Heights University Hospital

All Charges

Charge

Type

Setting

Price

PED PSYCH PRIVATE

Facility

$18,000.00

Hospital Charge Code	100801
Hospital Revenue Code	114
Min. Negotiated Rate	$1,109.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

PED PSYCH SEMI-PRIVATE

Facility

$18,000.00

Hospital Charge Code	100802
Hospital Revenue Code	124
Min. Negotiated Rate	$1,109.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

PEDS DEVELOP SCRE & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	87502390
Hospital Revenue Code	918
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.90

PEDS DEVELOP SCRE & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	87502390
Hospital Revenue Code	918
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: Aetna Medicare Advantage	$163.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.98
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.90
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

PEDS DEVLOPMNTL SCRN & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	73050860
Hospital Revenue Code	918
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.90

PEDS DEVLOPMNTL SCRN & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	73050860
Hospital Revenue Code	918
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: Aetna Medicare Advantage	$163.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.98
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.90
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

PEDS DEVLOPMNTL SCRN & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	83652385
Hospital Revenue Code	918
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$81.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.90

PEDS DEVLOPMNTL SCRN & INTERP

Facility

$546.00

Service Code	HCPCS 96110
Hospital Charge Code	83652385
Hospital Revenue Code	918
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$163.80
Rate for Payer: Aetna Medicare Advantage	$163.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.23
Rate for Payer: Cigna Commercial	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.98
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.90
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

PEDS PED DTAP < 7 YEARS OLD

Facility

$105.00

Service Code	HCPCS 90700
Hospital Charge Code	73050801
Hospital Revenue Code	636
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

PEDS PED DTAP < 7 YEARS OLD

Facility

$105.00

Service Code	HCPCS 90700
Hospital Charge Code	73050801
Hospital Revenue Code	636
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$25.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

PEDS PREV E&M NP 1-4 YRS OLD

Facility

$59.00

Service Code	HCPCS 99382
Hospital Charge Code	73050820
Hospital Revenue Code	515
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV E&M NP 1-4 YRS OLD

Facility

$59.00

Service Code	HCPCS 99382
Hospital Charge Code	73050820
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV. E&M NP < 1 YEAR OLD

Facility

$59.00

Service Code	HCPCS 99381
Hospital Charge Code	73050815
Hospital Revenue Code	515
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV. E&M NP < 1 YEAR OLD

Facility

$59.00

Service Code	HCPCS 99381
Hospital Charge Code	73050815
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV E&M NP 5-11 YRS OLD

Facility

$59.00

Service Code	HCPCS 99383
Hospital Charge Code	73050825
Hospital Revenue Code	515
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.67
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV E&M NP 5-11 YRS OLD

Facility

$59.00

Service Code	HCPCS 99383
Hospital Charge Code	73050825
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV EST PT 12 TO 17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	73050850
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 12 TO 17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	73050850
Hospital Revenue Code	515
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 1 TO 4 YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	73050840
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 1 TO 4 YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	73050840
Hospital Revenue Code	515
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT<1 YEAR OLD

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	73050835
Hospital Revenue Code	515
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT<1 YEAR OLD

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	73050835
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 5 TO 11 YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	73050845
Hospital Revenue Code	515
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 5 TO 11 YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	73050845
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83090005
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

Know your out-of-pocket cost for care.

All Charges