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	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	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	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	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

PSY-ED GR MEDS REINFORCEM

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246115
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

PSY-ED GR MEDS REINFORCEM

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246115
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

PSYLLIUM 3.5 G PACKET

Facility

$4.00

Service Code	NDC 38485080855
Hospital Charge Code	60628136
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PSYLLIUM 3.5 G PACKET

Facility

$4.00

Service Code	NDC 38485080855
Hospital Charge Code	60628136
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

PSY TX COMPLEX INTERACTIVE

Facility

$682.20

Service Code	HCPCS 90785
Hospital Charge Code	73237001
Hospital Revenue Code	900
Min. Negotiated Rate	$6.00
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	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.96
Rate for Payer: Cigna Commercial	$12.49
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

PSY TX COMPLEX INTERACTIVE

Facility

$682.20

Service Code	HCPCS 90785
Hospital Charge Code	73237001
Hospital Revenue Code	900
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 30 MIN

Facility

$501.15

Service Code	HCPCS 90832
Hospital Charge Code	73237007
Hospital Revenue Code	914
Min. Negotiated Rate	$75.17
Max. Negotiated Rate	$75.17
Rate for Payer: Qualcare PPO/HMO/WC	$75.17

PSY TX PT/FAM 30 MIN

Facility

$501.15

Service Code	HCPCS 90832
Hospital Charge Code	73237007
Hospital Revenue Code	914
Min. Negotiated Rate	$65.15
Max. Negotiated Rate	$422.69
Rate for Payer: Aetna Commercial	$150.34
Rate for Payer: Aetna Medicare Advantage	$150.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.79
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	$127.79
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.15
Rate for Payer: Qualcare PPO/HMO/WC	$75.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$71.39

PSY TX PT/FAM 30 MIN W E/M

Facility

$501.15

Service Code	HCPCS 90833
Hospital Charge Code	73237009
Hospital Revenue Code	914
Min. Negotiated Rate	$75.17
Max. Negotiated Rate	$75.17
Rate for Payer: Qualcare PPO/HMO/WC	$75.17

PSY TX PT/FAM 30 MIN W E/M

Facility

$501.15

Service Code	HCPCS 90833
Hospital Charge Code	73237009
Hospital Revenue Code	914
Min. Negotiated Rate	$65.15
Max. Negotiated Rate	$150.34
Rate for Payer: Aetna Commercial	$150.34
Rate for Payer: Aetna Medicare Advantage	$150.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.79
Rate for Payer: Cigna Commercial	$70.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.15
Rate for Payer: Qualcare PPO/HMO/WC	$75.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73.61

PSY TX PT/FAM 45 MIN

Facility

$682.20

Service Code	HCPCS 90834
Hospital Charge Code	73237011
Hospital Revenue Code	914
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 45 MIN

Facility

$682.20

Service Code	HCPCS 90834
Hospital Charge Code	73237011
Hospital Revenue Code	914
Min. Negotiated Rate	$88.69
Max. Negotiated Rate	$422.69
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	$150.25
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: Qualcare PPO/HMO/WC	$102.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46

PSY TX PT/FAM 45 MIN W E/M

Facility

$682.20

Service Code	HCPCS 90836
Hospital Charge Code	73237013
Hospital Revenue Code	914
Min. Negotiated Rate	$88.69
Max. Negotiated Rate	$204.66
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	$147.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.96
Rate for Payer: Cigna Commercial	$89.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.69
Rate for Payer: Qualcare PPO/HMO/WC	$102.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$94.46

PSY TX PT/FAM 45 MIN W E/M

Facility

$682.20

Service Code	HCPCS 90836
Hospital Charge Code	73237013
Hospital Revenue Code	914
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 60 MIN

Facility

$682.20

Service Code	HCPCS 90837
Hospital Charge Code	73237015
Hospital Revenue Code	914
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 60 MIN

Facility

$682.20

Service Code	HCPCS 90837
Hospital Charge Code	73237015
Hospital Revenue Code	914
Min. Negotiated Rate	$88.69
Max. Negotiated Rate	$422.69
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	$135.39
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: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 60 MIN W E/M

Facility

$682.20

Service Code	HCPCS 90838
Hospital Charge Code	73237017
Hospital Revenue Code	914
Min. Negotiated Rate	$88.69
Max. Negotiated Rate	$204.66
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	$141.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.96
Rate for Payer: Cigna Commercial	$118.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.69
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PSY TX PT/FAM 60 MIN W E/M

Facility

$682.20

Service Code	HCPCS 90838
Hospital Charge Code	73237017
Hospital Revenue Code	914
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Qualcare PPO/HMO/WC	$102.33

PTA AORTIC

Facility

$5,659.55

Service Code	HCPCS 35472
Hospital Charge Code	5100332
Hospital Revenue Code	761
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

PTA AORTIC

Facility

$5,659.55

Service Code	HCPCS 35472
Hospital Charge Code	5100332
Hospital Revenue Code	761
Min. Negotiated Rate	$735.74
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$1,697.87
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$735.74
Rate for Payer: Oxford Commercial	$2,829.78
Rate for Payer: Qualcare PPO/HMO/WC	$848.93
Rate for Payer: UnitedHealthcare Commercial	$2,829.78

PTA BRACHIOCEPHALIC

Facility

$5,659.55

Service Code	HCPCS 35475
Hospital Charge Code	5100510
Hospital Revenue Code	761
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

Know your out-of-pocket cost for care.

All Charges