Heights University Hospital

All Charges

Charge

Type

Setting

Price

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4818717
Hospital Revenue Code	913
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$81.64

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4502717
Hospital Revenue Code	913
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$81.64

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	485099213
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4509717
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84208275
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4832717
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4832717
Hospital Revenue Code	913
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$81.64

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	93950147
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4510717
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4824717
Hospital Revenue Code	913
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$81.64

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4818717
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	9800375
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	421099213
Hospital Revenue Code	510
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$196.56
Rate for Payer: Aetna Commercial	$196.56
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.18
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4517717
Hospital Revenue Code	913
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$81.64

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	45117170
Hospital Revenue Code	513
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ESTAB PATIENT LEV 3 >=20 MINS

Facility

$450.00

Service Code	HCPCS 99213
Hospital Charge Code	4546717
Hospital Revenue Code	913
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$81.64

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4832718
Hospital Revenue Code	913
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$179.78
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) NJ Health	$179.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$118.08

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	485599214
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	485599214
Hospital Revenue Code	510
Min. Negotiated Rate	$91.37
Max. Negotiated Rate	$248.64
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	74308310
Hospital Revenue Code	514
Min. Negotiated Rate	$91.37
Max. Negotiated Rate	$248.64
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$282.80

Service Code	HCPCS 99214
Hospital Charge Code	87502240
Hospital Revenue Code	510
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$42.42
Rate for Payer: Qualcare PPO/HMO/WC	$42.42

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4509718
Hospital Revenue Code	913
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$179.78
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) NJ Health	$179.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$118.08

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$484.05

Service Code	HCPCS 99214
Hospital Charge Code	87506085
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4517718
Hospital Revenue Code	913
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$179.78
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) NJ Health	$179.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$118.08

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4509718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

Know your out-of-pocket cost for care.

All Charges