Heights University Hospital

All Charges

Charge

Type

Setting

Price

OSTEOTOMY,CALCANEUS RT

Facility

$57,834.50

Service Code	HCPCS 28300
Hospital Charge Code	16000331
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,350.35
Rate for Payer: Aetna Commercial	$17,350.35
Rate for Payer: Aetna Medicare Advantage	$17,350.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,747.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,747.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,747.80
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,518.48
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OSTEOTOMY MIDT BONE-RT

Facility

$57,834.50

Service Code	HCPCS 28304
Hospital Charge Code	16000723
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,350.35
Rate for Payer: Aetna Commercial	$17,350.35
Rate for Payer: Aetna Medicare Advantage	$17,350.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,747.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,747.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,747.80
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,518.48
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OSTEOTOMY MIDT BONE-RT

Facility

$57,834.50

Service Code	HCPCS 28304
Hospital Charge Code	16000723
Hospital Revenue Code	360
Min. Negotiated Rate	$8,675.17
Max. Negotiated Rate	$8,675.17
Rate for Payer: Qualcare PPO/HMO/WC	$8,675.17

OSTEOTOMY MIDT BONES; W AUTOG

Facility

$28,042.44

Service Code	HCPCS 28305
Hospital Charge Code	16000906
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$17,279.91
Rate for Payer: Aetna Commercial	$8,412.73
Rate for Payer: Aetna Medicare Advantage	$8,412.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,150.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,150.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,150.82
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,645.52
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.37
Rate for Payer: UnitedHealthcare Commercial	$9,851.00

OSTEOTOMY MIDT BONES; W AUTOG

Facility

$28,042.44

Service Code	HCPCS 28305
Hospital Charge Code	16000906
Hospital Revenue Code	360
Min. Negotiated Rate	$4,206.37
Max. Negotiated Rate	$4,206.37
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.37

OSTETMY CRRCT DFRMITY,PHALANX

Facility

$26,471.80

Service Code	HCPCS 26567
Hospital Charge Code	16000856
Hospital Revenue Code	360
Min. Negotiated Rate	$3,970.77
Max. Negotiated Rate	$3,970.77
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77

OSTETMY CRRCT DFRMITY,PHALANX

Facility

$26,471.80

Service Code	HCPCS 26567
Hospital Charge Code	16000856
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$7,941.54
Rate for Payer: Aetna Commercial	$7,941.54
Rate for Payer: Aetna Medicare Advantage	$7,941.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.31
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,441.33
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77
Rate for Payer: UnitedHealthcare Commercial	$6,873.00

OSTOMY SURFIT POUCH 1-3/4 FLNG

Facility

$5.13

Hospital Charge Code	270650213
Hospital Revenue Code	270
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$1.54
Rate for Payer: Aetna Medicare Advantage	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.31
Rate for Payer: Cigna Commercial	$2.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.67
Rate for Payer: Oxford Commercial	$2.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$2.56

OSTOMY SURFIT POUCH 1-3/4 FLNG

Facility

$5.13

Hospital Charge Code	270650213
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

OSTOMY WOUND DRAIN UP TO 3

Facility

$36.88

Hospital Charge Code	270650208
Hospital Revenue Code	270
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.53

OSTOMY WOUND DRAIN UP TO 3

Facility

$36.88

Hospital Charge Code	270650208
Hospital Revenue Code	270
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$18.44
Rate for Payer: Aetna Commercial	$11.06
Rate for Payer: Aetna Medicare Advantage	$11.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.40
Rate for Payer: Cigna Commercial	$18.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.79
Rate for Payer: Oxford Commercial	$18.44
Rate for Payer: Qualcare PPO/HMO/WC	$5.53
Rate for Payer: UnitedHealthcare Commercial	$18.44

OT ADL SESSION EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97535GO
Hospital Charge Code	9100038
Hospital Revenue Code	430
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

OT ADL SESSION EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97535GO
Hospital Charge Code	9100038
Hospital Revenue Code	430
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$686.00
Rate for Payer: UnitedHealthcare Commercial	$686.00
Rate for Payer: Aetna Commercial	$42.49
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.41
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

OT BALANCE/NME/COOR 15MIN

Facility

$314.00

Service Code	HCPCS 97112GO
Hospital Charge Code	74203045
Hospital Revenue Code	430
Min. Negotiated Rate	$40.82
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$94.20
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.82
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT BALANCE/NME/COOR 15MIN

Facility

$314.00

Service Code	HCPCS 97112GO
Hospital Charge Code	74203045
Hospital Revenue Code	430
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

OT CHILD STUDY****

Facility

$125.00

Service Code	HCPCS 97003
Hospital Charge Code	9000464
Hospital Revenue Code	434
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

OT CHILD STUDY****

Facility

$125.00

Service Code	HCPCS 97003
Hospital Charge Code	9000464
Hospital Revenue Code	434
Min. Negotiated Rate	$16.25
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT CKOUT ORTHO/PROS 15MIN

Facility

$259.00

Service Code	HCPCS 97763GO
Hospital Charge Code	74203079
Hospital Revenue Code	430
Min. Negotiated Rate	$33.67
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$77.70
Rate for Payer: Aetna Medicare Advantage	$77.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.05
Rate for Payer: Cigna Commercial	$129.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.67
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT CKOUT ORTHO/PROS 15MIN

Facility

$259.00

Service Code	HCPCS 97763GO
Hospital Charge Code	74203079
Hospital Revenue Code	430
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

OT COGN SKILL DEVELOP EA 15 MN

Facility

$116.85

Service Code	HCPCS G0515GO
Hospital Charge Code	9100240
Hospital Revenue Code	430
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

OT COGN SKILL DEVELOP EA 15 MN

Facility

$116.85

Service Code	HCPCS G0515GO
Hospital Charge Code	9100240
Hospital Revenue Code	430
Min. Negotiated Rate	$15.19
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$35.05
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.19
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT COG SKILLS DEVEL 15MIN

Facility

$141.00

Service Code	HCPCS G0515GO
Hospital Charge Code	74203059
Hospital Revenue Code	430
Min. Negotiated Rate	$18.33
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$42.30
Rate for Payer: Aetna Medicare Advantage	$42.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.95
Rate for Payer: Cigna Commercial	$70.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.33
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT COG SKILLS DEVEL 15MIN

Facility

$141.00

Service Code	HCPCS G0515GO
Hospital Charge Code	74203059
Hospital Revenue Code	430
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

OT COLD/HEAT APPLICATION

Facility

$0.01

Service Code	HCPCS 97010GO
Hospital Charge Code	74203025
Hospital Revenue Code	430
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT COLD/HEAT APPLICATION

Facility

$0.01

Service Code	HCPCS 97010GO
Hospital Charge Code	74203025
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges