Heights University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL I ESTAB. 5 MINS

Facility

$550.00

Service Code	HCPCS 99211
Hospital Charge Code	84509039
Hospital Revenue Code	513
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

E&M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	84517039
Hospital Revenue Code	513
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$85.02
Rate for Payer: Aetna Commercial	$85.02
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.84
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL I ESTAB. 5 MINS

Facility

$367.85

Service Code	HCPCS 99211
Hospital Charge Code	87504105
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 I ESTAB. 5 MINS

Facility

$550.00

Service Code	HCPCS 99211
Hospital Charge Code	84509039
Hospital Revenue Code	513
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$165.00
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) PPO	$140.25
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

E&M LEVEL I ESTAB. 5 MINS

Facility

$367.85

Service Code	HCPCS 99211
Hospital Charge Code	87504105
Hospital Revenue Code	513
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$110.36
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	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL I -ESTAB PAT 5MINS

Facility

$283.40

Hospital Charge Code	84504110
Hospital Revenue Code	513
Min. Negotiated Rate	$36.84
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$85.02
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.84
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL I -ESTAB PAT 5MINS

Facility

$283.40

Hospital Charge Code	84504110
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL I EST PAT 5 MINS

Facility

$1,296.00

Service Code	HCPCS 99211
Hospital Charge Code	98410215
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

E&M LEVEL I EST PAT 5 MINS

Facility

$1,296.00

Service Code	HCPCS 99211
Hospital Charge Code	98410215
Hospital Revenue Code	914
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$388.80
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) NJ Health	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25.68

E&M LEVEL I EST PAT 5MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	87506065
Hospital Revenue Code	513
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$85.02
Rate for Payer: Aetna Commercial	$85.02
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.84
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL I EST PAT 5MINS

Facility

$283.40

Service Code	HCPCS 99211
Hospital Charge Code	87506065
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

E&M LEVEL II 20 MINS

Facility

$484.05

Service Code	HCPCS 99202
Hospital Charge Code	87504085
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL II 20 MINS

Facility

$364.85

Service Code	HCPCS 99202
Hospital Charge Code	84518031
Hospital Revenue Code	513
Min. Negotiated Rate	$54.73
Max. Negotiated Rate	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$54.73

E&M LEVEL II 20 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84509031
Hospital Revenue Code	513
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$110.36
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	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL II 20 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84517031
Hospital Revenue Code	513
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$110.36
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	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL II 20 MINS

Facility

$484.05

Service Code	HCPCS 99202
Hospital Charge Code	87504085
Hospital Revenue Code	513
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$145.22
Rate for Payer: Aetna Commercial	$145.22
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL II 20 MINS

Facility

$364.85

Service Code	HCPCS 99202
Hospital Charge Code	84518031
Hospital Revenue Code	513
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$109.45
Rate for Payer: Aetna Commercial	$109.45
Rate for Payer: Aetna Medicare Advantage	$109.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.04
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.43
Rate for Payer: Qualcare PPO/HMO/WC	$54.73

E&M LEVEL II 20 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84509031
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 II 20 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84517031
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 II ESTAB. 10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	84518041
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 II ESTAB. 10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	84517041
Hospital Revenue Code	513
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$110.36
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	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL II ESTAB. 10 MINS

Facility

$484.05

Service Code	HCPCS 99212
Hospital Charge Code	87504110
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL II ESTAB. 10 MINS

Facility

$367.85

Hospital Charge Code	84310170
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 II ESTAB. 10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	84509041
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 II ESTAB. 10 MINS

Facility

$484.05

Service Code	HCPCS 99212
Hospital Charge Code	87504110
Hospital Revenue Code	513
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$145.22
Rate for Payer: Aetna Commercial	$145.22
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

Know your out-of-pocket cost for care.

All Charges