Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

E&M LEVEL II NEW PATIENT20MINS

Facility

$367.85

Hospital Charge Code	84504090
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 NEW PATIENT20MINS

Facility

$367.85

Hospital Charge Code	84504090
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 NP 20 MINS

Facility

$333.00

Service Code	HCPCS 99202
Hospital Charge Code	94810195
Hospital Revenue Code	510
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$49.95
Rate for Payer: Qualcare PPO/HMO/WC	$49.95

E&M LEVEL II NP 20 MINS

Facility

$333.00

Service Code	HCPCS 99202
Hospital Charge Code	94810195
Hospital Revenue Code	510
Min. Negotiated Rate	$43.29
Max. Negotiated Rate	$99.90
Rate for Payer: Aetna Commercial	$99.90
Rate for Payer: Aetna Medicare Advantage	$99.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.92
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.29
Rate for Payer: Qualcare PPO/HMO/WC	$49.95

E&M LEVEL I NEW PATIENT10 MINS

Facility

$433.40

Hospital Charge Code	84504085
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 I NEW PATIENT10 MINS

Facility

$433.40

Hospital Charge Code	84504085
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 I NP 10 MINS

Facility

$1,879.97

Service Code	HCPCS 99201
Hospital Charge Code	94810190
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

E&M LEVEL I NP 10 MINS

Facility

$1,879.97

Service Code	HCPCS 99201
Hospital Charge Code	94810190
Hospital Revenue Code	900
Min. Negotiated Rate	$244.40
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$563.99
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$939.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.40
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

E&M LEVEL IV 45 MINS

Facility

$800.80

Service Code	HCPCS 99204
Hospital Charge Code	87504095
Hospital Revenue Code	513
Min. Negotiated Rate	$104.10
Max. Negotiated Rate	$240.24
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

E&M LEVEL IV 45 MINS

Facility

$800.80

Service Code	HCPCS 99204
Hospital Charge Code	87504095
Hospital Revenue Code	513
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84517035
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 IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84517035
Hospital Revenue Code	513
Min. Negotiated Rate	$83.39
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	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84509035
Hospital Revenue Code	513
Min. Negotiated Rate	$83.39
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	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84518035
Hospital Revenue Code	513
Min. Negotiated Rate	$83.39
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	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84518035
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 IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84509035
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 IV ESTAB. 25 MINS

Facility

$484.05

Hospital Charge Code	84310180
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 IV ESTAB. 25 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	84517045
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 IV ESTAB. 25 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	84518045
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 IV ESTAB. 25 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	84518045
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	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL IV ESTAB. 25 MINS

Facility

$800.80

Service Code	HCPCS 99214
Hospital Charge Code	87504120
Hospital Revenue Code	513
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

E&M LEVEL IV ESTAB. 25 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	84509045
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 IV ESTAB. 25 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	84517045
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	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL IV ESTAB. 25 MINS

Facility

$484.05

Hospital Charge Code	84310180
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

Know your out-of-pocket cost for care.

All Charges