Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLYNASE/1.5MG/U/D

Facility

$4.82

Service Code	NDC 9034101
Hospital Charge Code	60634936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$1.45
Rate for Payer: Aetna Medicare Advantage	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.23
Rate for Payer: Cigna Commercial	$2.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.63
Rate for Payer: Oxford Commercial	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.72
Rate for Payer: UnitedHealthcare Commercial	$2.41

GLYNASE/1.5MG/U/D

Facility

$4.82

Service Code	NDC 9034101
Hospital Charge Code	60634936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Qualcare PPO/HMO/WC	$0.72

GLYNASE 6MG TAB

Facility

$22.58

Service Code	NDC 9344901
Hospital Charge Code	60635201
Hospital Revenue Code	250
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$3.39
Rate for Payer: Qualcare PPO/HMO/WC	$3.39

GLYNASE 6MG TAB

Facility

$22.58

Service Code	NDC 9344901
Hospital Charge Code	60635201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$11.29
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Aetna Medicare Advantage	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.76
Rate for Payer: Cigna Commercial	$11.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.94
Rate for Payer: Oxford Commercial	$11.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.39
Rate for Payer: UnitedHealthcare Commercial	$11.29

GLY-OXIDE 10%/60ML

Facility

$48.00

Hospital Charge Code	60633050
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

GLY-OXIDE 10%/60ML

Facility

$48.00

Hospital Charge Code	60633050
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
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	$6.24
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$24.00

GM1 AB (IGG,M)I

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990010A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GM1 AB (IGG,M)I

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990010A
Hospital Revenue Code	301
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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

GM1 AB (IGG,M) II

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39990010B
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
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	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

GM1 AB (IGG,M) II

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39990010B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GM-1 ANTIBODY I

Facility

$998.00

Service Code	HCPCS 83520
Hospital Charge Code	3038090A
Hospital Revenue Code	301
Min. Negotiated Rate	$149.70
Max. Negotiated Rate	$149.70
Rate for Payer: Qualcare PPO/HMO/WC	$149.70

GM-1 ANTIBODY I

Facility

$998.00

Service Code	HCPCS 83520
Hospital Charge Code	3038090A
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$149.70
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

GM-1 ANTIBODY II

Facility

$998.00

Service Code	HCPCS 83520
Hospital Charge Code	3038090B
Hospital Revenue Code	301
Min. Negotiated Rate	$149.70
Max. Negotiated Rate	$149.70
Rate for Payer: Qualcare PPO/HMO/WC	$149.70

GM-1 ANTIBODY II

Facility

$998.00

Service Code	HCPCS 83520
Hospital Charge Code	3038090B
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$149.70
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.70
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

GM-1 ANTIBODY III

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3038090C
Hospital Revenue Code	301
Min. Negotiated Rate	$175.65
Max. Negotiated Rate	$175.65
Rate for Payer: Qualcare PPO/HMO/WC	$175.65

GM-1 ANTIBODY III

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3038090C
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$175.65
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	$16.83
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	$152.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.65
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

GM-1 ANTIBODY IV

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3038090D
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$175.65
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	$16.83
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	$152.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.65
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

GM-1 ANTIBODY IV

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3038090D
Hospital Revenue Code	301
Min. Negotiated Rate	$175.65
Max. Negotiated Rate	$175.65
Rate for Payer: Qualcare PPO/HMO/WC	$175.65

GM-1 ANTIBODY V

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3038090E
Hospital Revenue Code	301
Min. Negotiated Rate	$175.65
Max. Negotiated Rate	$175.65
Rate for Payer: Qualcare PPO/HMO/WC	$175.65

GM-1 ANTIBODY V

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3038090E
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$175.65
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	$16.83
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	$152.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.65
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

GM-1 ANTIBODY VI

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3038090F
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$175.65
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	$16.83
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	$152.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.65
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

GM-1 ANTIBODY VI

Facility

$1,171.00

Service Code	HCPCS 83516
Hospital Charge Code	3038090F
Hospital Revenue Code	301
Min. Negotiated Rate	$175.65
Max. Negotiated Rate	$175.65
Rate for Payer: Qualcare PPO/HMO/WC	$175.65

GMI ELISA - MAG ANTIBODY PANEL

Facility

$448.00

Hospital Charge Code	3031598
Hospital Revenue Code	301
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$67.20

GMI ELISA - MAG ANTIBODY PANEL

Facility

$448.00

Hospital Charge Code	3031598
Hospital Revenue Code	301
Min. Negotiated Rate	$58.24
Max. Negotiated Rate	$224.00
Rate for Payer: Aetna Commercial	$134.40
Rate for Payer: Aetna Medicare Advantage	$134.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.24
Rate for Payer: Cigna Commercial	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.20
Rate for Payer: UnitedHealthcare Commercial	$114.00

GMI ELISA PANEL A

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3031598A
Hospital Revenue Code	301
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.28
Rate for Payer: Cigna Commercial	$17.27
Rate for Payer: Cigna Medicare Advantage	$8.63
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$18.31
Rate for Payer: Wellcare Medicare Advantage	$17.27

Know your out-of-pocket cost for care.

All Charges