Heights University Hospital

All Charges

Charge

Type

Setting

Price

CNS INDIVIDUAL THERAPY 45-50

Facility

$1,017.00

Service Code	HCPCS 90806
Hospital Charge Code	94810025
Hospital Revenue Code	914
Min. Negotiated Rate	$132.21
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna Commercial	$305.10
Rate for Payer: Aetna Medicare Advantage	$305.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.33
Rate for Payer: Cigna Commercial	$508.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.21
Rate for Payer: Qualcare PPO/HMO/WC	$152.55

CNS INDIV THERAPY 1UNIT/30MIN

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	94810015
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

CNS INDIV THERAPY 1UNIT/30MIN

Facility

$1,296.00

Service Code	HCPCS 90804
Hospital Charge Code	94810015
Hospital Revenue Code	914
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

CNS IND THRPY W/MED MGT 20-30

Facility

$381.00

Service Code	HCPCS 90805
Hospital Charge Code	94810020
Hospital Revenue Code	914
Min. Negotiated Rate	$57.15
Max. Negotiated Rate	$57.15
Rate for Payer: Qualcare PPO/HMO/WC	$57.15

CNS IND THRPY W/MED MGT 20-30

Facility

$381.00

Service Code	HCPCS 90805
Hospital Charge Code	94810020
Hospital Revenue Code	914
Min. Negotiated Rate	$49.53
Max. Negotiated Rate	$190.50
Rate for Payer: Aetna Commercial	$114.30
Rate for Payer: Aetna Medicare Advantage	$114.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.16
Rate for Payer: Cigna Commercial	$190.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.53
Rate for Payer: Qualcare PPO/HMO/WC	$57.15

CNS IND THRPY W/MED MGT 45-50

Facility

$477.00

Service Code	HCPCS 90807
Hospital Charge Code	94810030
Hospital Revenue Code	914
Min. Negotiated Rate	$71.55
Max. Negotiated Rate	$71.55
Rate for Payer: Qualcare PPO/HMO/WC	$71.55

CNS IND THRPY W/MED MGT 45-50

Facility

$477.00

Service Code	HCPCS 90807
Hospital Charge Code	94810030
Hospital Revenue Code	914
Min. Negotiated Rate	$62.01
Max. Negotiated Rate	$238.50
Rate for Payer: Aetna Commercial	$143.10
Rate for Payer: Aetna Medicare Advantage	$143.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.64
Rate for Payer: Cigna Commercial	$238.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.01
Rate for Payer: Qualcare PPO/HMO/WC	$71.55

CNS INITIAL EVALUATION

Facility

$1,879.97

Service Code	HCPCS 90801
Hospital Charge Code	94810010
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

CNS INITIAL EVALUATION

Facility

$1,879.97

Service Code	HCPCS 90801
Hospital Charge Code	94810010
Hospital Revenue Code	900
Min. Negotiated Rate	$244.40
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$563.99
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$939.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.40
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

CNS MED MONITOR 2 UNITS/30MIN

Facility

$473.90

Service Code	HCPCS 90862
Hospital Charge Code	94810065
Hospital Revenue Code	914
Min. Negotiated Rate	$61.61
Max. Negotiated Rate	$236.95
Rate for Payer: Aetna Commercial	$142.17
Rate for Payer: Aetna Medicare Advantage	$142.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.84
Rate for Payer: Cigna Commercial	$236.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.61
Rate for Payer: Qualcare PPO/HMO/WC	$71.08

CNS MED MONITOR 2 UNITS/30MIN

Facility

$473.90

Service Code	HCPCS 90862
Hospital Charge Code	94810065
Hospital Revenue Code	914
Min. Negotiated Rate	$71.08
Max. Negotiated Rate	$71.08
Rate for Payer: Qualcare PPO/HMO/WC	$71.08

CNS MULTIPLE FAMILY THERAPY

Facility

$286.00

Service Code	HCPCS 90849
Hospital Charge Code	94810045
Hospital Revenue Code	916
Min. Negotiated Rate	$42.90
Max. Negotiated Rate	$42.90
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

