Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	4518519
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	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

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4517519
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	4832519
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	4518519
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	4510519
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	4517519
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	4515519
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	4511519
Hospital Revenue Code	915
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
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

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4504519
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	4509519
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	4504519
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	4546519
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	$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	4535519
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	4824519
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	$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	4515519
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	4535519
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	4824519
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	4510519
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	4546519
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	4511519
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 THERAPY

Facility

$464.00

Service Code	HCPCS 90849
Hospital Charge Code	83246270
Hospital Revenue Code	916
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$139.20
Rate for Payer: Aetna Medicare Advantage	$139.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.32
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	$118.32
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.32
Rate for Payer: Qualcare PPO/HMO/WC	$69.60

Know your out-of-pocket cost for care.

All Charges