Heights University Hospital

All Charges

Charge

Type

Setting

Price

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4511609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4824609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4517609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4546609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4517609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4504609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4510630
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4822609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4511609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4832609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4510630
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4509630
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4822609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4824630
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4546609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4535609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4527609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4518609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4504609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4515609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4822630
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4535609
Hospital Revenue Code	918
Min. Negotiated Rate	$1,020.00
Max. Negotiated Rate	$1,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.00

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4832609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4515609
Hospital Revenue Code	918
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

PSYDX EVAL NONMD CHILD CAID

Facility

$6,800.00

Service Code	HCPCS 90791
Hospital Charge Code	4509630
Hospital Revenue Code	918
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$2,040.00
Rate for Payer: Aetna Medicare Advantage	$2,040.00
Rate for Payer: Aetna Commercial	$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