Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSYCH DIAGNOSTIC EVAL W EM

Facility

$682.20

Service Code	HCPCS 90792
Hospital Charge Code	73237005
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	$765.93
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	$437.76

PSYCH DIAGNOSTIC INTERVIEW****

Facility

$250.00

Service Code	HCPCS 90801
Hospital Charge Code	9310079
Hospital Revenue Code	914
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

PSYCH DIAGNOSTIC INTERVIEW****

Facility

$250.00

Service Code	HCPCS 90801
Hospital Charge Code	9310079
Hospital Revenue Code	914
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

PSYCH DX ASSESSMENT ADULT****

Facility

$184.00

Service Code	HCPCS 90801
Hospital Charge Code	9300021
Hospital Revenue Code	910
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$55.20
Rate for Payer: Aetna Medicare Advantage	$55.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.92
Rate for Payer: Cigna Commercial	$92.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

PSYCH DX ASSESSMENT ADULT****

Facility

$184.00

Service Code	HCPCS 90801
Hospital Charge Code	9300021
Hospital Revenue Code	910
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$27.60
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

PSYCH DX INTERVIEW MD

Facility

$510.75

Service Code	HCPCS 90801
Hospital Charge Code	9310084
Hospital Revenue Code	900
Min. Negotiated Rate	$66.40
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$153.22
Rate for Payer: Aetna Medicare Advantage	$153.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.24
Rate for Payer: Cigna Commercial	$255.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.40
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.61
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

PSYCH DX INTERVIEW MD

Facility

$510.75

Service Code	HCPCS 90801
Hospital Charge Code	9310084
Hospital Revenue Code	900
Min. Negotiated Rate	$76.61
Max. Negotiated Rate	$76.61
Rate for Payer: Qualcare PPO/HMO/WC	$76.61

PSYCH DX INTERVIEW W/MD

Facility

$1,879.97

Hospital Charge Code	7500128
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) PPO	$479.39
Rate for Payer: Cigna Commercial	$939.99
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

PSYCH DX INTERVIEW W/MD

Facility

$1,879.97

Hospital Charge Code	7500128
Hospital Revenue Code	900
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

PSYCH DX INTERVIEW W/SOC WRKR

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	7500050
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 DX INTERVIEW W/SOC WRKR

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	7500050
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 DYFS CLUBHOUSE GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84310115
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

PSYCH DYFS CLUBHOUSE GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84310115
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP ADL

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246050
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

PSYCH-ED GROUP ADL

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246050
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP ANGER/ANXIETY/F

Facility

$800.80

Hospital Charge Code	24746085
Hospital Revenue Code	915
Min. Negotiated Rate	$104.10
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP ANGER/ANXIETY/F

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246085
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP ANGER/ANXIETY/F

Facility

$800.80

Hospital Charge Code	24846085
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP ANGER/ANXIETY/F

Facility

$800.80

Hospital Charge Code	24846085
Hospital Revenue Code	915
Min. Negotiated Rate	$104.10
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP ANGER/ANXIETY/F

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246085
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

PSYCH-ED GROUP ANGER/ANXIETY/F

Facility

$800.80

Hospital Charge Code	24746085
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP-ASSERTIVE BEHAV

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246035
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP-ASSERTIVE BEHAV

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246035
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

PSYCH-ED GROUP DEPRESSION/SADN

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246045
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSYCH-ED GROUP DEPRESSION/SADN

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246045
Hospital Revenue Code	915
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$241.93
Rate for Payer: Aetna Commercial	$240.24
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48

Know your out-of-pocket cost for care.

All Charges