Heights University Hospital

All Charges

Charge

Type

Setting

Price

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	83653190
Hospital Revenue Code	514
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OV ESTAB PT EXPAND PROB FOCUS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84506120
Hospital Revenue Code	510
Min. Negotiated Rate	$33.58
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	$33.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OV ESTAB PT EXPAND PROB FOCUS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84506120
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OV ESTAB PT HIGH COMPLEXITY

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84506135
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

OV ESTAB PT HIGH COMPLEXITY

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84506135
Hospital Revenue Code	510
Min. Negotiated Rate	$135.96
Max. Negotiated Rate	$364.14
Rate for Payer: Aetna Commercial	$364.14
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$135.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.79
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

OV ESTAB PT LOW COMPLEXITY

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84506125
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OV ESTAB PT LOW COMPLEXITY

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	84506125
Hospital Revenue Code	510
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$196.56
Rate for Payer: Aetna Commercial	$196.56
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.18
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OV ESTAB PT MODERATE COMPLEX

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84506130
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV ESTAB PT MODERATE COMPLEX

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84506130
Hospital Revenue Code	510
Min. Negotiated Rate	$91.37
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	$91.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV ESTAB PT STRAIGHT FORWARD

Facility

$3,107.20

Service Code	HCPCS 99211
Hospital Charge Code	84506115
Hospital Revenue Code	510
Min. Negotiated Rate	$466.08
Max. Negotiated Rate	$466.08
Rate for Payer: Qualcare PPO/HMO/WC	$466.08

OV ESTAB PT STRAIGHT FORWARD

Facility

$3,107.20

Service Code	HCPCS 99211
Hospital Charge Code	84506115
Hospital Revenue Code	510
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$932.16
Rate for Payer: Aetna Commercial	$932.16
Rate for Payer: Aetna Medicare Advantage	$932.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$792.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$792.34
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.94
Rate for Payer: Qualcare PPO/HMO/WC	$466.08

OVITEX CORE 6X10CM

Facility

$3,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270705069
Hospital Revenue Code	278
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$822.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

OVITEX CORE 6X10CM

Facility

$3,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270705069
Hospital Revenue Code	278
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,020.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

OV-NEW-BRIEF

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	83653155
Hospital Revenue Code	514
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$159.82
Rate for Payer: Aetna Commercial	$95.89
Rate for Payer: Aetna Medicare Advantage	$95.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.51
Rate for Payer: Cigna Commercial	$159.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OV-NEW-BRIEF

Facility

$319.65

Service Code	HCPCS 99201
Hospital Charge Code	83653155
Hospital Revenue Code	514
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$47.95
Rate for Payer: Qualcare PPO/HMO/WC	$47.95

OV-NEW-COMPREHENSIVE

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	83653175
Hospital Revenue Code	514
Min. Negotiated Rate	$136.36
Max. Negotiated Rate	$314.68
Rate for Payer: Aetna Commercial	$314.68
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.36
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

OV-NEW-COMPREHENSIVE

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	83653175
Hospital Revenue Code	514
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83653170
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

OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83653165
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83653165
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

OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	83653170
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV-NEW-LIMITED

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	83653160
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

OV-NEW-LIMITED

Facility

$446.00

Service Code	HCPCS 99202
Hospital Charge Code	83653160
Hospital Revenue Code	514
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OV NEW PATIENT HIGH COMPLEXITY

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84506110
Hospital Revenue Code	510
Min. Negotiated Rate	$136.36
Max. Negotiated Rate	$314.68
Rate for Payer: Aetna Commercial	$314.68
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.36
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

OV NEW PATIENT HIGH COMPLEXITY

Facility

$1,048.92

Service Code	HCPCS 99205
Hospital Charge Code	84506110
Hospital Revenue Code	510
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

Know your out-of-pocket cost for care.

All Charges