Heights University Hospital

All Charges

Charge

Type

Setting

Price

FHC MUMPS

Facility

$738.45

Service Code	HCPCS 90704
Hospital Charge Code	9400093
Hospital Revenue Code	636
Min. Negotiated Rate	$110.77
Max. Negotiated Rate	$178.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.70
Rate for Payer: Qualcare PPO/HMO/WC	$110.77

FHC MUMPS

Facility

$738.45

Service Code	HCPCS 90704
Hospital Charge Code	9400093
Hospital Revenue Code	636
Min. Negotiated Rate	$110.77
Max. Negotiated Rate	$369.23
Rate for Payer: Aetna Commercial	$221.53
Rate for Payer: Aetna Medicare Advantage	$221.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.30
Rate for Payer: Cigna Commercial	$369.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.70
Rate for Payer: Qualcare PPO/HMO/WC	$110.77

FHC NEW PT PREV MED VS 40-64YR

Facility

$281.65

Service Code	HCPCS 99386
Hospital Charge Code	9400048
Hospital Revenue Code	510
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

FHC NEW PT PREV MED VS 40-64YR

Facility

$281.65

Service Code	HCPCS 99386
Hospital Charge Code	9400048
Hospital Revenue Code	510
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.61
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

FHC NEW PT VS LEVEL 1

Facility

$261.25

Service Code	HCPCS 99201
Hospital Charge Code	9400068
Hospital Revenue Code	510
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$39.19
Rate for Payer: Qualcare PPO/HMO/WC	$39.19

FHC NEW PT VS LEVEL 1

Facility

$261.25

Service Code	HCPCS 99201
Hospital Charge Code	9400068
Hospital Revenue Code	510
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$130.62
Rate for Payer: Aetna Commercial	$78.38
Rate for Payer: Aetna Medicare Advantage	$78.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.62
Rate for Payer: Cigna Commercial	$130.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.96
Rate for Payer: Qualcare PPO/HMO/WC	$39.19

FHC NEW PT VS LEVEL 2

Facility

$385.00

Service Code	HCPCS 99202
Hospital Charge Code	9400056
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$115.50
Rate for Payer: Aetna Commercial	$115.50
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.05
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

FHC NEW PT VS LEVEL 2

Facility

$385.00

Service Code	HCPCS 99202
Hospital Charge Code	9400056
Hospital Revenue Code	510
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$57.75
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

FHC NEW PT VS LEVEL 3

Facility

$480.00

Service Code	HCPCS 99203
Hospital Charge Code	9400070
Hospital Revenue Code	510
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

FHC NEW PT VS LEVEL 3

Facility

$480.00

Service Code	HCPCS 99203
Hospital Charge Code	9400070
Hospital Revenue Code	510
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$144.00
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

FHC NEW PT VS LEVEL 4

Facility

$598.75

Service Code	HCPCS 99204
Hospital Charge Code	9400072
Hospital Revenue Code	510
Min. Negotiated Rate	$77.84
Max. Negotiated Rate	$179.62
Rate for Payer: Aetna Commercial	$179.62
Rate for Payer: Aetna Medicare Advantage	$179.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.68
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.84
Rate for Payer: Qualcare PPO/HMO/WC	$89.81

FHC NEW PT VS LEVEL 4

Facility

$598.75

Service Code	HCPCS 99204
Hospital Charge Code	9400072
Hospital Revenue Code	510
Min. Negotiated Rate	$89.81
Max. Negotiated Rate	$89.81
Rate for Payer: Qualcare PPO/HMO/WC	$89.81

FHC NEW PT VS LEVEL 5

Facility

$1,100.00

Service Code	HCPCS 99205
Hospital Charge Code	9400058
Hospital Revenue Code	510
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

FHC NEW PT VS LEVEL 5

Facility

$1,100.00

Service Code	HCPCS 99205
Hospital Charge Code	9400058
Hospital Revenue Code	510
Min. Negotiated Rate	$143.00
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$330.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

FHC NORMAL NEWBORN

Facility

$425.00

Service Code	HCPCS 99460EP
Hospital Charge Code	9400103
Hospital Revenue Code	450
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.25
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

FHC NORMAL NEWBORN

Facility

$425.00

Service Code	HCPCS 99460EP
Hospital Charge Code	9400103
Hospital Revenue Code	450
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

FHC NURSE VISIT*****

Facility

$71.50

Hospital Charge Code	9400011
Hospital Revenue Code	519
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$10.72
Rate for Payer: Qualcare PPO/HMO/WC	$10.72

FHC NURSE VISIT*****

Facility

$71.50

Hospital Charge Code	9400011
Hospital Revenue Code	519
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$35.75
Rate for Payer: Aetna Commercial	$21.45
Rate for Payer: Aetna Medicare Advantage	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.23
Rate for Payer: Cigna Commercial	$35.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$10.72

FHC OTHER REFERRAL

Facility

$581.25

Service Code	HCPCS 99241EP
Hospital Charge Code	9400101
Hospital Revenue Code	510
Min. Negotiated Rate	$87.19
Max. Negotiated Rate	$87.19
Rate for Payer: Qualcare PPO/HMO/WC	$87.19

FHC OTHER REFERRAL

Facility

$581.25

Service Code	HCPCS 99241EP
Hospital Charge Code	9400101
Hospital Revenue Code	510
Min. Negotiated Rate	$75.56
Max. Negotiated Rate	$290.62
Rate for Payer: Aetna Commercial	$174.38
Rate for Payer: Aetna Medicare Advantage	$174.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.22
Rate for Payer: Cigna Commercial	$290.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.56
Rate for Payer: Qualcare PPO/HMO/WC	$87.19

FHC POSTPARTUM HEALTHSTART VS

Facility

$505.00

Service Code	HCPCS 99241
Hospital Charge Code	9400060
Hospital Revenue Code	510
Min. Negotiated Rate	$65.65
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$151.50
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.65
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

FHC POSTPARTUM HEALTHSTART VS

Facility

$505.00

Service Code	HCPCS 99241
Hospital Charge Code	9400060
Hospital Revenue Code	510
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

FHC REFER LAB-LEAD

Facility

$38.45

Service Code	HCPCS 83655EP
Hospital Charge Code	9400090
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.54
Rate for Payer: Aetna Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.80
Rate for Payer: Cigna Commercial	$19.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.77
Rate for Payer: UnitedHealthcare Commercial	$114.00

FHC REFER LAB-LEAD

Facility

$38.45

Service Code	HCPCS 83655EP
Hospital Charge Code	9400090
Hospital Revenue Code	301
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$5.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.77

FHC REFER LAB-OTHER

Facility

$246.45

Service Code	HCPCS 84999EP
Hospital Charge Code	9400091
Hospital Revenue Code	301
Min. Negotiated Rate	$36.97
Max. Negotiated Rate	$36.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.97

Know your out-of-pocket cost for care.

All Charges