Heights University Hospital

All Charges

Charge

Type

Setting

Price

OT FINGER SPLINT STATI RT

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203013
Hospital Revenue Code	430
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

OT FINGER SPLINT STATI RT

Facility

$351.00

Service Code	HCPCS 29130GO
Hospital Charge Code	74203013
Hospital Revenue Code	430
Min. Negotiated Rate	$45.63
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$105.30
Rate for Payer: Aetna Medicare Advantage	$105.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.50
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	$89.50
Rate for Payer: Cigna Commercial	$175.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.63
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.65
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT FLUIDOTHERAPY

Facility

$77.65

Service Code	HCPCS 97022GO
Hospital Charge Code	9100054
Hospital Revenue Code	430
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$686.00
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	$90.00
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	$10.09
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT FLUIDOTHERAPY

Facility

$77.65

Service Code	HCPCS 97022GO
Hospital Charge Code	9100054
Hospital Revenue Code	430
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

OT FOR PARTIAL HOSP PER DAY

Facility

$900.50

Hospital Charge Code	50021
Hospital Revenue Code	430
Min. Negotiated Rate	$135.07
Max. Negotiated Rate	$135.07
Rate for Payer: Qualcare PPO/HMO/WC	$135.07

OT FOR PARTIAL HOSP PER DAY

Facility

$900.50

Hospital Charge Code	50021
Hospital Revenue Code	430
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$270.15
Rate for Payer: Aetna Medicare Advantage	$270.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.63
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	$229.63
Rate for Payer: Cigna Commercial	$450.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.06
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.07
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT FUNC ACT THER EA 15 MIN

Facility

$244.50

Service Code	HCPCS 97530GO
Hospital Charge Code	9100036
Hospital Revenue Code	430
Min. Negotiated Rate	$31.79
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$73.35
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
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	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.79
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT FUNC ACT THER EA 15 MIN

Facility

$244.50

Service Code	HCPCS 97530GO
Hospital Charge Code	9100036
Hospital Revenue Code	430
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$36.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

OT FUNCTIONAL 15MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	74203057
Hospital Revenue Code	430
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$73.50
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
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	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.85
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT FUNCTIONAL 15MIN

Facility

$245.00

Service Code	HCPCS 97530GO
Hospital Charge Code	74203057
Hospital Revenue Code	430
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

OT FUNCTIONAL AMBUL 15MIN

Facility

$412.61

Service Code	HCPCS 97116GO
Hospital Charge Code	74203049
Hospital Revenue Code	430
Min. Negotiated Rate	$61.89
Max. Negotiated Rate	$61.89
Rate for Payer: Qualcare PPO/HMO/WC	$61.89

OT FUNCTIONAL AMBUL 15MIN

Facility

$412.61

Service Code	HCPCS 97116GO
Hospital Charge Code	74203049
Hospital Revenue Code	430
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$123.78
Rate for Payer: Aetna Medicare Advantage	$123.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.22
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	$105.22
Rate for Payer: Cigna Commercial	$206.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.64
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.89
Rate for Payer: UnitedHealthcare Commercial	$686.00

OTHER AFTERCARE AND CONVALESCENCE

Facility

$4,468.73

Service Code	APR-DRG 8621
Min. Negotiated Rate	$4,014.30
Max. Negotiated Rate	$4,468.73
Rate for Payer: Aetna Better Health Medicaid	$4,381.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,468.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4,014.30

OTHER AFTERCARE AND CONVALESCENCE

Facility

$6,238.33

Service Code	APR-DRG 8622
Min. Negotiated Rate	$6,114.58
Max. Negotiated Rate	$6,238.33
Rate for Payer: Aetna Better Health Medicaid	$6,114.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,236.87
Rate for Payer: Wellpoint Medicaid Managed Care	$6,238.33

OTHER AFTERCARE AND CONVALESCENCE

Facility

$14,908.27

Service Code	APR-DRG 8624
Min. Negotiated Rate	$8,241.80
Max. Negotiated Rate	$14,908.27
Rate for Payer: Aetna Better Health Medicaid	$8,241.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,406.64
Rate for Payer: Wellpoint Medicaid Managed Care	$14,908.27

OTHER AFTERCARE AND CONVALESCENCE

Facility

$9,097.60

Service Code	APR-DRG 8623
Min. Negotiated Rate	$7,849.41
Max. Negotiated Rate	$9,097.60
Rate for Payer: Aetna Better Health Medicaid	$7,849.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,006.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9,097.60

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$14,331.72

Service Code	APR-DRG 2533
Min. Negotiated Rate	$9,975.49
Max. Negotiated Rate	$14,331.72
Rate for Payer: Aetna Better Health Medicaid	$14,050.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,331.72
Rate for Payer: Wellpoint Medicaid Managed Care	$9,975.49

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$10,079.27

Service Code	APR-DRG 2532
Min. Negotiated Rate	$6,679.79
Max. Negotiated Rate	$10,079.27
Rate for Payer: Aetna Better Health Medicaid	$9,881.64
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,079.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6,679.79

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$7,814.01

Service Code	APR-DRG 2531
Min. Negotiated Rate	$5,191.29
Max. Negotiated Rate	$7,814.01
Rate for Payer: Aetna Better Health Medicaid	$7,660.79
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,814.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5,191.29

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$24,659.51

Service Code	APR-DRG 2534
Min. Negotiated Rate	$20,664.31
Max. Negotiated Rate	$24,659.51
Rate for Payer: Aetna Better Health Medicaid	$24,175.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,659.51
Rate for Payer: Wellpoint Medicaid Managed Care	$20,664.31

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$6,542.98

Service Code	APR-DRG 6631
Min. Negotiated Rate	$4,653.46
Max. Negotiated Rate	$6,542.98
Rate for Payer: Aetna Better Health Medicaid	$6,414.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,542.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4,653.46

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$22,314.24

Service Code	APR-DRG 6634
Min. Negotiated Rate	$15,701.52
Max. Negotiated Rate	$22,314.24
Rate for Payer: Aetna Better Health Medicaid	$21,876.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,314.24
Rate for Payer: Wellpoint Medicaid Managed Care	$15,701.52

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$9,384.06

Service Code	APR-DRG 6632
Min. Negotiated Rate	$5,874.86
Max. Negotiated Rate	$9,384.06
Rate for Payer: Aetna Better Health Medicaid	$9,200.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,384.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5,874.86

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$13,083.19

Service Code	APR-DRG 6633
Min. Negotiated Rate	$8,406.29
Max. Negotiated Rate	$13,083.19
Rate for Payer: Aetna Better Health Medicaid	$12,826.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,083.19
Rate for Payer: Wellpoint Medicaid Managed Care	$8,406.29

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$45,468.87

Service Code	MSDRG 818
Min. Negotiated Rate	$12,649.87
Max. Negotiated Rate	$45,468.87
Rate for Payer: Aetna Commercial	$39,088.10
Rate for Payer: Aetna Medicare Advantage	$12,649.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39,420.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39,420.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,156.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39,420.81
Rate for Payer: Cigna Commercial	$22,687.44
Rate for Payer: Cigna Medicare Advantage	$15,156.29
Rate for Payer: Clover Medicare Advantage	$14,398.48
Rate for Payer: EmblemHealth Commercial	$45,468.87
Rate for Payer: Humana Medicare Advantage	$15,610.98
Rate for Payer: Oxford Commercial	$14,178.99
Rate for Payer: UnitedHealthcare Commercial	$16,094.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,156.29
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$16,065.67
Rate for Payer: Wellcare Medicare Advantage	$15,156.29

Know your out-of-pocket cost for care.

All Charges