Heights University Hospital

All Charges

Charge

Type

Setting

Price

RW PSYCHIATRIC DIAGNOSTIC EVAL

Facility

$1,296.00

Service Code	HCPCS 90791
Hospital Charge Code	87502890
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

RW PSYCHIATRIC DIAGNOSTIC EVAL

Facility

$1,296.00

Service Code	HCPCS 90791
Hospital Charge Code	87502890
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

RW PSYCH NON MD W PATIENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84206265
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

RW PSYCH NON MD W PATIENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84206265
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

RW PSY IND 20-30 MIN

Facility

$730.00

Service Code	HCPCS 90805
Hospital Charge Code	87502035
Hospital Revenue Code	914
Min. Negotiated Rate	$109.50
Max. Negotiated Rate	$109.50
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

RW PSY IND 20-30 MIN

Facility

$730.00

Service Code	HCPCS 90805
Hospital Charge Code	87502035
Hospital Revenue Code	914
Min. Negotiated Rate	$94.90
Max. Negotiated Rate	$365.00
Rate for Payer: Aetna Commercial	$219.00
Rate for Payer: Aetna Medicare Advantage	$219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.15
Rate for Payer: Cigna Commercial	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.90
Rate for Payer: Qualcare PPO/HMO/WC	$109.50

RW PSY IND 45-50 MIN

Facility

$1,080.00

Service Code	HCPCS 90807
Hospital Charge Code	87502040
Hospital Revenue Code	914
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

RW PSY IND 45-50 MIN

Facility

$1,080.00

Service Code	HCPCS 90807
Hospital Charge Code	87502040
Hospital Revenue Code	914
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$324.00
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.40
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

RW PSY MEDICATION REVIEW

Facility

$421.00

Service Code	HCPCS 90862
Hospital Charge Code	84206270
Hospital Revenue Code	914
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

RW PSY MEDICATION REVIEW

Facility

$421.00

Service Code	HCPCS 90862
Hospital Charge Code	84206270
Hospital Revenue Code	914
Min. Negotiated Rate	$54.73
Max. Negotiated Rate	$210.50
Rate for Payer: Aetna Commercial	$126.30
Rate for Payer: Aetna Medicare Advantage	$126.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.36
Rate for Payer: Cigna Commercial	$210.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.73
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

RW PULSE OXIMETRY

Facility

$503.00

Service Code	HCPCS 94760
Hospital Charge Code	87502280
Hospital Revenue Code	460
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$75.45
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

RW PULSE OXIMETRY

Facility

$503.00

Service Code	HCPCS 94760
Hospital Charge Code	84206295
Hospital Revenue Code	460
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$75.45
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

RW PULSE OXIMETRY

Facility

$503.00

Service Code	HCPCS 94760
Hospital Charge Code	87502280
Hospital Revenue Code	460
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$150.90
Rate for Payer: Aetna Medicare Advantage	$150.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.26
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.39
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.45
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

RW PULSE OXIMETRY

Facility

$503.00

Service Code	HCPCS 94760
Hospital Charge Code	84206295
Hospital Revenue Code	460
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$150.90
Rate for Payer: Aetna Medicare Advantage	$150.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.26
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.39
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.45
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

RW RAPID STREP

Facility

$390.00

Service Code	HCPCS 87880
Hospital Charge Code	87502300
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RW RAPID STREP

Facility

$390.00

Service Code	HCPCS 87880
Hospital Charge Code	87502300
Hospital Revenue Code	306
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$53.56
Rate for Payer: Aetna Medicare Advantage	$16.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.57
Rate for Payer: Cigna Commercial	$16.53
Rate for Payer: Cigna Medicare Advantage	$8.27
Rate for Payer: Clover Medicare Advantage	$15.70
Rate for Payer: EmblemHealth Commercial	$49.59
Rate for Payer: Humana Medicare Advantage	$17.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.53
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$17.52
Rate for Payer: Wellcare Medicare Advantage	$16.53

RW RATA TEQ 2 ML (ROTAVIRUS)

Facility

$168.00

Service Code	HCPCS 90680
Hospital Charge Code	84206400
Hospital Revenue Code	636
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$50.40
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.66
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

RW RATA TEQ 2 ML (ROTAVIRUS)

Facility

$168.00

Service Code	HCPCS 90680
Hospital Charge Code	84206400
Hospital Revenue Code	636
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$40.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.66
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

RW ROCEPHIN 250MG

Facility

$12.00

Hospital Charge Code	83652633
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

RW ROCEPHIN 250MG

Facility

$12.00

Hospital Charge Code	83652633
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$6.00

RW SHAVE BIOPSY DERMAL LESION

Facility

$69.00

Service Code	HCPCS 11300
Hospital Charge Code	87502870
Hospital Revenue Code	510
Min. Negotiated Rate	$8.97
Max. Negotiated Rate	$968.07
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

RW SHAVE BIOPSY DERMAL LESION

Facility

$69.00

Service Code	HCPCS 11300
Hospital Charge Code	87502870
Hospital Revenue Code	510
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

RW SILVER NITRATE APP

Facility

$16.00

Service Code	HCPCS 90710
Hospital Charge Code	84206390
Hospital Revenue Code	636
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

RW SILVER NITRATE APP

Facility

$16.00

Service Code	HCPCS 90710
Hospital Charge Code	84206390
Hospital Revenue Code	636
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$14.95
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

RW SKIN TAG REM @ ADDTL 10 L

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	87502265
Hospital Revenue Code	510
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

Know your out-of-pocket cost for care.

All Charges