Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLYCOHEMOGLOBIN/A1C PANEL

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3004273
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.46
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.58
Rate for Payer: Cigna Commercial	$9.71
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.29
Rate for Payer: Wellcare Medicare Advantage	$9.71

GLYCOHEMOGLOBIN (GHB) TOTAL

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3035005
Hospital Revenue Code	301
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

GLYCOHEMOGLOBIN (GHB) TOTAL

Facility

$48.00

Service Code	HCPCS 83036
Hospital Charge Code	3035005
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.46
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.58
Rate for Payer: Cigna Commercial	$9.71
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.29
Rate for Payer: Wellcare Medicare Advantage	$9.71

GLYCOHEMOGLOBIN (HgbA1C)

Facility

$469.00

Service Code	HCPCS 83036
Hospital Charge Code	38472392
Hospital Revenue Code	301
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$70.35
Rate for Payer: Qualcare PPO/HMO/WC	$70.35

GLYCOHEMOGLOBIN (HgbA1C)

Facility

$469.00

Service Code	HCPCS 83036
Hospital Charge Code	38472392
Hospital Revenue Code	301
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$31.46
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.58
Rate for Payer: Cigna Commercial	$9.71
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.35
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$10.29
Rate for Payer: Wellcare Medicare Advantage	$9.71

GLYCOMARK

Facility

$667.59

Service Code	HCPCS 84378
Hospital Charge Code	39900136
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.79
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

GLYCOMARK

Facility

$667.59

Service Code	HCPCS 84378
Hospital Charge Code	39900136
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

GLYCOMARK SUGAR SINGLE

Facility

$81.59

Service Code	HCPCS 84378
Hospital Charge Code	38478085
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$37.36
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.25
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: Cigna Medicare Advantage	$5.76
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.61
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.24
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.22
Rate for Payer: Wellcare Medicare Advantage	$11.53

GLYCOMARK SUGAR SINGLE

Facility

$81.59

Service Code	HCPCS 84378
Hospital Charge Code	38478085
Hospital Revenue Code	301
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$12.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.24

GLYCOPYROLATE .2MG/INJ/1M

Facility

$89.00

Hospital Charge Code	60634725
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

GLYCOPYROLATE .2MG/INJ/1M

Facility

$89.00

Hospital Charge Code	60634725
Hospital Revenue Code	250
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$26.70
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.57
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$44.50

GLYCOPYROLATE .2MG/INJ/2M

Facility

$127.00

Hospital Charge Code	60634726
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

GLYCOPYROLATE .2MG/INJ/2M

Facility

$127.00

Hospital Charge Code	60634726
Hospital Revenue Code	250
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$63.50
Rate for Payer: Aetna Commercial	$38.10
Rate for Payer: Aetna Medicare Advantage	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.38
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.51
Rate for Payer: Oxford Commercial	$63.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$63.50

GLYCO PYRROLATE

Facility

$47.35

Hospital Charge Code	270656757
Hospital Revenue Code	270
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.16
Rate for Payer: Oxford Commercial	$23.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$23.68

GLYCO PYRROLATE

Facility

$47.35

Hospital Charge Code	270656757
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

GLYCOPYRROLATE 0.2MG/1ML

Facility

$40.06

Hospital Charge Code	606380019
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$6.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01

GLYCOPYRROLATE 0.2MG/1ML

Facility

$40.06

Hospital Charge Code	606380019
Hospital Revenue Code	250
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$20.03
Rate for Payer: Aetna Commercial	$12.02
Rate for Payer: Aetna Medicare Advantage	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.22
Rate for Payer: Cigna Commercial	$20.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.21
Rate for Payer: Oxford Commercial	$20.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.01
Rate for Payer: UnitedHealthcare Commercial	$20.03

GLYCOPYRROLATE 0.2 MG/ML INJ

Facility

$108.88

Service Code	NDC 517460125
Hospital Charge Code	60627431
Hospital Revenue Code	250
Min. Negotiated Rate	$14.15
Max. Negotiated Rate	$54.44
Rate for Payer: Aetna Commercial	$32.66
Rate for Payer: Aetna Medicare Advantage	$32.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.76
Rate for Payer: Cigna Commercial	$54.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.15
Rate for Payer: Oxford Commercial	$54.44
Rate for Payer: Qualcare PPO/HMO/WC	$16.33
Rate for Payer: UnitedHealthcare Commercial	$54.44

GLYCOPYRROLATE 0.2 MG/ML INJ

Facility

$108.88

Service Code	NDC 517460125
Hospital Charge Code	60627431
Hospital Revenue Code	250
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$16.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.33

GLYCOPYRROLATE 1 MG/5ML INJ

Facility

$73.70

Service Code	NDC 517460525
Hospital Charge Code	60627432
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

GLYCOPYRROLATE 1 MG/5ML INJ

Facility

$73.70

Service Code	NDC 517460525
Hospital Charge Code	60627432
Hospital Revenue Code	250
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$36.85
Rate for Payer: Aetna Commercial	$22.11
Rate for Payer: Aetna Medicare Advantage	$22.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$36.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.58
Rate for Payer: Oxford Commercial	$36.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$36.85

GLYCOPYRROLATE VIAL 0.2MG

Facility

$3.20

Hospital Charge Code	6022503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

GLYCOPYRROLATE VIAL 0.2MG

Facility

$3.20

Hospital Charge Code	6022503
Hospital Revenue Code	250
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

GLYCPYROLTE .2MGML 5M 5VL

Facility

$4.00

Hospital Charge Code	60635635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLYCPYROLTE .2MGML 5M 5VL

Facility

$4.00

Hospital Charge Code	60635635
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

Know your out-of-pocket cost for care.

All Charges