Heights University Hospital

All Charges

Charge

Type

Setting

Price

FHC EST PT PREV MED VS 40-64YR

Facility

$281.65

Service Code	HCPCS 99396
Hospital Charge Code	9400028
Hospital Revenue Code	510
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

FHC EST PT VS LEVEL 1

Facility

$90.00

Service Code	HCPCS 99211
Hospital Charge Code	9400034
Hospital Revenue Code	510
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

FHC EST PT VS LEVEL 1

Facility

$90.00

Service Code	HCPCS 99211
Hospital Charge Code	9400034
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

FHC EST PT VS LEVEL 2

Facility

$200.00

Service Code	HCPCS 99212
Hospital Charge Code	9400062
Hospital Revenue Code	510
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

FHC EST PT VS LEVEL 2

Facility

$200.00

Service Code	HCPCS 99212
Hospital Charge Code	9400062
Hospital Revenue Code	510
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00

FHC EST PT VS LEVEL 3

Facility

$292.50

Service Code	HCPCS 99213
Hospital Charge Code	9400036
Hospital Revenue Code	510
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$87.75
Rate for Payer: Aetna Medicare Advantage	$87.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.59
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

FHC EST PT VS LEVEL 3

Facility

$292.50

Service Code	HCPCS 99213
Hospital Charge Code	9400036
Hospital Revenue Code	510
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$43.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

FHC EST PT VS LEVEL 4

Facility

$554.00

Service Code	HCPCS 99214
Hospital Charge Code	9400064
Hospital Revenue Code	510
Min. Negotiated Rate	$83.10
Max. Negotiated Rate	$83.10
Rate for Payer: Qualcare PPO/HMO/WC	$83.10

FHC EST PT VS LEVEL 4

Facility

$554.00

Service Code	HCPCS 99214
Hospital Charge Code	9400064
Hospital Revenue Code	510
Min. Negotiated Rate	$72.02
Max. Negotiated Rate	$166.20
Rate for Payer: Aetna Commercial	$166.20
Rate for Payer: Aetna Medicare Advantage	$166.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.27
Rate for Payer: Cigna Commercial	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.02
Rate for Payer: Qualcare PPO/HMO/WC	$83.10

FHC EST PT VS LEVEL 5

Facility

$501.25

Service Code	HCPCS 99215
Hospital Charge Code	9400066
Hospital Revenue Code	510
Min. Negotiated Rate	$75.19
Max. Negotiated Rate	$75.19
Rate for Payer: Qualcare PPO/HMO/WC	$75.19

FHC EST PT VS LEVEL 5

Facility

$501.25

Service Code	HCPCS 99215
Hospital Charge Code	9400066
Hospital Revenue Code	510
Min. Negotiated Rate	$65.16
Max. Negotiated Rate	$150.38
Rate for Payer: Aetna Commercial	$150.38
Rate for Payer: Aetna Medicare Advantage	$150.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.82
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.16
Rate for Payer: Qualcare PPO/HMO/WC	$75.19

FHC HEALTHSTART ENROLLMENT

Facility

$309.65

Service Code	HCPCS 99241
Hospital Charge Code	9400052
Hospital Revenue Code	510
Min. Negotiated Rate	$40.25
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.25
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

FHC HEALTHSTART ENROLLMENT

Facility

$309.65

Service Code	HCPCS 99241
Hospital Charge Code	9400052
Hospital Revenue Code	510
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$46.45
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

FHC HEARING REFERRAL

Facility

$128.85

Service Code	HCPCS 92700EP
Hospital Charge Code	9400099
Hospital Revenue Code	444
Min. Negotiated Rate	$19.33
Max. Negotiated Rate	$19.33
Rate for Payer: Qualcare PPO/HMO/WC	$19.33

FHC HEARING REFERRAL

Facility

$128.85

Service Code	HCPCS 92700EP
Hospital Charge Code	9400099
Hospital Revenue Code	444
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$38.66
Rate for Payer: Aetna Medicare Advantage	$38.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.86
Rate for Payer: Cigna Commercial	$64.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.75
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.33
Rate for Payer: UnitedHealthcare Commercial	$686.00

FHC INFLU, SPLIT V PRES FREE

Facility

$80.00

Service Code	HCPCS 90655
Hospital Charge Code	9400092
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

FHC INFLU, SPLIT V PRES FREE

Facility

$80.00

Service Code	HCPCS 90655
Hospital Charge Code	9400092
Hospital Revenue Code	636
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$19.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

FHC IN-OFFICE SCREENING AUDIO

Facility

$267.25

Service Code	HCPCS 92551
Hospital Charge Code	9400098
Hospital Revenue Code	510
Min. Negotiated Rate	$40.09
Max. Negotiated Rate	$40.09
Rate for Payer: Qualcare PPO/HMO/WC	$40.09

FHC IN-OFFICE SCREENING AUDIO

Facility

$267.25

Service Code	HCPCS 92551
Hospital Charge Code	9400098
Hospital Revenue Code	510
Min. Negotiated Rate	$34.74
Max. Negotiated Rate	$133.62
Rate for Payer: Aetna Commercial	$80.17
Rate for Payer: Aetna Medicare Advantage	$80.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.15
Rate for Payer: Cigna Commercial	$133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.74
Rate for Payer: Qualcare PPO/HMO/WC	$40.09

FHC IN-OFFICE SCREENING VISIT

Facility

$160.00

Service Code	HCPCS 99173
Hospital Charge Code	9400100
Hospital Revenue Code	510
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$48.00
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

FHC IN-OFFICE SCREENING VISIT

Facility

$160.00

Service Code	HCPCS 99173
Hospital Charge Code	9400100
Hospital Revenue Code	510
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

FHC MENTAL HEALTH REFERRAL

Facility

$369.65

Service Code	HCPCS 90899EP
Hospital Charge Code	9400096
Hospital Revenue Code	900
Min. Negotiated Rate	$55.45
Max. Negotiated Rate	$55.45
Rate for Payer: Qualcare PPO/HMO/WC	$55.45

FHC MENTAL HEALTH REFERRAL

Facility

$369.65

Service Code	HCPCS 90899EP
Hospital Charge Code	9400096
Hospital Revenue Code	900
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$110.89
Rate for Payer: Aetna Medicare Advantage	$110.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.26
Rate for Payer: Cigna Commercial	$184.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.05
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.45
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

FHC MULTIDISCIPLINARY TEAM VS

Facility

$320.85

Hospital Charge Code	9400038
Hospital Revenue Code	510
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$48.13
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

FHC MULTIDISCIPLINARY TEAM VS

Facility

$320.85

Hospital Charge Code	9400038
Hospital Revenue Code	510
Min. Negotiated Rate	$41.71
Max. Negotiated Rate	$160.43
Rate for Payer: Aetna Commercial	$96.25
Rate for Payer: Aetna Medicare Advantage	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.82
Rate for Payer: Cigna Commercial	$160.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.71
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

Know your out-of-pocket cost for care.

All Charges