CNS MULTIPLE FAMILY THERAPY

Facility

$286.00

Service Code	HCPCS 90849
Hospital Charge Code	94810045
Hospital Revenue Code	916
Min. Negotiated Rate	$37.18
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$85.80
Rate for Payer: Aetna Medicare Advantage	$85.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.18
Rate for Payer: Qualcare PPO/HMO/WC	$42.90

CNS PA-GROUP

Facility

$183.00

Service Code	HCPCS 90857
Hospital Charge Code	94810055
Hospital Revenue Code	915
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

CNS PA-GROUP

Facility

$183.00

Service Code	HCPCS 90857
Hospital Charge Code	94810055
Hospital Revenue Code	915
Min. Negotiated Rate	$23.79
Max. Negotiated Rate	$91.50
Rate for Payer: Aetna Commercial	$54.90
Rate for Payer: Aetna Medicare Advantage	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.66
Rate for Payer: Cigna Commercial	$91.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.79
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

CNS PHARMACOLOGIC MANAGEMENT

Facility

$473.90

Service Code	HCPCS 90863
Hospital Charge Code	94810060
Hospital Revenue Code	914
Min. Negotiated Rate	$61.61
Max. Negotiated Rate	$236.95
Rate for Payer: Aetna Commercial	$142.17
Rate for Payer: Aetna Medicare Advantage	$142.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.84
Rate for Payer: Cigna Commercial	$236.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.61
Rate for Payer: Qualcare PPO/HMO/WC	$71.08

CNS PHARMACOLOGIC MANAGEMENT

Facility

$473.90

Service Code	HCPCS 90863
Hospital Charge Code	94810060
Hospital Revenue Code	914
Min. Negotiated Rate	$71.08
Max. Negotiated Rate	$71.08
Rate for Payer: Qualcare PPO/HMO/WC	$71.08

CNS PSC-WF-INDIVID 45-50

Facility

$1,017.00

Service Code	HCPCS 90806HF
Hospital Charge Code	94810095
Hospital Revenue Code	914
Min. Negotiated Rate	$152.55
Max. Negotiated Rate	$152.55
Rate for Payer: Qualcare PPO/HMO/WC	$152.55

CNS PSC-WF-INDIVID 45-50

Facility

$1,017.00

Service Code	HCPCS 90806HF
Hospital Charge Code	94810095
Hospital Revenue Code	914
Min. Negotiated Rate	$132.21
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna Commercial	$305.10
Rate for Payer: Aetna Medicare Advantage	$305.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.33
Rate for Payer: Cigna Commercial	$508.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.21
Rate for Payer: Qualcare PPO/HMO/WC	$152.55

CNS PSC-WF-IND PSYCH TX 20-30

Facility

$1,296.00

Service Code	HCPCS 90804HF
Hospital Charge Code	94810090
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

CNS PSC-WF-IND PSYCH TX 20-30

Facility

$1,296.00

Service Code	HCPCS 90804HF
Hospital Charge Code	94810090
Hospital Revenue Code	914
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

CNS PSC-WF-INITAL INTAKE EVAL

Facility

$1,879.97

Service Code	HCPCS 9080152
Hospital Charge Code	94810075
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

CNS PSC-WF-INITAL INTAKE EVAL

Facility

$1,879.97

Service Code	HCPCS 9080152
Hospital Charge Code	94810075
Hospital Revenue Code	900
Min. Negotiated Rate	$244.40
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$563.99
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$939.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.40
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

CNS PSC-WF IOP-GROUP

Facility

$188.00

Service Code	HCPCS 90857HF
Hospital Charge Code	94810100
Hospital Revenue Code	915
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$94.00
Rate for Payer: Aetna Commercial	$56.40
Rate for Payer: Aetna Medicare Advantage	$56.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.94
Rate for Payer: Cigna Commercial	$94.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.44
Rate for Payer: Qualcare PPO/HMO/WC	$28.20

CNS PSC-WF IOP-GROUP

Facility

$188.00

Service Code	HCPCS 90857HF
Hospital Charge Code	94810100
Hospital Revenue Code	915
Min. Negotiated Rate	$28.20
Max. Negotiated Rate	$28.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.20

Know your out-of-pocket cost for care.

All Charges