Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

$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	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

$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

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	485099202
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	4546711
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	74308275
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	4822711
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	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

$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	84511031
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 3 >=30 MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84511033
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

NEW PATIENT LEV 3 >=30 MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84517033
Hospital Revenue Code	513
Min. Negotiated Rate	$62.93
Max. Negotiated Rate	$145.22
Rate for Payer: Aetna Commercial	$145.22
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4504712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4824712
Hospital Revenue Code	913
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83652397
Hospital Revenue Code	514
Min. Negotiated Rate	$77.24
Max. Negotiated Rate	$248.64
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4822712
Hospital Revenue Code	913
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$621.00

Service Code	HCPCS 99203
Hospital Charge Code	93950137
Hospital Revenue Code	510
Min. Negotiated Rate	$77.24
Max. Negotiated Rate	$186.30
Rate for Payer: Aetna Commercial	$186.30
Rate for Payer: Aetna Medicare Advantage	$186.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.35
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.73
Rate for Payer: Qualcare PPO/HMO/WC	$93.15

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	485599203
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4822712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$450.00

Service Code	HCPCS 99203
Hospital Charge Code	4510712
Hospital Revenue Code	913
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

NEW PATIENT LEV 3 >=30 MINS

Facility

$621.00

Service Code	HCPCS 99203
Hospital Charge Code	93950137
Hospital Revenue Code	510
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$93.15
Rate for Payer: Qualcare PPO/HMO/WC	$93.15

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	84208250
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

NEW PATIENT LEV 3 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	485099203
Hospital Revenue Code	510
Min. Negotiated Rate	$77.24
Max. Negotiated Rate	$248.64
Rate for Payer: Aetna Commercial	$248.64
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

Know your out-of-pocket cost for care.

All Charges