Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSYCH-ED WRAP UP GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246065
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 EMERGENCY SCREENING

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84310190
Hospital Revenue Code	914
Min. Negotiated Rate	$71.39
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$388.80
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.48
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39

PSYCH EMERGENCY SCREENING

Facility

$1,296.00

Service Code	HCPCS 90832
Hospital Charge Code	84310190
Hospital Revenue Code	914
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

PSYCH E&M LEVEL I 10 MINS

Facility

$433.40

Hospital Charge Code	84310140
Hospital Revenue Code	513
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

PSYCH E&M LEVEL I 10 MINS

Facility

$433.40

Hospital Charge Code	84310140
Hospital Revenue Code	513
Min. Negotiated Rate	$56.34
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$130.02
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.34
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

PSYCH E&M LEVEL II 20MINS

Facility

$367.85

Hospital Charge Code	84310145
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

PSYCH E&M LEVEL II 20MINS

Facility

$367.85

Hospital Charge Code	84310145
Hospital Revenue Code	513
Min. Negotiated Rate	$47.82
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$110.36
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.82
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

PSYCH E&M LEVEL III 30MINS

Facility

$484.05

Hospital Charge Code	84310150
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

PSYCH E&M LEVEL III 30MINS

Facility

$484.05

Hospital Charge Code	84310150
Hospital Revenue Code	513
Min. Negotiated Rate	$62.93
Max. Negotiated Rate	$242.03
Rate for Payer: Aetna Commercial	$145.22
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.93
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

PSYCH E&M LEVEL IV 45 MINS

Facility

$641.45

Hospital Charge Code	84310155
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

PSYCH E&M LEVEL IV 45 MINS

Facility

$641.45

Hospital Charge Code	84310155
Hospital Revenue Code	513
Min. Negotiated Rate	$83.39
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$192.44
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.39
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

PSYCH E&M LEVEL V 60 MINS

Facility

$877.65

Hospital Charge Code	84310160
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

PSYCH E&M LEVEL V 60 MINS

Facility

$877.65

Hospital Charge Code	84310160
Hospital Revenue Code	513
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$438.82
Rate for Payer: Aetna Commercial	$263.30
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$438.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.09
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

PSYCH E/R 1 1/2 TO 2 1/2 HR***

Facility

$846.00

Service Code	HCPCS 90808
Hospital Charge Code	7500036
Hospital Revenue Code	914
Min. Negotiated Rate	$126.90
Max. Negotiated Rate	$126.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.90

PSYCH E/R 1 1/2 TO 2 1/2 HR***

Facility

$846.00

Service Code	HCPCS 90808
Hospital Charge Code	7500036
Hospital Revenue Code	914
Min. Negotiated Rate	$109.98
Max. Negotiated Rate	$423.00
Rate for Payer: Aetna Commercial	$253.80
Rate for Payer: Aetna Medicare Advantage	$253.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.73
Rate for Payer: Cigna Commercial	$423.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.98
Rate for Payer: Qualcare PPO/HMO/WC	$126.90

PSYCH E/R 1/2 TO 1 1/2 HR*****

Facility

$261.80

Service Code	HCPCS 90804
Hospital Charge Code	7500028
Hospital Revenue Code	914
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$39.27
Rate for Payer: Qualcare PPO/HMO/WC	$39.27

PSYCH E/R 1/2 TO 1 1/2 HR*****

Facility

$261.80

Service Code	HCPCS 90804
Hospital Charge Code	7500028
Hospital Revenue Code	914
Min. Negotiated Rate	$34.03
Max. Negotiated Rate	$130.90
Rate for Payer: Aetna Commercial	$78.54
Rate for Payer: Aetna Medicare Advantage	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.76
Rate for Payer: Cigna Commercial	$130.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$39.27

PSYCH E/R 2 1/2 TO 3 1/2 HR***

Facility

$427.90

Hospital Charge Code	7500085
Hospital Revenue Code	914
Min. Negotiated Rate	$64.19
Max. Negotiated Rate	$64.19
Rate for Payer: Qualcare PPO/HMO/WC	$64.19

PSYCH E/R 2 1/2 TO 3 1/2 HR***

Facility

$427.90

Hospital Charge Code	7500085
Hospital Revenue Code	914
Min. Negotiated Rate	$55.63
Max. Negotiated Rate	$213.95
Rate for Payer: Aetna Commercial	$128.37
Rate for Payer: Aetna Medicare Advantage	$128.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.11
Rate for Payer: Cigna Commercial	$213.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.63
Rate for Payer: Qualcare PPO/HMO/WC	$64.19

PSYCH E/R GROUP****

Facility

$130.00

Hospital Charge Code	7500101
Hospital Revenue Code	914
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$39.00
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.90
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

PSYCH E/R GROUP****

Facility

$130.00

Hospital Charge Code	7500101
Hospital Revenue Code	914
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

PSYCH E/R UP TO 1/2 HOUR***

Facility

$137.50

Hospital Charge Code	7500010
Hospital Revenue Code	914
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$20.62
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

PSYCH E/R UP TO 1/2 HOUR***

Facility

$137.50

Hospital Charge Code	7500010
Hospital Revenue Code	914
Min. Negotiated Rate	$17.88
Max. Negotiated Rate	$68.75
Rate for Payer: Aetna Commercial	$41.25
Rate for Payer: Aetna Medicare Advantage	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.06
Rate for Payer: Cigna Commercial	$68.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.88
Rate for Payer: Qualcare PPO/HMO/WC	$20.62

PSYCH ER URINALYSIS,DIP STICK

Facility

$22.00

Service Code	HCPCS 81000
Hospital Charge Code	7508001
Hospital Revenue Code	307
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

PSYCH ER URINALYSIS,DIP STICK

Facility

$22.00

Service Code	HCPCS 81000
Hospital Charge Code	7508001
Hospital Revenue Code	307
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$13.02
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.73
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: Cigna Medicare Advantage	$2.01
Rate for Payer: Clover Medicare Advantage	$3.82
Rate for Payer: EmblemHealth Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$4.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.02
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$4.26
Rate for Payer: Wellcare Medicare Advantage	$4.02

Know your out-of-pocket cost for care.

All Charges