Heights University Hospital

All Charges

Charge

Type

Setting

Price

ATROVENT INH SOL 0.02%

Facility

$7.00

Hospital Charge Code	60635140
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.91
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$3.50

ATROVENT INH SOL 0.02%

Facility

$7.00

Hospital Charge Code	60635140
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

ATTACHMENT 5.5 ROD

Facility

$2,175.00

Hospital Charge Code	270698379
Hospital Revenue Code	272
Min. Negotiated Rate	$282.75
Max. Negotiated Rate	$1,087.50
Rate for Payer: Aetna Commercial	$652.50
Rate for Payer: Aetna Medicare Advantage	$652.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$554.62
Rate for Payer: Cigna Commercial	$1,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$282.75
Rate for Payer: Oxford Commercial	$1,087.50
Rate for Payer: Qualcare PPO/HMO/WC	$326.25
Rate for Payer: UnitedHealthcare Commercial	$1,087.50

ATTACHMENT 5.5 ROD

Facility

$2,175.00

Hospital Charge Code	270698379
Hospital Revenue Code	272
Min. Negotiated Rate	$326.25
Max. Negotiated Rate	$326.25
Rate for Payer: Qualcare PPO/HMO/WC	$326.25

ATTAPULGITE BELLADONNA LQ

Facility

$40.35

Hospital Charge Code	60628113
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$6.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.05

ATTAPULGITE BELLADONNA LQ

Facility

$40.35

Hospital Charge Code	60628113
Hospital Revenue Code	250
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$20.18
Rate for Payer: Aetna Commercial	$12.11
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.29
Rate for Payer: Cigna Commercial	$20.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.25
Rate for Payer: Oxford Commercial	$20.18
Rate for Payer: Qualcare PPO/HMO/WC	$6.05
Rate for Payer: UnitedHealthcare Commercial	$20.18

ATTEN CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9165GN
Hospital Charge Code	84201050
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTEN CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9165GN
Hospital Charge Code	84201050
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ATTEN CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9165GN
Hospital Charge Code	84201168
Hospital Revenue Code	449
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTEN CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9165GN
Hospital Charge Code	84201168
Hospital Revenue Code	449
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ATTEN D/C STATUS

Facility

$0.01

Service Code	HCPCS G9167GN
Hospital Charge Code	84201060
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ATTEN D/C STATUS

Facility

$0.01

Service Code	HCPCS G9167GN
Hospital Charge Code	84201170
Hospital Revenue Code	449
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ATTEN D/C STATUS

Facility

$0.01

Service Code	HCPCS G9167GN
Hospital Charge Code	84201060
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTEN D/C STATUS

Facility

$0.01

Service Code	HCPCS G9167GN
Hospital Charge Code	84201170
Hospital Revenue Code	449
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATT E/N/E/L,D 10 SQ CM

Facility

$16,286.20

Service Code	HCPCS 14060
Hospital Charge Code	16000291
Hospital Revenue Code	360
Min. Negotiated Rate	$2,442.93
Max. Negotiated Rate	$2,442.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93

ATT E/N/E/L,D 10 SQ CM

Facility

$16,286.20

Service Code	HCPCS 14060
Hospital Charge Code	16000291
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$4,913.48
Rate for Payer: Aetna Commercial	$4,885.86
Rate for Payer: Aetna Medicare Advantage	$4,885.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,152.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,152.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,152.98
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.21
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

ATTEN GOAL STATUS

Facility

$0.01

Service Code	HCPCS G9166GN
Hospital Charge Code	84201169
Hospital Revenue Code	449
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTEN GOAL STATUS

Facility

$0.01

Service Code	HCPCS G9166GN
Hospital Charge Code	84201055
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTEN GOAL STATUS

Facility

$0.01

Service Code	HCPCS G9166GN
Hospital Charge Code	84201169
Hospital Revenue Code	449
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ATTEN GOAL STATUS

Facility

$0.01

Service Code	HCPCS G9166GN
Hospital Charge Code	84201055
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ATTENTION CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G9165GNCH
Hospital Charge Code	74204071CH
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ATTENTION CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G9165GNCH
Hospital Charge Code	74204071CH
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTENTION CURRENT STATUS CI

Facility

$0.01

Service Code	HCPCS G9165GNCI
Hospital Charge Code	74204071CI
Hospital Revenue Code	440
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

ATTENTION CURRENT STATUS CI

Facility

$0.01

Service Code	HCPCS G9165GNCI
Hospital Charge Code	74204071CI
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

ATTENTION CURRENT STATUS CJ

Facility

$0.01

Service Code	HCPCS G9165GNCJ
Hospital Charge Code	74204071CJ
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges