Heights University Hospital

All Charges

Charge

Type

Setting

Price

MED MALLWOLUS PT 7- HOL ANATM

Facility

$7,136.25

Service Code	HCPCS C1713
Hospital Charge Code	270701647
Hospital Revenue Code	278
Min. Negotiated Rate	$1,070.44
Max. Negotiated Rate	$3,568.12
Rate for Payer: Aetna Commercial	$2,140.88
Rate for Payer: Aetna Medicare Advantage	$2,140.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,819.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,819.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,427.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,819.74
Rate for Payer: Cigna Commercial	$3,568.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,726.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,070.44

MED MALLWOLUS PT 7- HOL ANATM

Facility

$7,136.25

Service Code	HCPCS C1713
Hospital Charge Code	270701647
Hospital Revenue Code	278
Min. Negotiated Rate	$1,070.44
Max. Negotiated Rate	$1,726.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,427.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,726.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,070.44

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4535608
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4502608
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4822608
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4818608
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4535608
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4818608
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4832608
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4822608
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4511608
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4504608
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4504608
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4832608
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4511608
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4502608
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4509622
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4822622
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4822622
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG ADULT/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4509622
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4518618
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4511618
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4546618
Hospital Revenue Code	919
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$112.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4515618
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN MEDICAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4517618
Hospital Revenue Code	919
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