Heights University Hospital

All Charges

Charge

Type

Setting

Price

NEVOS SPONGE 50X20X7MM DBM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692542
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

NEVOS SPONGE 50X20X7MM DBM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692542
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$4,125.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

NEWBORN HEARING SCREENING

Facility

$72.00

Service Code	HCPCS 92551
Hospital Charge Code	1800030
Hospital Revenue Code	471
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$1,180.00
Rate for Payer: Aetna Commercial	$21.60
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$1,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$1,180.00

NEWBORN HEARING SCREENING

Facility

$72.00

Service Code	HCPCS 92551
Hospital Charge Code	1800030
Hospital Revenue Code	471
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

NEW I/P CONSULT LEVEL 4

Facility

$628.83

Service Code	HCPCS 99222
Hospital Charge Code	85000870
Hospital Revenue Code	510
Min. Negotiated Rate	$94.32
Max. Negotiated Rate	$94.32
Rate for Payer: Qualcare PPO/HMO/WC	$94.32

NEW I/P CONSULT LEVEL 4

Facility

$628.83

Service Code	HCPCS 99222
Hospital Charge Code	85000870
Hospital Revenue Code	510
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$188.65
Rate for Payer: Aetna Commercial	$188.65
Rate for Payer: Aetna Medicare Advantage	$188.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.35
Rate for Payer: Cigna Commercial	$126.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.75
Rate for Payer: Qualcare PPO/HMO/WC	$94.32

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4822711
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4511711
Hospital Revenue Code	513
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4515711
Hospital Revenue Code	913
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	83652395
Hospital Revenue Code	514
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$133.80
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

NEW PATIENT LEV 2 >=15 MINS

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84208245
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$133.80
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

NEW PATIENT LEV 2 >=15 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	87506045
Hospital Revenue Code	513
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$110.36
Rate for Payer: Aetna Commercial	$110.36
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4818711
Hospital Revenue Code	913
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4832711
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4502711
Hospital Revenue Code	913
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	485599202
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

NEW PATIENT LEV 2 >=15 MINS

Facility

$234.00

Service Code	HCPCS 99202
Hospital Charge Code	93950133
Hospital Revenue Code	510
Min. Negotiated Rate	$30.42
Max. Negotiated Rate	$70.20
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.42
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

NEW PATIENT LEV 2 >=15 MINS

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	87502205
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4535711
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

NEW PATIENT LEV 2 >=15 MINS

Facility

$575.00

Service Code	HCPCS 99202
Hospital Charge Code	421599202
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

NEW PATIENT LEV 2 >=15 MINS

Facility

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	87506045
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

NEW PATIENT LEV 2 >=15 MINS

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	74308275
Hospital Revenue Code	514
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

NEW PATIENT LEV 2 >=15 MINS

Facility

$575.00

Service Code	HCPCS 99202
Hospital Charge Code	421099202
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$172.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

NEW PATIENT LEV 2 >=15 MINS

Facility

$575.00

Service Code	HCPCS 99202
Hospital Charge Code	421599202
Hospital Revenue Code	510
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4546711
Hospital Revenue Code	913
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$105.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

Know your out-of-pocket cost for care.

All Charges