Heights University Hospital

All Charges

Charge

Type

Setting

Price

MULTI-FAMILY

Facility

$336.35

Service Code	HCPCS 90849
Hospital Charge Code	84509025
Hospital Revenue Code	912
Min. Negotiated Rate	$50.45
Max. Negotiated Rate	$50.45
Rate for Payer: Qualcare PPO/HMO/WC	$50.45

MULTI FAMILY GROUP PSYCHOTHER

Facility

$628.50

Service Code	HCPCS 90849
Hospital Charge Code	9310110
Hospital Revenue Code	916
Min. Negotiated Rate	$94.28
Max. Negotiated Rate	$94.28
Rate for Payer: Qualcare PPO/HMO/WC	$94.28

MULTI FAMILY GROUP PSYCHOTHER

Facility

$628.50

Service Code	HCPCS 90849
Hospital Charge Code	9310110
Hospital Revenue Code	916
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$188.55
Rate for Payer: Aetna Medicare Advantage	$188.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.27
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.70
Rate for Payer: Qualcare PPO/HMO/WC	$94.28

MULTI-FAMILY GROUP THERAPY

Facility

$750.00

Service Code	HCPCS 750
Hospital Charge Code	4546774
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI-FAMILY GROUP THERAPY

Facility

$750.00

Service Code	HCPCS 750
Hospital Charge Code	4546774
Hospital Revenue Code	915
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$375.00
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) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI-FAMILY GROUP THERAPY IOP

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4546754
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI-FAMILY GROUP THERAPY IOP

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4546754
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4504518
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4511518
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4832518
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4504518
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4502518
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4511518
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4832518
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4535518
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4818518
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4509518
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4502518
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4818518
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4822518
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4822518
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4535518
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX ADULT

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4509518
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4822519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4527519
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
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	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

Know your out-of-pocket cost for care.

All Charges