Heights University Hospital

All Charges

Charge

Type

Setting

Price

LEVEL 4 GRS & MICRO EXAM

Facility

$1,358.00

Service Code	HCPCS 88305
Hospital Charge Code	38474049
Hospital Revenue Code	310
Min. Negotiated Rate	$203.70
Max. Negotiated Rate	$203.70
Rate for Payer: Qualcare PPO/HMO/WC	$203.70

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	395099244
Hospital Revenue Code	510
Min. Negotiated Rate	$174.09
Max. Negotiated Rate	$174.09
Rate for Payer: Qualcare PPO/HMO/WC	$174.09

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	485599244
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421099244
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	485599244
Hospital Revenue Code	510
Min. Negotiated Rate	$138.87
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421599244
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	395099244
Hospital Revenue Code	510
Min. Negotiated Rate	$150.88
Max. Negotiated Rate	$580.30
Rate for Payer: Aetna Commercial	$348.18
Rate for Payer: Aetna Medicare Advantage	$348.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.95
Rate for Payer: Cigna Commercial	$580.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.88
Rate for Payer: Qualcare PPO/HMO/WC	$174.09

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421599244
Hospital Revenue Code	510
Min. Negotiated Rate	$138.87
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 4 OUTPATIENT CONSULT

Facility

$1,068.20

Service Code	HCPCS 99244
Hospital Charge Code	421099244
Hospital Revenue Code	510
Min. Negotiated Rate	$138.87
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

LEVEL 5 GRS & MICRO EXAM

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	38474052
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$853.60
Rate for Payer: Aetna Commercial	$329.70
Rate for Payer: Aetna Medicare Advantage	$329.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.25
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$158.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.87
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.85
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL 5 GRS & MICRO EXAM

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	38474052
Hospital Revenue Code	310
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$164.85
Rate for Payer: Qualcare PPO/HMO/WC	$164.85

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421099245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	485599245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421599245
Hospital Revenue Code	510
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$435.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	485599245
Hospital Revenue Code	510
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$435.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421099245
Hospital Revenue Code	510
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$435.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 5 OUTPATIENT CONSULT

Facility

$1,450.00

Service Code	HCPCS 99245
Hospital Charge Code	421599245
Hospital Revenue Code	510
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

LEVEL 6 GRS & MICRO EXAM

Facility

$2,184.00

Service Code	HCPCS 88309
Hospital Charge Code	38474055
Hospital Revenue Code	310
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$327.60
Rate for Payer: Qualcare PPO/HMO/WC	$327.60

LEVEL 6 GRS & MICRO EXAM

Facility

$2,184.00

Service Code	HCPCS 88309
Hospital Charge Code	38474055
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$1,918.64
Rate for Payer: Aetna Commercial	$655.20
Rate for Payer: Aetna Medicare Advantage	$655.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.92
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$235.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.92
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$327.60
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL II-GRS/MICRO EXAM

Facility

$418.00

Service Code	HCPCS 88302
Hospital Charge Code	38474043
Hospital Revenue Code	310
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$125.40
Rate for Payer: Aetna Commercial	$125.40
Rate for Payer: Aetna Medicare Advantage	$125.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.59
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$18.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVEL II-GRS/MICRO EXAM

Facility

$418.00

Service Code	HCPCS 88302
Hospital Charge Code	38474043
Hospital Revenue Code	310
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

LEVELIII,GRS & MICRO EXAM

Facility

$873.60

Service Code	HCPCS 88304
Hospital Charge Code	38474046
Hospital Revenue Code	310
Min. Negotiated Rate	$23.45
Max. Negotiated Rate	$262.08
Rate for Payer: Aetna Commercial	$262.08
Rate for Payer: Aetna Medicare Advantage	$262.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$222.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$222.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$222.77
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$23.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.57
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.04
Rate for Payer: UnitedHealthcare Commercial	$114.00

LEVELIII,GRS & MICRO EXAM

Facility

$873.60

Service Code	HCPCS 88304
Hospital Charge Code	38474046
Hospital Revenue Code	310
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$131.04
Rate for Payer: Qualcare PPO/HMO/WC	$131.04

LEVEL III SP GROSS&MICROSCOP**

Facility

$22.00

Service Code	HCPCS 8830459
Hospital Charge Code	3005290A
Hospital Revenue Code	312
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

LEVEL III SP GROSS&MICROSCOP**

Facility

$22.00

Service Code	HCPCS 8830459
Hospital Charge Code	3005290A
Hospital Revenue Code	312
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare Advantage	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.61
Rate for Payer: Cigna Commercial	$11.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$114.00

Know your out-of-pocket cost for care.

All Charges