Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	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	4517613
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	4517613
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	4535613
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	4824613
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	4511613
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	4515613
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	4511613
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	4515613
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	$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	4832613
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	4518613
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	4535613
Hospital Revenue Code	914
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CRISIS INTERVNT 1/2 - 1-1/2HR*

Facility

$216.00

Hospital Charge Code	7500127
Hospital Revenue Code	914
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna Commercial	$64.80
Rate for Payer: Aetna Medicare Advantage	$64.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.08
Rate for Payer: Cigna Commercial	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.08
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

CRISIS INTERVNT 1/2 - 1-1/2HR*

Facility

$216.00

Hospital Charge Code	7500127
Hospital Revenue Code	914
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

CRISIS INTERVNT UP TO 1/2HR***

Facility

$135.00

Hospital Charge Code	7500119
Hospital Revenue Code	914
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

CRISIS INTERVNT UP TO 1/2HR***

Facility

$135.00

Hospital Charge Code	7500119
Hospital Revenue Code	914
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

CRISIS PSYCHOTHERAPY

Facility

$550.00

Service Code	HCPCS 90839
Hospital Charge Code	87506015
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CRISIS PSYCHOTHERAPY

Facility

$550.00

Service Code	HCPCS 90839
Hospital Charge Code	84504050
Hospital Revenue Code	914
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
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	$140.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CRISIS PSYCHOTHERAPY

Facility

$550.00

Service Code	HCPCS 90839
Hospital Charge Code	87506015
Hospital Revenue Code	914
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
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	$140.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CRISIS PSYCHOTHERAPY

Facility

$550.00

Service Code	HCPCS 90839
Hospital Charge Code	84504050
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CRISIS PSYCHOTHERAPY 60 MINS

Facility

$550.00

Service Code	HCPCS 90839
Hospital Charge Code	84517017
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CRISIS PSYCHOTHERAPY 60 MINS

Facility

$550.00

Service Code	HCPCS 90839
Hospital Charge Code	84518017
Hospital Revenue Code	914
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
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	$140.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

Know your out-of-pocket cost for care.

All Charges