Heights University Hospital

All Charges

Charge

Type

Setting

Price

GRANISETRON 1MG/1ML VIAL

Facility

$190.00

Hospital Charge Code	60635644
Hospital Revenue Code	250
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$95.00

GRANISETRON 1MG/D5W 50ML BAG

Facility

$1,423.40

Hospital Charge Code	60628141
Hospital Revenue Code	636
Min. Negotiated Rate	$213.51
Max. Negotiated Rate	$711.70
Rate for Payer: Aetna Commercial	$427.02
Rate for Payer: Aetna Medicare Advantage	$427.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.97
Rate for Payer: Cigna Commercial	$711.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.51

GRANISETRON 1MG/D5W 50ML BAG

Facility

$1,423.40

Hospital Charge Code	60628141
Hospital Revenue Code	636
Min. Negotiated Rate	$213.51
Max. Negotiated Rate	$344.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.51

GRANISETRON 1MG/NS 50ML BAG

Facility

$1,423.40

Hospital Charge Code	60628142
Hospital Revenue Code	636
Min. Negotiated Rate	$213.51
Max. Negotiated Rate	$344.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.51

GRANISETRON 1MG/NS 50ML BAG

Facility

$1,423.40

Hospital Charge Code	60628142
Hospital Revenue Code	636
Min. Negotiated Rate	$213.51
Max. Negotiated Rate	$711.70
Rate for Payer: Aetna Commercial	$427.02
Rate for Payer: Aetna Medicare Advantage	$427.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.97
Rate for Payer: Cigna Commercial	$711.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.51

GRANISETRON 1 MG TAB

Facility

$314.70

Hospital Charge Code	60628886
Hospital Revenue Code	636
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$157.35
Rate for Payer: Aetna Commercial	$94.41
Rate for Payer: Aetna Medicare Advantage	$94.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.25
Rate for Payer: Cigna Commercial	$157.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.16
Rate for Payer: Qualcare PPO/HMO/WC	$47.20

GRANISETRON 1 MG TAB

Facility

$314.70

Hospital Charge Code	60628886
Hospital Revenue Code	636
Min. Negotiated Rate	$47.20
Max. Negotiated Rate	$76.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.16
Rate for Payer: Qualcare PPO/HMO/WC	$47.20

GRANISETRON 1MG TAB

Facility

$193.00

Hospital Charge Code	60635020
Hospital Revenue Code	250
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$96.50
Rate for Payer: Aetna Commercial	$57.90
Rate for Payer: Aetna Medicare Advantage	$57.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.22
Rate for Payer: Cigna Commercial	$96.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.09
Rate for Payer: Oxford Commercial	$96.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.95
Rate for Payer: UnitedHealthcare Commercial	$96.50

GRANISETRON 1MG TAB

Facility

$15.00

Hospital Charge Code	60635647
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

GRANISETRON 1MG TAB

Facility

$15.00

Hospital Charge Code	60635647
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

GRANISETRON 1MG TAB

Facility

$193.00

Hospital Charge Code	60635020
Hospital Revenue Code	250
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

GRANISETRON HYDROCHLORIDE 1 MG

Facility

$395.43

Service Code	HCPCS Q0166
Hospital Charge Code	6063943201
Hospital Revenue Code	636
Min. Negotiated Rate	$59.31
Max. Negotiated Rate	$197.72
Rate for Payer: Aetna Commercial	$118.63
Rate for Payer: Aetna Medicare Advantage	$118.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.83
Rate for Payer: Cigna Commercial	$197.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.69
Rate for Payer: Qualcare PPO/HMO/WC	$59.31

GRANISETRON HYDROCHLORIDE 1 MG

Facility

$395.43

Service Code	HCPCS Q0166
Hospital Charge Code	6063943201
Hospital Revenue Code	636
Min. Negotiated Rate	$59.31
Max. Negotiated Rate	$95.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.69
Rate for Payer: Qualcare PPO/HMO/WC	$59.31

GRANULES 24MM 20CC

Facility

$14,140.00

Service Code	HCPCS C1765
Hospital Charge Code	270706183
Hospital Revenue Code	278
Min. Negotiated Rate	$2,121.00
Max. Negotiated Rate	$7,070.00
Rate for Payer: Aetna Commercial	$4,242.00
Rate for Payer: Aetna Medicare Advantage	$4,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,828.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,605.70
Rate for Payer: Cigna Commercial	$7,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,421.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,121.00

