$534.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$454.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$454.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$454.22
Rate for Payer: Cigna Commercial	$890.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.56
Rate for Payer: Oxford Commercial	$890.62
Rate for Payer: Qualcare PPO/HMO/WC	$267.19
Rate for Payer: UnitedHealthcare Commercial	$890.62

G-LOK 25MM LOOP

Facility

$1,781.25

Hospital Charge Code	270676528
Hospital Revenue Code	272
Min. Negotiated Rate	$267.19
Max. Negotiated Rate	$267.19
Rate for Payer: Qualcare PPO/HMO/WC	$267.19

Know your out-of-pocket cost for care.

All Charges