Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	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

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4510711
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

$474.10

Service Code	HCPCS 99202
Hospital Charge Code	9800290
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$142.23
Rate for Payer: Aetna Commercial	$142.23
Rate for Payer: Aetna Medicare Advantage	$142.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.90
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.63
Rate for Payer: Qualcare PPO/HMO/WC	$71.11

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4518711
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

$367.85

Service Code	HCPCS 99202
Hospital Charge Code	84511031
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

$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

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4832711
Hospital Revenue Code	913
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
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

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4527711
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	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

$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

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4518711
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

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4504711
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

$234.00

Service Code	HCPCS 99202
Hospital Charge Code	93950133
Hospital Revenue Code	510
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

NEW PATIENT LEV 2 >=15 MINS

Facility

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4527711
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	4502711
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

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	93950135
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$120.60
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$120.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.51
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.26
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	4509711
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

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	93950135
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

$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

$350.00

Service Code	HCPCS 99202
Hospital Charge Code	4517711
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	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

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	84208245
Hospital Revenue Code	510
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

$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

Know your out-of-pocket cost for care.

All Charges