Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	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 PAT 25MINS

Facility

$484.05

Hospital Charge Code	84504125
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 PAT 25MINS

Facility

$484.05

Hospital Charge Code	84504125
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 IV- NEW PAT 45 MINS

Facility

$641.45

Hospital Charge Code	84504100
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- NEW PAT 45 MINS

Facility

$641.45

Hospital Charge Code	84504100
Hospital Revenue Code	513
Min. Negotiated Rate	$83.39
Max. Negotiated Rate	$320.73
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	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV NP 45MINS

Facility

$284.00

Service Code	HCPCS 99204
Hospital Charge Code	94810205
Hospital Revenue Code	513
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$42.60
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

E&M LEVEL IV NP 45MINS

Facility

$284.00

Service Code	HCPCS 99204
Hospital Charge Code	94810205
Hospital Revenue Code	513
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$126.45
Rate for Payer: Aetna Commercial	$85.20
Rate for Payer: Aetna Medicare Advantage	$85.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.42
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.92
Rate for Payer: Qualcare PPO/HMO/WC	$42.60

E&M LEVEL V 60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	84517037
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V 60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	84517037
Hospital Revenue Code	513
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$263.30
Rate for Payer: Aetna Commercial	$263.30
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.09
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V 60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	84509037
Hospital Revenue Code	513
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$263.30
Rate for Payer: Aetna Commercial	$263.30
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.09
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V 60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	84509037
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V 60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	84518037
Hospital Revenue Code	513
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$263.30
Rate for Payer: Aetna Commercial	$263.30
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.09
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V 60 MINS

Facility

$877.65

Service Code	HCPCS 99205
Hospital Charge Code	84518037
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

E&M LEVEL V 60 MINS

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	87504100
Hospital Revenue Code	513
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

E&M LEVEL V 60 MINS

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	87504100
Hospital Revenue Code	513
Min. Negotiated Rate	$136.36
Max. Negotiated Rate	$314.68
Rate for Payer: Aetna Commercial	$314.68
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.36
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84509047
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	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84517047
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 V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84517047
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	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84518047
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 V ESTAB. 40 MINS

Facility

$641.45

Hospital Charge Code	84310185
Hospital Revenue Code	513
Min. Negotiated Rate	$83.39
Max. Negotiated Rate	$320.73
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	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Hospital Charge Code	84310185
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 V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84509047
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 V ESTAB. 40 MINS

Facility

$1,048.92

Service Code	HCPCS 99215
Hospital Charge Code	87504125
Hospital Revenue Code	513
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

E&M LEVEL V ESTAB. 40 MINS

Facility

$1,048.92

Service Code	HCPCS 99215
Hospital Charge Code	87504125
Hospital Revenue Code	513
Min. Negotiated Rate	$135.96
Max. Negotiated Rate	$314.68
Rate for Payer: Aetna Commercial	$314.68
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.36
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

Know your out-of-pocket cost for care.

All Charges