GRANULES 24MM 20CC

Facility

$14,140.00

Service Code	HCPCS C1765
Hospital Charge Code	270706183
Hospital Revenue Code	278
Min. Negotiated Rate	$2,121.00
Max. Negotiated Rate	$3,421.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,828.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,421.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,121.00

GRANULES <2MM 15CC

Facility

$11,310.00

Service Code	HCPCS C1889
Hospital Charge Code	270704065
Hospital Revenue Code	278
Min. Negotiated Rate	$1,696.50
Max. Negotiated Rate	$2,737.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,262.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,737.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,696.50

GRANULES <2MM 15CC

Facility

$11,310.00

Service Code	HCPCS C1889
Hospital Charge Code	270704065
Hospital Revenue Code	278
Min. Negotiated Rate	$1,696.50
Max. Negotiated Rate	$5,655.00
Rate for Payer: Aetna Commercial	$3,393.00
Rate for Payer: Aetna Medicare Advantage	$3,393.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,884.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,884.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,262.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,884.05
Rate for Payer: Cigna Commercial	$5,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,737.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,696.50

GRANULES CANCELLOUS SPONGIOSA

Facility

$1,517.65

Hospital Charge Code	270612036
Hospital Revenue Code	270
Min. Negotiated Rate	$227.65
Max. Negotiated Rate	$227.65
Rate for Payer: Qualcare PPO/HMO/WC	$227.65

GRANULES CANCELLOUS SPONGIOSA

Facility

$1,517.65

Hospital Charge Code	270612036
Hospital Revenue Code	270
Min. Negotiated Rate	$197.29
Max. Negotiated Rate	$758.83
Rate for Payer: Aetna Commercial	$455.30
Rate for Payer: Aetna Medicare Advantage	$455.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$387.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$387.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$387.00
Rate for Payer: Cigna Commercial	$758.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.29
Rate for Payer: Oxford Commercial	$758.83
Rate for Payer: Qualcare PPO/HMO/WC	$227.65
Rate for Payer: UnitedHealthcare Commercial	$758.83

GRANULES CHRONOS 2.8 5 6M/10CC

Facility

$2,874.00

Service Code	HCPCS C1713
Hospital Charge Code	270673440
Hospital Revenue Code	278
Min. Negotiated Rate	$431.10
Max. Negotiated Rate	$1,437.00
Rate for Payer: Aetna Commercial	$862.20
Rate for Payer: Aetna Medicare Advantage	$862.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$732.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$732.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$732.87
Rate for Payer: Cigna Commercial	$1,437.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.51
Rate for Payer: Qualcare PPO/HMO/WC	$431.10

GRANULES CHRONOS 2.8 5 6M/10CC

Facility

$2,874.00

Service Code	HCPCS C1713
Hospital Charge Code	270673440
Hospital Revenue Code	278
Min. Negotiated Rate	$431.10
Max. Negotiated Rate	$695.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$574.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.51
Rate for Payer: Qualcare PPO/HMO/WC	$431.10

GRANULES CO2 ABSORBENT

Facility

$99.25

Hospital Charge Code	270600652
Hospital Revenue Code	270
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$14.89
Rate for Payer: Qualcare PPO/HMO/WC	$14.89

GRANULES CO2 ABSORBENT

Facility

$99.25

Hospital Charge Code	270600652
Hospital Revenue Code	270
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$49.62
Rate for Payer: Aetna Commercial	$29.77
Rate for Payer: Aetna Medicare Advantage	$29.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.31
Rate for Payer: Cigna Commercial	$49.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$49.62
Rate for Payer: Qualcare PPO/HMO/WC	$14.89
Rate for Payer: UnitedHealthcare Commercial	$49.62

GRANULEX/120ML

Facility

$95.00

Hospital Charge Code	60633056
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

GRANULEX/120ML

Facility

$95.00

Hospital Charge Code	60633056
Hospital Revenue Code	250
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.35
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$47.50

Know your out-of-pocket cost for care.

All Charges