Heights University Hospital

All Charges

Charge

Type

Setting

Price

CRE WG 15-18MM/180/5.5F/G 5843

Facility

$1,089.15

Service Code	HCPCS C1726
Hospital Charge Code	270619660
Hospital Revenue Code	278
Min. Negotiated Rate	$163.37
Max. Negotiated Rate	$263.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.57
Rate for Payer: Qualcare PPO/HMO/WC	$163.37

CRE WG 15-18MM/180/5.5F/G 5843

Facility

$1,089.15

Service Code	HCPCS C1726
Hospital Charge Code	270619660
Hospital Revenue Code	278
Min. Negotiated Rate	$163.37
Max. Negotiated Rate	$544.58
Rate for Payer: Aetna Commercial	$326.75
Rate for Payer: Aetna Medicare Advantage	$326.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$277.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$277.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$277.73
Rate for Payer: Cigna Commercial	$544.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.57
Rate for Payer: Qualcare PPO/HMO/WC	$163.37

CRICOTHYROTOMY EMERGENCY

Facility

$746.00

Hospital Charge Code	270332334
Hospital Revenue Code	272
Min. Negotiated Rate	$111.90
Max. Negotiated Rate	$111.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.90

CRICOTHYROTOMY EMERGENCY

Facility

$746.00

Hospital Charge Code	270332334
Hospital Revenue Code	272
Min. Negotiated Rate	$96.98
Max. Negotiated Rate	$373.00
Rate for Payer: Aetna Commercial	$223.80
Rate for Payer: Aetna Medicare Advantage	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$190.23
Rate for Payer: Cigna Commercial	$373.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.98
Rate for Payer: Oxford Commercial	$373.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.90
Rate for Payer: UnitedHealthcare Commercial	$373.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4535604
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4502604
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4832604
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4822604
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4818604
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4504604
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4535604
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4511604
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4511604
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4818604
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4832604
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4822604
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4504604
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS ADULT/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4502604
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS CHILD/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4832613
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS CHILD/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4824613
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS CHILD/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4504613
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS CHILD/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4527613
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS CHILD/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4546613
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS CHILD/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4546613
Hospital Revenue Code	914
Min. Negotiated Rate	$130.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$300.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS CHILD/30MIN MEDICAID

Facility

$1,000.00

Service Code	HCPCS 90839
Hospital Charge Code	4504613
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

Know your out-of-pocket cost for care.

All Charges