Heights University Hospital

All Charges

Charge

Type

Setting

Price

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84208280
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

$678.40

Service Code	HCPCS 99214
Hospital Charge Code	84511045
Hospital Revenue Code	513
Min. Negotiated Rate	$101.76
Max. Negotiated Rate	$101.76
Rate for Payer: Qualcare PPO/HMO/WC	$101.76

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	421599214
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	$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	421599214
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

$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	$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

$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

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4518718
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	9800385
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

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4822718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4502718
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	485099214
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

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4818718
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	4517718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	485099214
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

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4527718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4535718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4511718
Hospital Revenue Code	513
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4511719
Hospital Revenue Code	513
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4502719
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	421099215
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

Know your out-of-pocket cost for care.

All Charges