Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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	4515503
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	4527503
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	$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	4527503
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	4832503
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	4515503
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	4504503
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 W/MED SER

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	94810160
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 W/MED SER

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	94810160
Hospital Revenue Code	900
Min. Negotiated Rate	$422.69
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	$765.93
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	$437.76

PSYCH DIAG EVAL W/MED SERVCS

Facility

$1,879.97

Service Code	HCPCS 90792
Hospital Charge Code	7500130
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

PSYCH DIAG EVAL W/MED SERVCS

Facility

$1,879.97

Service Code	HCPCS 90792
Hospital Charge Code	7500130
Hospital Revenue Code	900
Min. Negotiated Rate	$244.40
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$563.99
Rate for Payer: Aetna Medicare Advantage	$563.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.39
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.40
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76

PSYCH DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84310005
Hospital Revenue Code	900
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$1,994.00
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	$765.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76

PSYCH DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84310005
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCH DIAGNOSTIC EVAL

Facility

$550.00

Service Code	HCPCS 90791
Hospital Charge Code	84310001
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCH DIAGNOSTIC EVAL

Facility

$550.00

Service Code	HCPCS 90791
Hospital Charge Code	84310001
Hospital Revenue Code	900
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$1,994.00
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	$308.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAGNOSTIC EVAL

Facility

$682.20

Service Code	HCPCS 90791
Hospital Charge Code	73237003
Hospital Revenue Code	900
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSYCH DIAGNOSTIC EVAL

Facility

$682.20

Service Code	HCPCS 90791
Hospital Charge Code	73237003
Hospital Revenue Code	900
Min. Negotiated Rate	$88.69
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$204.66
Rate for Payer: Aetna Medicare Advantage	$204.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.96
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	$173.96
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.69
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.33
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$171.99

PSYCH DIAGNOSTIC EVAL MD

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	83246145
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCH DIAGNOSTIC EVAL MD

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	83246145
Hospital Revenue Code	900
Min. Negotiated Rate	$71.50
Max. Negotiated Rate	$1,994.00
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	$765.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76

PSYCH DIAGNOSTIC EVAL NON MD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	83246140
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 DIAGNOSTIC EVAL NON MD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	83246140
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 DIAGNOSTIC EVALUATION

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	7500129
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 DIAGNOSTIC EVALUATION

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	7500129
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 DIAGNOSTIC EVAL W EM

Facility

$682.20

Service Code	HCPCS 90792
Hospital Charge Code	73237005
Hospital Revenue Code	900
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

Know your out-of-pocket cost for care.

All Charges