Heights University Hospital

All Charges

Charge

Type

Setting

Price

IND PSYCHOTX NONMD 60MIN CHILD

Facility

$2,000.00

Service Code	HCPCS 90837
Hospital Charge Code	4535509
Hospital Revenue Code	914
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4818704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4511704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4504704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4517704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4818704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4511704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4502704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4527704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4832704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4546704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4515704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4509704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4527704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4832704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4518704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4517704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4515704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4509704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4546704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4504704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4822704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4510704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4518704
Hospital Revenue Code	914
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$122.43
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

IND PSYCHOTX W E&M MD 30MIN

Facility

$375.00

Service Code	HCPCS 90833
Hospital Charge Code	4822704
Hospital Revenue Code	914
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

Know your out-of-pocket cost for care.

All Charges