Heights University Hospital

All Charges

Charge

Type

Setting

Price

INTERACT COMPLEX MD (ADD ON CO

Facility

$275.00

Service Code	HCPCS 90785
Hospital Charge Code	4510709
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4535500
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4818500
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4509500
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4511500
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4502500
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4535500
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4822500
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4504500
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4504500
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4511500
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4832500
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4832500
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4502500
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4822500
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4509500
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD ADULT

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4818500
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4546501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4527501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4822501
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4832501
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4504501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4517501
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4509501
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4535501
Hospital Revenue Code	914
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

Know your out-of-pocket cost for care.

All Charges