Heights University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL 10 MINS

Facility

$433.40

Service Code	HCPCS 99201
Hospital Charge Code	84511029
Hospital Revenue Code	513
Min. Negotiated Rate	$56.34
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$130.02
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.34
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

E&M LEVEL 10 MINS

Facility

$433.40

Service Code	HCPCS 99201
Hospital Charge Code	84509029
Hospital Revenue Code	513
Min. Negotiated Rate	$56.34
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$130.02
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.34
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

E&M LEVEL 1 10 MINS

Facility

$367.85

Service Code	HCPCS 99201
Hospital Charge Code	87504080
Hospital Revenue Code	513
Min. Negotiated Rate	$47.82
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$110.36
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL 1 10 MINS

Facility

$367.85

Service Code	HCPCS 99201
Hospital Charge Code	87504080
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL 111 ESTAB. MINS

Facility

$367.85

Hospital Charge Code	84310175
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL 111 ESTAB. MINS

Facility

$367.85

Hospital Charge Code	84310175
Hospital Revenue Code	513
Min. Negotiated Rate	$47.82
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$110.36
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL 1 NEW PATIENT10 MINS

Facility

$433.40

Service Code	HCPCS 99201
Hospital Charge Code	87506040
Hospital Revenue Code	513
Min. Negotiated Rate	$56.34
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$130.02
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.34
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

E&M LEVEL 1 NEW PATIENT10 MINS

Facility

$433.40

Service Code	HCPCS 99201
Hospital Charge Code	87506040
Hospital Revenue Code	513
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

E/M LEVEL 2

Facility

$679.20

Service Code	HCPCS 99212
Hospital Charge Code	403699212
Hospital Revenue Code	761
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$339.60
Rate for Payer: Aetna Commercial	$203.76
Rate for Payer: Aetna Medicare Advantage	$203.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.20
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.30
Rate for Payer: Oxford Commercial	$339.60
Rate for Payer: Qualcare PPO/HMO/WC	$101.88
Rate for Payer: UnitedHealthcare Commercial	$339.60

E/M LEVEL 2

Facility

$679.20

Service Code	HCPCS 99212
Hospital Charge Code	403699212
Hospital Revenue Code	761
Min. Negotiated Rate	$101.88
Max. Negotiated Rate	$101.88
Rate for Payer: Qualcare PPO/HMO/WC	$101.88

E&M LEVEL 3 >20 MINS

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4511710
Hospital Revenue Code	513
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL 3 >20 MINS

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4511710
Hospital Revenue Code	513
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4504710
Hospital Revenue Code	913
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4502710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4832710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4504710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4822710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4535710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4527710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4518710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4510710
Hospital Revenue Code	913
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4515710
Hospital Revenue Code	913
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4546710
Hospital Revenue Code	913
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4824710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4502710
Hospital Revenue Code	913
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges