Heights University Hospital

All Charges

Charge

Type

Setting

Price

SELF CARE D/C STATUS

Facility

$0.01

Service Code	HCPCS G8989GO
Hospital Charge Code	9109141
Hospital Revenue Code	430
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) NJ Health	$90.00
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

SELF CARE D/C STATUS

Facility

$0.01

Service Code	HCPCS G8989GO
Hospital Charge Code	9109141
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS

Facility

$0.01

Service Code	HCPCS G8989GO
Hospital Charge Code	84201149
Hospital Revenue Code	439
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CH

Facility

$0.01

Service Code	HCPCS G8989GPCH
Hospital Charge Code	84202055CH
Hospital Revenue Code	420
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CH

Facility

$0.01

Service Code	HCPCS G8989GOCH
Hospital Charge Code	74203109CH
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CH

Facility

$0.01

Service Code	HCPCS G8989GPCH
Hospital Charge Code	84202055CH
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CH

Facility

$0.01

Service Code	HCPCS G8989GOCH
Hospital Charge Code	74203109CH
Hospital Revenue Code	430
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CI

Facility

$0.01

Service Code	HCPCS G8989GOCI
Hospital Charge Code	74203109CI
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CI

Facility

$0.01

Service Code	HCPCS G8989GOCI
Hospital Charge Code	74203109CI
Hospital Revenue Code	430
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CI

Facility

$0.01

Service Code	HCPCS G8989GPCI
Hospital Charge Code	84202055CI
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CI

Facility

$0.01

Service Code	HCPCS G8989GPCI
Hospital Charge Code	84202055CI
Hospital Revenue Code	420
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CJ

Facility

$0.01

Service Code	HCPCS G8989GOCJ
Hospital Charge Code	74203109CJ
Hospital Revenue Code	430
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CJ

Facility

$0.01

Service Code	HCPCS G8989GPCJ
Hospital Charge Code	84202055CJ
Hospital Revenue Code	420
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CJ

Facility

$0.01

Service Code	HCPCS G8989GPCJ
Hospital Charge Code	84202055CJ
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CJ

Facility

$0.01

Service Code	HCPCS G8989GOCJ
Hospital Charge Code	74203109CJ
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CK

Facility

$0.01

Service Code	HCPCS G8989GOCK
Hospital Charge Code	74203109CK
Hospital Revenue Code	430
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CK

Facility

$0.01

Service Code	HCPCS G8989GPCK
Hospital Charge Code	84202055CK
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CK

Facility

$0.01

Service Code	HCPCS G8989GOCK
Hospital Charge Code	74203109CK
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CK

Facility

$0.01

Service Code	HCPCS G8989GPCK
Hospital Charge Code	84202055CK
Hospital Revenue Code	420
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CL

Facility

$0.01

Service Code	HCPCS G8989GOCL
Hospital Charge Code	74203109CL
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CL

Facility

$0.01

Service Code	HCPCS G8989GPCL
Hospital Charge Code	84202055CL
Hospital Revenue Code	420
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CL

Facility

$0.01

Service Code	HCPCS G8989GOCL
Hospital Charge Code	74203109CL
Hospital Revenue Code	430
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CL

Facility

$0.01

Service Code	HCPCS G8989GPCL
Hospital Charge Code	84202055CL
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE D/C STATUS CM

Facility

$0.01

Service Code	HCPCS G8989GPCM
Hospital Charge Code	84202055CM
Hospital Revenue Code	420
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) NJ Health	$90.00
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

SELF CARE D/C STATUS CM

Facility

$0.01

Service Code	HCPCS G8989GOCM
Hospital Charge Code	74203109CM
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

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