Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSYCH EVALUATION******

Facility

$207.90

Service Code	HCPCS 90801
Hospital Charge Code	50006
Hospital Revenue Code	910
Min. Negotiated Rate	$31.18
Max. Negotiated Rate	$31.18
Rate for Payer: Qualcare PPO/HMO/WC	$31.18

PSYCH EVALUATION******

Facility

$207.90

Service Code	HCPCS 90801
Hospital Charge Code	50006
Hospital Revenue Code	910
Min. Negotiated Rate	$27.03
Max. Negotiated Rate	$103.95
Rate for Payer: Aetna Commercial	$62.37
Rate for Payer: Aetna Medicare Advantage	$62.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.01
Rate for Payer: Cigna Commercial	$103.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.03
Rate for Payer: Qualcare PPO/HMO/WC	$31.18

PSYCHIARIST EMERGENCY C****

Facility

$648.00

Hospital Charge Code	7500051
Hospital Revenue Code	914
Min. Negotiated Rate	$84.24
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna Commercial	$194.40
Rate for Payer: Aetna Medicare Advantage	$194.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.24
Rate for Payer: Cigna Commercial	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Qualcare PPO/HMO/WC	$97.20

PSYCHIARIST EMERGENCY C****

Facility

$648.00

Hospital Charge Code	7500051
Hospital Revenue Code	914
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$97.20
Rate for Payer: Qualcare PPO/HMO/WC	$97.20

PSYCHIATRIC DIAG EVAL NON MD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	87506080
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

PSYCHIATRIC DIAG EVAL NON MD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4546768
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

PSYCHIATRIC DIAG EVAL NON MD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	87506080
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

PSYCHIATRIC DIAG EVAL NON MD

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4546768
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

PSYCHIATRIC DIAG EVAL NON MD

Facility

$550.00

Service Code	HCPCS 90791
Hospital Charge Code	84504005
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

PSYCHIATRIC DIAG EVAL NON MD

Facility

$550.00

Service Code	HCPCS 90791
Hospital Charge Code	84504005
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	84511003
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

PSYCHIATRIC DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84504010
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCHIATRIC DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84518003
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCHIATRIC DIAG EVAL W/MS

Facility

$1,296.00

Service Code	HCPCS 90792
Hospital Charge Code	87504010
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	84509003
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

PSYCHIATRIC DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84518003
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

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	84509003
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

PSYCHIATRIC DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84517003
Hospital Revenue Code	900
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PSYCHIATRIC DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84517003
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

PSYCHIATRIC DIAG EVAL W/MS

Facility

$550.00

Service Code	HCPCS 90792
Hospital Charge Code	84504010
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

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	87506020
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

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	87506020
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

PSYCHIATRIC DIAG EVAL W/MS

Facility

$1,296.00

Service Code	HCPCS 90792
Hospital Charge Code	87504010
Hospital Revenue Code	900
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$1,994.00
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	$765.93
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: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$1,994.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$437.76

PSYCHIATRIC DIAG EVAL W/MS

Facility

$6,800.00

Service Code	HCPCS 90792
Hospital Charge Code	84511003
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

PSYCHIATRIC DIAGNOSTIC EVAL

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	84527001
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

Know your out-of-pocket cost for care.

All Charges