Heights University Hospital

All Charges

Charge

Type

Setting

Price

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2692144
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2692144
Hospital Revenue Code	370
Min. Negotiated Rate	$53.26
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$122.91
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$76.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.26
Rate for Payer: Oxford Commercial	$204.85
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$204.85

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	5100852
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	2500268
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	7412073
Hospital Revenue Code	370
Min. Negotiated Rate	$53.26
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$122.91
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$76.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.26
Rate for Payer: Oxford Commercial	$204.85
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$204.85

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	321099156
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD >5YO1ST 15MIN

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	5792289
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5100853
Hospital Revenue Code	370
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$93.22
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.40
Rate for Payer: Oxford Commercial	$155.38
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$155.38

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5100853
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5792290
Hospital Revenue Code	370
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$93.22
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.40
Rate for Payer: Oxford Commercial	$155.38
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$155.38

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2500269
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2500269
Hospital Revenue Code	370
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$93.22
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.40
Rate for Payer: Oxford Commercial	$155.38
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$155.38

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	321099157
Hospital Revenue Code	370
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$93.22
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.40
Rate for Payer: Oxford Commercial	$155.38
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$155.38

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2692147
Hospital Revenue Code	370
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$93.22
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.40
Rate for Payer: Oxford Commercial	$155.38
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$155.38

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	5792290
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	7412074
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	7412074
Hospital Revenue Code	370
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$93.22
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.40
Rate for Payer: Oxford Commercial	$155.38
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$155.38

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	321099157
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED DIFF MD EA ADD 15MIN

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	2692147
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED OTHER PHYS/QHP EA

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	366899157
Hospital Revenue Code	370
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$46.61
Rate for Payer: Qualcare PPO/HMO/WC	$46.61

MOD SED OTHER PHYS/QHP EA

Facility

$310.75

Service Code	HCPCS 99157
Hospital Charge Code	366899157
Hospital Revenue Code	370
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$155.38
Rate for Payer: Aetna Commercial	$93.22
Rate for Payer: Aetna Medicare Advantage	$93.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.24
Rate for Payer: Cigna Commercial	$58.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.40
Rate for Payer: Oxford Commercial	$155.38
Rate for Payer: Qualcare PPO/HMO/WC	$46.61
Rate for Payer: UnitedHealthcare Commercial	$155.38

MOD SED OTH PHYS/QHP 5/>YRS

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	366899156
Hospital Revenue Code	370
Min. Negotiated Rate	$53.26
Max. Negotiated Rate	$204.85
Rate for Payer: Aetna Commercial	$122.91
Rate for Payer: Aetna Medicare Advantage	$122.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.47
Rate for Payer: Cigna Commercial	$76.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.26
Rate for Payer: Oxford Commercial	$204.85
Rate for Payer: Qualcare PPO/HMO/WC	$61.45
Rate for Payer: UnitedHealthcare Commercial	$204.85

MOD SED OTH PHYS/QHP 5/>YRS

Facility

$409.70

Service Code	HCPCS 99156
Hospital Charge Code	366899156
Hospital Revenue Code	370
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$61.45

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	5792285
Hospital Revenue Code	370
Min. Negotiated Rate	$19.19
Max. Negotiated Rate	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$19.19

MOD SED SAME MD <5YO 1ST 15MIN

Facility

$127.95

Service Code	HCPCS 99151
Hospital Charge Code	2500264
Hospital Revenue Code	370
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$63.98
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$38.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.63
Rate for Payer: Cigna Commercial	$22.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.63
Rate for Payer: Oxford Commercial	$63.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.19
Rate for Payer: UnitedHealthcare Commercial	$63.98

Know your out-of-pocket cost for care.

All Charges