Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLUTOSE 15G GEL

Facility

$15.80

Hospital Charge Code	60635732
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.37

GLUTOSE 15- ORAL GLUCOSE GEL

Facility

$10.59

Service Code	NDC 574007015
Hospital Charge Code	60630105
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$5.29
Rate for Payer: Aetna Commercial	$3.18
Rate for Payer: Aetna Medicare Advantage	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.70
Rate for Payer: Cigna Commercial	$5.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.38
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.59
Rate for Payer: UnitedHealthcare Commercial	$5.29

GLUTOSE 15- ORAL GLUCOSE GEL

Facility

$10.59

Service Code	NDC 574007015
Hospital Charge Code	60630105
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.59

GLUTOSE 5 GEL 12.5 GM ORAL

Facility

$17.35

Service Code	NDC 574006924
Hospital Charge Code	606390291
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$8.68
Rate for Payer: Aetna Commercial	$5.21
Rate for Payer: Aetna Medicare Advantage	$5.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.42
Rate for Payer: Cigna Commercial	$8.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.26
Rate for Payer: Oxford Commercial	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.60
Rate for Payer: UnitedHealthcare Commercial	$8.68

GLUTOSE 5 GEL 12.5 GM ORAL

Facility

$17.35

Service Code	NDC 574006924
Hospital Charge Code	606390291
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.60

GLVE SRG SENSICARE SZ8 MSG1080

Facility

$8.95

Hospital Charge Code	270060940C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.34

GLVE SRG SENSICARE SZ8 MSG1080

Facility

$8.95

Hospital Charge Code	270060940C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$4.47
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna Medicare Advantage	$2.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.28
Rate for Payer: Cigna Commercial	$4.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.34
Rate for Payer: UnitedHealthcare Commercial	$4.47

GL-WIRE STRAIGHTTIP 035 180CM

Facility

$207.16

Hospital Charge Code	2709007221
Hospital Revenue Code	272
Min. Negotiated Rate	$26.93
Max. Negotiated Rate	$103.58
Rate for Payer: Aetna Commercial	$62.15
Rate for Payer: Aetna Medicare Advantage	$62.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.83
Rate for Payer: Cigna Commercial	$103.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.93
Rate for Payer: Oxford Commercial	$103.58
Rate for Payer: Qualcare PPO/HMO/WC	$31.07
Rate for Payer: UnitedHealthcare Commercial	$103.58

GL-WIRE STRAIGHTTIP 035 180CM

Facility

$207.16

Hospital Charge Code	2709007221
Hospital Revenue Code	272
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$31.07
Rate for Payer: Qualcare PPO/HMO/WC	$31.07

GLYBURIDE 2.5 MG TAB

Facility

$4.00

Service Code	NDC 51079087220
Hospital Charge Code	60628235
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

GLYBURIDE 2.5 MG TAB

Facility

$4.00

Service Code	NDC 51079087220
Hospital Charge Code	60628235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLYBURIDE 5 MG TAB

Facility

$4.00

Service Code	NDC 51079087320
Hospital Charge Code	60628236
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

GLYBURIDE 5 MG TAB

Facility

$4.00

Service Code	NDC 51079087320
Hospital Charge Code	60628236
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLYBURIDE MICRONIZED 3 MG TAB

Facility

$4.42

Service Code	NDC 93803501
Hospital Charge Code	60628623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

GLYBURIDE MICRONIZED 3 MG TAB

Facility

$4.42

Service Code	NDC 93803501
Hospital Charge Code	60628623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.33
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.57
Rate for Payer: Oxford Commercial	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$2.21

GLYBURIDE MICRONIZED 6 MG TAB

Facility

$10.95

Hospital Charge Code	60628624
Hospital Revenue Code	250
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$5.47
Rate for Payer: Aetna Commercial	$3.29
Rate for Payer: Aetna Medicare Advantage	$3.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.79
Rate for Payer: Cigna Commercial	$5.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$5.47

GLYBURIDE MICRONIZED 6 MG TAB

Facility

$10.95

Hospital Charge Code	60628624
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

GLYCERIN 50% ORAL SOLN

Facility

$2.45

Hospital Charge Code	6002646
Hospital Revenue Code	251
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

GLYCERIN 50% ORAL SOLN

Facility

$2.45

Hospital Charge Code	6002646
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

GLYCERIN 72% 1ML

Facility

$143.65

Service Code	NDC 73198010310
Hospital Charge Code	6063943381
Hospital Revenue Code	250
Min. Negotiated Rate	$18.67
Max. Negotiated Rate	$71.83
Rate for Payer: Aetna Commercial	$43.09
Rate for Payer: Aetna Medicare Advantage	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.63
Rate for Payer: Cigna Commercial	$71.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.67
Rate for Payer: Oxford Commercial	$71.83
Rate for Payer: Qualcare PPO/HMO/WC	$21.55
Rate for Payer: UnitedHealthcare Commercial	$71.83

GLYCERIN 72% 1ML

Facility

$143.65

Service Code	NDC 73198010310
Hospital Charge Code	6063943381
Hospital Revenue Code	250
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$21.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.55

GLYCERIN ADULT SUPP

Facility

$5.23

Service Code	NDC 713010109
Hospital Charge Code	6022495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.78

GLYCERIN ADULT SUPP

Facility

$5.23

Service Code	NDC 713010109
Hospital Charge Code	6022495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$2.62
Rate for Payer: Aetna Commercial	$1.57
Rate for Payer: Aetna Medicare Advantage	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.33
Rate for Payer: Cigna Commercial	$2.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.68
Rate for Payer: Oxford Commercial	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.78
Rate for Payer: UnitedHealthcare Commercial	$2.62

GLYCERIN ADULT SUPP/EACH

Facility

$1.00

Hospital Charge Code	60633052
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

GLYCERIN ADULT SUPP/EACH

Facility

$1.00

Hospital Charge Code	60633051
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.13
Rate for Payer: Oxford Commercial	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.50

Know your out-of-pocket cost for care.

All Charges