Heights University Hospital

All Charges

Charge

Type

Setting

Price

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$33,249.03

Service Code	MSDRG 153
Min. Negotiated Rate	$8,055.67
Max. Negotiated Rate	$33,249.03
Rate for Payer: Aetna Commercial	$24,892.02
Rate for Payer: Aetna Medicare Advantage	$8,055.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,123.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,123.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,083.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,123.91
Rate for Payer: Cigna Commercial	$15,886.80
Rate for Payer: Cigna Medicare Advantage	$11,083.01
Rate for Payer: Clover Medicare Advantage	$10,528.86
Rate for Payer: EmblemHealth Commercial	$33,249.03
Rate for Payer: Humana Medicare Advantage	$11,415.50
Rate for Payer: Oxford Commercial	$9,928.79
Rate for Payer: UnitedHealthcare Commercial	$11,270.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,083.01
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$11,747.99
Rate for Payer: Wellcare Medicare Advantage	$11,083.01

OT MANUAL THERAPY 15MIN

Facility

$159.00

Service Code	HCPCS 97140GO
Hospital Charge Code	74203053
Hospital Revenue Code	430
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

OT MANUAL THERAPY 15MIN

Facility

$159.00

Service Code	HCPCS 97140GO
Hospital Charge Code	74203053
Hospital Revenue Code	430
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$47.70
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.55
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	$40.55
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.67
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT MANUAL THERAPY EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97140GO
Hospital Charge Code	9100170
Hospital Revenue Code	430
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$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
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT MANUAL THERAPY EA 15 MIN

Facility

$141.65

Service Code	HCPCS 97140GO
Hospital Charge Code	9100170
Hospital Revenue Code	430
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

OT MASSAGE 15 MIN

Facility

$328.00

Service Code	HCPCS 97124GO
Hospital Charge Code	74203051
Hospital Revenue Code	430
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$49.20
Rate for Payer: Qualcare PPO/HMO/WC	$49.20

OT MASSAGE 15 MIN

Facility

$328.00

Service Code	HCPCS 97124GO
Hospital Charge Code	74203051
Hospital Revenue Code	430
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$98.40
Rate for Payer: Aetna Medicare Advantage	$98.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.64
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	$83.64
Rate for Payer: Cigna Commercial	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.64
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.20
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT MASSAGE THERAPY

Facility

$116.85

Service Code	HCPCS 97124GO
Hospital Charge Code	9100185
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 MASSAGE THERAPY

Facility

$116.85

Service Code	HCPCS 97124GO
Hospital Charge Code	9100185
Hospital Revenue Code	430
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

OT MODALITY ELC STM WOUND CARE

Facility

$91.25

Service Code	HCPCS G0281GO
Hospital Charge Code	9100166
Hospital Revenue Code	430
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$27.38
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
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	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT MODALITY ELC STM WOUND CARE

Facility

$91.25

Service Code	HCPCS G0281GO
Hospital Charge Code	9100166
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

OT MODALITY ELEC STIM UNATTEND

Facility

$91.25

Service Code	HCPCS G0283GO
Hospital Charge Code	9100175
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

OT MODALITY ELEC STIM UNATTEND

Facility

$91.25

Service Code	HCPCS G0283GO
Hospital Charge Code	9100175
Hospital Revenue Code	430
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$27.38
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
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	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT NEUROMUSCULAR RE-EDUCATION

Facility

$128.00

Service Code	HCPCS 97112GO
Hospital Charge Code	9100180
Hospital Revenue Code	430
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

OT NEUROMUSCULAR RE-EDUCATION

Facility

$128.00

Service Code	HCPCS 97112GO
Hospital Charge Code	9100180
Hospital Revenue Code	430
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$38.40
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
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	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$686.00

OTOBIOTIC/15ML

Facility

$75.00

Hospital Charge Code	60633596
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

OTOBIOTIC/15ML

Facility

$75.00

Hospital Charge Code	60633596
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$37.50

OTOLOGICAL DRAIN TUBE 1.0 MM

Facility

$248.00

Hospital Charge Code	270331530
Hospital Revenue Code	278
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$60.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.02
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

OTOLOGICAL DRAIN TUBE 1.0 MM

Facility

$248.00

Hospital Charge Code	270331530
Hospital Revenue Code	278
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$74.40
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.02
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

OTOPROBE LONG ANGLE F/IRIDEX

Facility

$1,500.00

Hospital Charge Code	270639255
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

OTOPROBE LONG ANGLE F/IRIDEX

Facility

$1,500.00

Hospital Charge Code	270639255
Hospital Revenue Code	272
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$450.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$750.00

OT ORTHOT MNG/TRAIN 15MIN 1ST

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008365
Hospital Revenue Code	430
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

OT ORTHOT MNG/TRAIN 15MIN 1ST

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008365
Hospital Revenue Code	430
Min. Negotiated Rate	$24.57
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$56.70
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
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	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.57
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT ORTHOT MNG/TRAIN EA 15M 1ST

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	74203075
Hospital Revenue Code	430
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

OT ORTHOT MNG/TRAIN EA 15M 1ST

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	74203075
Hospital Revenue Code	430
Min. Negotiated Rate	$57.98
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$133.80
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
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	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.98
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

Know your out-of-pocket cost for care.

All Charges