Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLYCERIN ADULT SUPP/EACH

Facility

$1.00

Hospital Charge Code	60633052
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

GLYCERIN ADULT SUPP/EACH

Facility

$1.00

Hospital Charge Code	60633051
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

GLYCERIN ORL LQ 50% 177ML

Facility

$95.40

Hospital Charge Code	6002661
Hospital Revenue Code	251
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare Advantage	$28.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.33
Rate for Payer: Cigna Commercial	$47.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.40
Rate for Payer: Oxford Commercial	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.31
Rate for Payer: UnitedHealthcare Commercial	$47.70

GLYCERIN ORL LQ 50% 177ML

Facility

$95.40

Hospital Charge Code	6002661
Hospital Revenue Code	251
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$14.31
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

GLYCERIN ORL LQ 75% 120ML

Facility

$82.60

Hospital Charge Code	6002679
Hospital Revenue Code	251
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: Qualcare PPO/HMO/WC	$12.39

GLYCERIN ORL LQ 75% 120ML

Facility

$82.60

Hospital Charge Code	6002679
Hospital Revenue Code	251
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$41.30
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: Aetna Medicare Advantage	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.06
Rate for Payer: Cigna Commercial	$41.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.74
Rate for Payer: Oxford Commercial	$41.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.39
Rate for Payer: UnitedHealthcare Commercial	$41.30

GLYCERIN PEDIATRIC SUPP

Facility

$5.09

Service Code	NDC 713010209
Hospital Charge Code	60628129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare Advantage	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.66
Rate for Payer: Oxford Commercial	$2.54
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$2.54

GLYCERIN PEDIATRIC SUPP

Facility

$5.09

Service Code	NDC 713010209
Hospital Charge Code	60628129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

GLYCERIN PEDIATRIC SUPP/1

Facility

$1.00

Hospital Charge Code	60633054
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

GLYCERIN PEDIATRIC SUPP/1

Facility

$4.00

Hospital Charge Code	60633053
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLYCERIN PEDIATRIC SUPP/1

Facility

$1.00

Hospital Charge Code	60633054
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

GLYCERIN PEDIATRIC SUPP/1

Facility

$4.00

Hospital Charge Code	60633053
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

GLYCERIN SOL OPH 7.5ML

Facility

$143.40

Hospital Charge Code	6002653
Hospital Revenue Code	251
Min. Negotiated Rate	$21.51
Max. Negotiated Rate	$21.51
Rate for Payer: Qualcare PPO/HMO/WC	$21.51

GLYCERIN SOL OPH 7.5ML

Facility

$143.40

Hospital Charge Code	6002653
Hospital Revenue Code	251
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$71.70
Rate for Payer: Aetna Commercial	$43.02
Rate for Payer: Aetna Medicare Advantage	$43.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.57
Rate for Payer: Cigna Commercial	$71.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.64
Rate for Payer: Oxford Commercial	$71.70
Rate for Payer: Qualcare PPO/HMO/WC	$21.51
Rate for Payer: UnitedHealthcare Commercial	$71.70

GLYCERIN USP/40Z

Facility

$15.00

Hospital Charge Code	60634430
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

GLYCERIN USP/40Z

Facility

$15.00

Hospital Charge Code	60634430
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

GLYCINE 1.5% 3000ML

Facility

$51.25

Hospital Charge Code	60630176
Hospital Revenue Code	250
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

GLYCINE 1.5% 3000ML

Facility

$51.25

Hospital Charge Code	60630176
Hospital Revenue Code	250
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$15.38
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.66
Rate for Payer: Oxford Commercial	$25.62
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$25.62

GLYCINE 3000 ML **********

Facility

$28.00

Hospital Charge Code	1608256
Hospital Revenue Code	272
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$14.00

GLYCINE 3000 ML **********

Facility

$28.00

Hospital Charge Code	1608256
Hospital Revenue Code	272
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

GLYCINE IRRIGATION GU ******

Facility

$25.00

Hospital Charge Code	7000474
Hospital Revenue Code	279
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$7.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$12.50

GLYCINE IRRIGATION GU ******

Facility

$25.00

Hospital Charge Code	7000474
Hospital Revenue Code	279
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

GLYCOGEN-PAS STAIN

Facility

$324.85

Service Code	HCPCS 88312
Hospital Charge Code	3005307
Hospital Revenue Code	310
Min. Negotiated Rate	$48.73
Max. Negotiated Rate	$48.73
Rate for Payer: Qualcare PPO/HMO/WC	$48.73

GLYCOGEN-PAS STAIN

Facility

$324.85

Service Code	HCPCS 88312
Hospital Charge Code	3005307
Hospital Revenue Code	310
Min. Negotiated Rate	$42.23
Max. Negotiated Rate	$124.10
Rate for Payer: Aetna Commercial	$97.45
Rate for Payer: Aetna Medicare Advantage	$97.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.84
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$62.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.73
Rate for Payer: UnitedHealthcare Commercial	$114.00

GLYCOHEMOGLOBIN/A1C PANEL

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3004273
Hospital Revenue Code	301
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

Know your out-of-pocket cost for care.

All Charges