Heights University Hospital

All Charges

Charge

Type

Setting

Price

INTERACT COMPLEX NON MD CHILD

Facility

$750.00

Service Code	HCPCS 90785
Hospital Charge Code	4822501
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	$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	4535501
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	4546501
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	$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	4527501
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	4511501
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	4518501
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	4510501
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	4518501
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	4511501
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	$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	4824501
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	4515501
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	4510501
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	4515501
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	4824501
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	4832501
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84518049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84511049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$6,800.00

Service Code	HCPCS 90785
Hospital Charge Code	83246150
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

INTERACTIVE COMPLEXITY

Facility

$550.00

Service Code	HCPCS 90785
Hospital Charge Code	87504130
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84509049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84517049
Hospital Revenue Code	900
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.44

INTERACTIVE COMPLEXITY

Facility

$76.25

Service Code	HCPCS 90785
Hospital Charge Code	84517049
Hospital Revenue Code	900
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$22.88
Rate for Payer: Aetna Medicare Advantage	$22.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.44
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	$19.44
Rate for Payer: Cigna Commercial	$12.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.91
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.44
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

Know your out-of-pocket cost for care.

All Charges