Heights University Hospital

All Charges

Charge

Type

Setting

Price

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4527515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4832515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4515515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4824515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4546515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4510515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4517515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4504515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4832515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4535515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4518515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4504515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4822515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4546515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4511515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4824515
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4517515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX WO PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90846
Hospital Charge Code	4535515
Hospital Revenue Code	916
Min. Negotiated Rate	$170.91
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX W PATIENT 50 MIN

Facility

$1,094.00

Service Code	HCPCS 90847
Hospital Charge Code	84509023
Hospital Revenue Code	916
Min. Negotiated Rate	$113.84
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$328.20
Rate for Payer: Aetna Medicare Advantage	$328.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.97
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.22
Rate for Payer: Qualcare PPO/HMO/WC	$164.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84

FAMILY TX W PATIENT 50 MIN

Facility

$1,094.00

Service Code	HCPCS 90847
Hospital Charge Code	84504060
Hospital Revenue Code	916
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

FAMILY TX W PATIENT 50 MIN

Facility

$1,094.00

Service Code	HCPCS 90847
Hospital Charge Code	84517023
Hospital Revenue Code	916
Min. Negotiated Rate	$113.84
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$328.20
Rate for Payer: Aetna Medicare Advantage	$328.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.97
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.22
Rate for Payer: Qualcare PPO/HMO/WC	$164.10
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84

FAMILY TX W PATIENT 50 MIN

Facility

$896.00

Service Code	HCPCS 90847
Hospital Charge Code	83246265
Hospital Revenue Code	916
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$134.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.40

FAMILY TX W PATIENT 50 MIN

Facility

$1,094.00

Service Code	HCPCS 90847
Hospital Charge Code	84517023
Hospital Revenue Code	916
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

FAMILY TX W PATIENT 50 MIN

Facility

$896.00

Service Code	HCPCS 90847
Hospital Charge Code	83246100
Hospital Revenue Code	916
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$134.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.40

FAMILY TX W PATIENT 50 MIN

Facility

$1,094.00

Service Code	HCPCS 90847
Hospital Charge Code	84206250
Hospital Revenue Code	916
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$164.10
Rate for Payer: Qualcare PPO/HMO/WC	$164.10

Know your out-of-pocket cost for care.

All Charges