Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSYCHIATRIC DIAGNOSTIC EVAL

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	84518001
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	84509001
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	84511001
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	84518001
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 DIAGNOSTIC EVAL

Facility

$1,296.00

Service Code	HCPCS 90791
Hospital Charge Code	87504005
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	$308.16
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	$171.99

PSYCHIATRIC DIAGNOSTIC EVAL

Facility

$1,296.00

Service Code	HCPCS 90791
Hospital Charge Code	87504005
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

PSYCHIATRIC DIAGNOSTIC EVAL

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	84517001
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	84511001
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 DIAGNOSTIC EVAL

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	84509001
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 DIAGNOSTIC EVAL

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	84527001
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	84517001
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 DIAGNOSTIC EXAM

Facility

$613.15

Service Code	HCPCS 90801
Hospital Charge Code	50011
Hospital Revenue Code	900
Min. Negotiated Rate	$91.97
Max. Negotiated Rate	$91.97
Rate for Payer: Qualcare PPO/HMO/WC	$91.97

PSYCHIATRIC DIAGNOSTIC EXAM

Facility

$613.15

Service Code	HCPCS 90801
Hospital Charge Code	50011
Hospital Revenue Code	900
Min. Negotiated Rate	$79.71
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$183.94
Rate for Payer: Aetna Medicare Advantage	$183.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.35
Rate for Payer: Cigna Commercial	$306.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.71
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.97
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

PSYCHIATRIC EMER SCREENING EVA

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	5792230
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 EMER SCREENING EVA

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	5792230
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

PSYCHIATRIST PHONE CONSU****

Facility

$162.00

Hospital Charge Code	7500044
Hospital Revenue Code	914
Min. Negotiated Rate	$21.06
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.06
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

PSYCHIATRIST PHONE CONSU****

Facility

$162.00

Hospital Charge Code	7500044
Hospital Revenue Code	914
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$24.30
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

PSYCHIATRY INDIV DX SESS****

Facility

$210.00

Service Code	HCPCS 90801
Hospital Charge Code	9300062
Hospital Revenue Code	910
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

PSYCHIATRY INDIV DX SESS****

Facility

$210.00

Service Code	HCPCS 90801
Hospital Charge Code	9300062
Hospital Revenue Code	910
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$63.00
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

PSYCH INDIVIDUAL SESSION

Facility

$449.95

Service Code	HCPCS 90807
Hospital Charge Code	9310053
Hospital Revenue Code	914
Min. Negotiated Rate	$58.49
Max. Negotiated Rate	$224.97
Rate for Payer: Aetna Commercial	$134.99
Rate for Payer: Aetna Medicare Advantage	$134.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.74
Rate for Payer: Cigna Commercial	$224.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.49
Rate for Payer: Qualcare PPO/HMO/WC	$67.49

PSYCH INDIVIDUAL SESSION

Facility

$449.95

Service Code	HCPCS 90807
Hospital Charge Code	9310053
Hospital Revenue Code	914
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$67.49
Rate for Payer: Qualcare PPO/HMO/WC	$67.49

PSYCH INTERACTIVE COMPLEXITY

Facility

$275.00

Service Code	HCPCS 90875
Hospital Charge Code	84310130
Hospital Revenue Code	914
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.75
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PSYCH INTERACTIVE COMPLEXITY

Facility

$275.00

Service Code	HCPCS 90875
Hospital Charge Code	84310130
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PSYCH NJCAID RESIDENTIAL

Facility

$18,000.00

Hospital Charge Code	100082
Hospital Revenue Code	190
Min. Negotiated Rate	$1,465.00
Max. Negotiated Rate	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,028.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

PSYCHO-ED GOALS GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246135
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

Know your out-of-pocket cost for care.

All Charges