Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

$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	84517041
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 PAT 10MINS

Facility

$367.85

Hospital Charge Code	84504115
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 PAT 10MINS

Facility

$367.85

Hospital Charge Code	84504115
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 EST PT 10MINS

Facility

$1,296.00

Service Code	HCPCS 99212
Hospital Charge Code	94810220
Hospital Revenue Code	914
Min. Negotiated Rate	$33.58
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	$73.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$33.58
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	$49.91

E&M LEVEL II EST PT 10MINS

Facility

$1,296.00

Service Code	HCPCS 99212
Hospital Charge Code	94810220
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 III 30MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84509033
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 III 30MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84518033
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 III 30MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84518033
Hospital Revenue Code	513
Min. Negotiated Rate	$62.93
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	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL III 30MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84509033
Hospital Revenue Code	513
Min. Negotiated Rate	$62.93
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	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL III ESTAB. 15 MINS

Facility

$641.45

Service Code	HCPCS 99213
Hospital Charge Code	87504115
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL III ESTAB. 15 MINS

Facility

$641.45

Service Code	HCPCS 99213
Hospital Charge Code	87504115
Hospital Revenue Code	513
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$192.44
Rate for Payer: Aetna Commercial	$192.44
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84509043
Hospital Revenue Code	513
Min. Negotiated Rate	$47.82
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	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84509043
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 III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84517043
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 III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84517043
Hospital Revenue Code	513
Min. Negotiated Rate	$47.82
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	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84518043
Hospital Revenue Code	513
Min. Negotiated Rate	$47.82
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	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84518043
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 IIIESTAB PAT 15MINS

Facility

$367.85

Hospital Charge Code	84504120
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 IIIESTAB PAT 15MINS

Facility

$367.85

Hospital Charge Code	84504120
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 IIINEW PAT 30MINS

Facility

$484.05

Hospital Charge Code	84504095
Hospital Revenue Code	513
Min. Negotiated Rate	$62.93
Max. Negotiated Rate	$242.03
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	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL IIINEW PAT 30MINS

Facility

$484.05

Hospital Charge Code	84504095
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 III NP 30 MINS

Facility

$578.00

Service Code	HCPCS 99203
Hospital Charge Code	94810200
Hospital Revenue Code	513
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

Know your out-of-pocket cost for care.

All Charges