Heights University Hospital

All Charges

Charge

Type

Setting

Price

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4510713
Hospital Revenue Code	913
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$741.52

Service Code	HCPCS 99204
Hospital Charge Code	93950139
Hospital Revenue Code	510
Min. Negotiated Rate	$111.23
Max. Negotiated Rate	$111.23
Rate for Payer: Qualcare PPO/HMO/WC	$111.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4832713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	9800310
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$320.46
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4527713
Hospital Revenue Code	913
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4510713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	485599204
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$320.46
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	485599204
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	9800310
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	87502215
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$320.46
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$833.26

Service Code	HCPCS 99204
Hospital Charge Code	85000835
Hospital Revenue Code	510
Min. Negotiated Rate	$108.32
Max. Negotiated Rate	$249.98
Rate for Payer: Aetna Commercial	$249.98
Rate for Payer: Aetna Medicare Advantage	$249.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.48
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.99

NEW PATIENT LEV 4 >=45 MINS

Facility

$833.26

Service Code	HCPCS 99204
Hospital Charge Code	85000835
Hospital Revenue Code	510
Min. Negotiated Rate	$124.99
Max. Negotiated Rate	$124.99
Rate for Payer: Qualcare PPO/HMO/WC	$124.99

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4822713
Hospital Revenue Code	913
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4515713
Hospital Revenue Code	913
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	421099204
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$741.52

Service Code	HCPCS 99204
Hospital Charge Code	93950139
Hospital Revenue Code	510
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$222.46
Rate for Payer: Aetna Commercial	$222.46
Rate for Payer: Aetna Medicare Advantage	$222.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.09
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.40
Rate for Payer: Qualcare PPO/HMO/WC	$111.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4527713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	421099204
Hospital Revenue Code	510
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$320.46
Rate for Payer: Aetna Commercial	$320.46
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.87
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	87502215
Hospital Revenue Code	510
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4518713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4824713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4502713
Hospital Revenue Code	913
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4504713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4535713
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

NEW PATIENT LEV 4 >=45 MINS

Facility

$550.00

Service Code	HCPCS 99204
Hospital Charge Code	4511713
Hospital Revenue Code	513
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

Know your out-of-pocket cost for care.

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