Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSYCH DIAG EVAL NON MD ADULT

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4832502
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD ADULT

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4512502
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD ADULT

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4509502
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD ADULT

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4509502
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD ADULT

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4502502
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD ADULT

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4502502
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD ADULT

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4511502
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4517503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4546503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4822503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4535503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4546503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4824503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4511503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4510503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4518503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4822503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4509503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4510503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4535503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4824503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4504503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4832503
Hospital Revenue Code	900
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Commercial	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.00
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4509503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYCH DIAG EVAL NON MD CHILD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4518503
Hospital Revenue Code	900
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

Know your out-of-pocket cost for care.

All Charges