Heights University Hospital

All Charges

Charge

Type

Setting

Price

OT COMMUNTY/WORK TRAING EA 15M

Facility

$102.40

Service Code	HCPCS 97537GO
Hospital Charge Code	9100130
Hospital Revenue Code	430
Min. Negotiated Rate	$13.31
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$30.72
Rate for Payer: Aetna Medicare Advantage	$30.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.11
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	$26.11
Rate for Payer: Cigna Commercial	$51.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.31
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.36
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT COMMUNTY/WORK TRAING EA 15M

Facility

$102.40

Service Code	HCPCS 97537GO
Hospital Charge Code	9100130
Hospital Revenue Code	430
Min. Negotiated Rate	$15.36
Max. Negotiated Rate	$15.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.36

OT CONTRAST BATH EACH 15 MIN

Facility

$106.00

Service Code	HCPCS 97034GO
Hospital Charge Code	1008180
Hospital Revenue Code	430
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

OT CONTRAST BATH EACH 15 MIN

Facility

$106.00

Service Code	HCPCS 97034GO
Hospital Charge Code	1008180
Hospital Revenue Code	430
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
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	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.78
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT CONTRAST BATHS 15MIN

Facility

$106.00

Service Code	HCPCS 97034GO
Hospital Charge Code	74203039
Hospital Revenue Code	430
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
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	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.78
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT CONTRAST BATHS 15MIN

Facility

$106.00

Service Code	HCPCS 97034GO
Hospital Charge Code	74203039
Hospital Revenue Code	430
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

OT CUSTOM SPLINT - LEVEL 1

Facility

$77.65

Hospital Charge Code	9100010
Hospital Revenue Code	274
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.79
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

OT CUSTOM SPLINT - LEVEL 1

Facility

$77.65

Hospital Charge Code	9100010
Hospital Revenue Code	274
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$38.83
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.79
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

OT CUSTOM SPLINT - LEVEL 2

Facility

$153.65

Hospital Charge Code	9100011
Hospital Revenue Code	274
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$76.83
Rate for Payer: Aetna Commercial	$46.09
Rate for Payer: Aetna Medicare Advantage	$46.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.18
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.18
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

OT CUSTOM SPLINT - LEVEL 2

Facility

$153.65

Hospital Charge Code	9100011
Hospital Revenue Code	274
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$37.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.18
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

OT CUSTOM SPLINT - LEVEL 3

Facility

$192.85

Hospital Charge Code	9100012
Hospital Revenue Code	270
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

OT CUSTOM SPLINT - LEVEL 3

Facility

$192.85

Hospital Charge Code	9100012
Hospital Revenue Code	270
Min. Negotiated Rate	$25.07
Max. Negotiated Rate	$96.42
Rate for Payer: Aetna Commercial	$57.85
Rate for Payer: Aetna Medicare Advantage	$57.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.18
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.07
Rate for Payer: Oxford Commercial	$96.42
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$96.42

OT CUSTOM SPLINT - LEVEL 4

Facility

$307.25

Hospital Charge Code	9100013
Hospital Revenue Code	274
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$74.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

OT CUSTOM SPLINT - LEVEL 4

Facility

$307.25

Hospital Charge Code	9100013
Hospital Revenue Code	274
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$153.62
Rate for Payer: Aetna Commercial	$92.17
Rate for Payer: Aetna Medicare Advantage	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.35
Rate for Payer: Cigna Commercial	$153.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

OT CYBEX EVALUATION EA 15 MIN

Facility

$113.30

Service Code	HCPCS 97750GO
Hospital Charge Code	9100044
Hospital Revenue Code	430
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

OT CYBEX EVALUATION EA 15 MIN

Facility

$113.30

Service Code	HCPCS 97750GO
Hospital Charge Code	9100044
Hospital Revenue Code	430
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$33.99
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
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	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.73
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT CYBEX TREATMENT EA 15 MIN**

Facility

$45.00

Service Code	HCPCS 97110GO
Hospital Charge Code	9100042
Hospital Revenue Code	430
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
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	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT CYBEX TREATMENT EA 15 MIN**

Facility

$45.00

Service Code	HCPCS 97110GO
Hospital Charge Code	9100042
Hospital Revenue Code	430
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

OT DEVELOPMENTAL TESTING: EXTE

Facility

$256.65

Service Code	HCPCS 96111
Hospital Charge Code	9100210
Hospital Revenue Code	918
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$38.50
Rate for Payer: Qualcare PPO/HMO/WC	$38.50

OT DEVELOPMENTAL TESTING: EXTE

Facility

$256.65

Service Code	HCPCS 96111
Hospital Charge Code	9100210
Hospital Revenue Code	918
Min. Negotiated Rate	$33.36
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$77.00
Rate for Payer: Aetna Medicare Advantage	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.45
Rate for Payer: Cigna Commercial	$128.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.36
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.50
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

OT DEVELOPMENTAL TESTING: LIMI

Facility

$204.80

Service Code	HCPCS 96110
Hospital Charge Code	9100205
Hospital Revenue Code	918
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$1,994.00
Rate for Payer: Aetna Commercial	$61.44
Rate for Payer: Aetna Medicare Advantage	$61.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.22
Rate for Payer: Cigna Commercial	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.72
Rate for Payer: UnitedHealthcare Commercial	$1,994.00

OT DEVELOPMENTAL TESTING: LIMI

Facility

$204.80

Service Code	HCPCS 96110
Hospital Charge Code	9100205
Hospital Revenue Code	918
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

OT ELEC STIM ATTEND 15MIN

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	74203035
Hospital Revenue Code	430
Min. Negotiated Rate	$32.11
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
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	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.11
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT ELEC STIM ATTEND 15MIN

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	74203035
Hospital Revenue Code	430
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

OT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GO
Hospital Charge Code	9100050
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

Know your out-of-pocket cost for care.

All Charges