Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEVEL 1 FOLLOW-UP VISIT

Facility

$575.00

Service Code	HCPCS 99211
Hospital Charge Code	421099211
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485599211
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$93.30
Rate for Payer: Aetna Commercial	$93.30
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.43
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485099211
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$93.30
Rate for Payer: Aetna Commercial	$93.30
Rate for Payer: Aetna Medicare Advantage	$93.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.31
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.43
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 FOLLOW-UP VISIT

Facility

$311.00

Service Code	HCPCS 99211
Hospital Charge Code	485599211
Hospital Revenue Code	510
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.65

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421599241
Hospital Revenue Code	510
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	485599241
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421599241
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421099241
Hospital Revenue Code	510
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	485599241
Hospital Revenue Code	510
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 1 OUTPATIENT CONSULT

Facility

$575.00

Service Code	HCPCS 99241
Hospital Charge Code	421099241
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	485599242
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	485599242
Hospital Revenue Code	510
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	421599242
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	421099242
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	421599242
Hospital Revenue Code	510
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 OUTPATIENT CONSULT

Facility

$610.00

Service Code	HCPCS 99242
Hospital Charge Code	421099242
Hospital Revenue Code	510
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$183.00
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

LEVEL 2 PLATE CERVICAL 50MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692100
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

LEVEL 2 PLATE CERVICAL 50MM

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692100
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$1,956.00
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	421599243
Hospital Revenue Code	510
Min. Negotiated Rate	$107.74
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	421099243
Hospital Revenue Code	510
Min. Negotiated Rate	$107.74
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	485599243
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	485599243
Hospital Revenue Code	510
Min. Negotiated Rate	$107.74
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	421099243
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

LEVEL 3 OUTPATIENT CONSULT

Facility

$828.80

Service Code	HCPCS 99243
Hospital Charge Code	421599243
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

LEVEL 4 GRS & MICRO EXAM

Facility

$1,358.00

Service Code	HCPCS 88305
Hospital Charge Code	38474049
Hospital Revenue Code	310
Min. Negotiated Rate	$39.47
Max. Negotiated Rate	$407.40
Rate for Payer: Aetna Commercial	$407.40
Rate for Payer: Aetna Medicare Advantage	$407.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$346.29
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$39.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges