Heights University Hospital

All Charges

Charge

Type

Setting

Price

ESTABLISHED BRAIN CAVITY SHUNT

Facility

$18,183.00

Service Code	HCPCS 62223
Hospital Charge Code	1600000643
Hospital Revenue Code	360
Min. Negotiated Rate	$2,727.45
Max. Negotiated Rate	$2,727.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,727.45

ESTABLISHED BRAIN CAVITY SHUNT

Facility

$18,183.00

Service Code	HCPCS 62223
Hospital Charge Code	1600000643
Hospital Revenue Code	360
Min. Negotiated Rate	$1,127.18
Max. Negotiated Rate	$6,873.00
Rate for Payer: Aetna Commercial	$5,454.90
Rate for Payer: Aetna Medicare Advantage	$5,454.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,636.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,636.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,636.66
Rate for Payer: Cigna Commercial	$1,127.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,363.79
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,727.45
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

ESTABLISH PATIENT SAME DAY

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	3408040
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$95.89
Rate for Payer: Aetna Commercial	$95.89
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

ESTABLISH PATIENT SAME DAY

Facility

$319.65

Service Code	HCPCS 99211
Hospital Charge Code	3408040
Hospital Revenue Code	510
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4535716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$477.85

Service Code	HCPCS 99212
Hospital Charge Code	85000850
Hospital Revenue Code	510
Min. Negotiated Rate	$71.68
Max. Negotiated Rate	$71.68
Rate for Payer: Qualcare PPO/HMO/WC	$71.68

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	9800365
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4535716
Hospital Revenue Code	913
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
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	$89.25
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4818716
Hospital Revenue Code	913
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
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	$89.25
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4504716
Hospital Revenue Code	913
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
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	$89.25
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4518716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$610.00

Service Code	HCPCS 99212
Hospital Charge Code	421599212
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	87502230
Hospital Revenue Code	510
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4824716
Hospital Revenue Code	913
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
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	$89.25
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4504716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$610.00

Service Code	HCPCS 99212
Hospital Charge Code	421099212
Hospital Revenue Code	510
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4502716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	485099212
Hospital Revenue Code	510
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$133.80
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4511716
Hospital Revenue Code	513
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	74308300
Hospital Revenue Code	514
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	83652405
Hospital Revenue Code	514
Min. Negotiated Rate	$30.68
Max. Negotiated Rate	$70.80
Rate for Payer: Aetna Commercial	$70.80
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4515716
Hospital Revenue Code	913
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
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	$89.25
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4822716
Hospital Revenue Code	913
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
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	$89.25
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84208270
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$477.85

Service Code	HCPCS 99212
Hospital Charge Code	85000850
Hospital Revenue Code	510
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$143.35
Rate for Payer: Aetna Commercial	$143.35
Rate for Payer: Aetna Medicare Advantage	$143.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.85
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.12
Rate for Payer: Qualcare PPO/HMO/WC	$71.68

Know your out-of-pocket cost for care.

All Charges