Heights University Hospital

All Charges

Charge

Type

Setting

Price

OT PARAFFIN BATH

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	74203031
Hospital Revenue Code	430
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.58
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT PARAFFIN BATH

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	74203031
Hospital Revenue Code	430
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

OT PHYS PERF TEST 15MIN

Facility

$218.00

Service Code	HCPCS 97750GO
Hospital Charge Code	74203073
Hospital Revenue Code	430
Min. Negotiated Rate	$28.34
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$65.40
Rate for Payer: Aetna Medicare Advantage	$65.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.59
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	$55.59
Rate for Payer: Cigna Commercial	$109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.70
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT PHYS PERF TEST 15MIN

Facility

$218.00

Service Code	HCPCS 97750GO
Hospital Charge Code	74203073
Hospital Revenue Code	430
Min. Negotiated Rate	$32.70
Max. Negotiated Rate	$32.70
Rate for Payer: Qualcare PPO/HMO/WC	$32.70

OT PULSE LAVAGE/WOUND DEBR<20C

Facility

$205.65

Hospital Charge Code	9100200
Hospital Revenue Code	430
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

OT PULSE LAVAGE/WOUND DEBR<20C

Facility

$205.65

Hospital Charge Code	9100200
Hospital Revenue Code	430
Min. Negotiated Rate	$26.73
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$61.70
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
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	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.73
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT PULSE LAVAGE/WOUND DEBR>20C

Facility

$205.65

Hospital Charge Code	9100201
Hospital Revenue Code	430
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

OT PULSE LAVAGE/WOUND DEBR>20C

Facility

$205.65

Hospital Charge Code	9100201
Hospital Revenue Code	430
Min. Negotiated Rate	$26.73
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$61.70
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
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	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.73
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT REEVALUATION

Facility

$167.25

Service Code	HCPCS 97004GO
Hospital Charge Code	9001020
Hospital Revenue Code	434
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

OT REEVALUATION

Facility

$167.25

Service Code	HCPCS 97004GO
Hospital Charge Code	9001020
Hospital Revenue Code	434
Min. Negotiated Rate	$21.74
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: Aetna Medicare Advantage	$50.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.65
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	$42.65
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.74
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97168GO
Hospital Charge Code	74203128
Hospital Revenue Code	434
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OT RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97168GO
Hospital Charge Code	74203128
Hospital Revenue Code	434
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$720.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT ROM STRENGTHENIN 15MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	74203043
Hospital Revenue Code	430
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

OT ROM STRENGTHENIN 15MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	74203043
Hospital Revenue Code	430
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$130.20
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
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	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.42
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT SENSORY INTEGRAT/WRITI

Facility

$112.00

Service Code	HCPCS 97533GO
Hospital Charge Code	74203061
Hospital Revenue Code	430
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

OT SENSORY INTEGRAT/WRITI

Facility

$112.00

Service Code	HCPCS 97533GO
Hospital Charge Code	74203061
Hospital Revenue Code	430
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$33.60
Rate for Payer: Aetna Medicare Advantage	$33.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.56
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	$28.56
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.56
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT SHORT ARM SPLIN DYN RT

Facility

$358.00

Service Code	HCPCS 29126GO
Hospital Charge Code	74203011
Hospital Revenue Code	430
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

OT SHORT ARM SPLIN DYN RT

Facility

$358.00

Service Code	HCPCS 29126GO
Hospital Charge Code	74203011
Hospital Revenue Code	430
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$107.40
Rate for Payer: Aetna Medicare Advantage	$107.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.29
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	$91.29
Rate for Payer: Cigna Commercial	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.54
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.70
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT SHORT ARM SPLN STAT RT

Facility

$351.00

Service Code	HCPCS 29125GO
Hospital Charge Code	74203009
Hospital Revenue Code	430
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Qualcare PPO/HMO/WC	$52.65

OT SHORT ARM SPLN STAT RT

Facility

$351.00

Service Code	HCPCS 29125GO
Hospital Charge Code	74203009
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-SHORT ARM SPNT DYNC-LT

Facility

$0.01

Service Code	HCPCS 29126GO
Hospital Charge Code	74203129
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OT-SHORT ARM SPNT DYNC-LT

Facility

$0.01

Service Code	HCPCS 29126GO
Hospital Charge Code	74203129
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 SHORT ARM SPNT STAT-LT

Facility

$0.01

Service Code	HCPCS 29125GO
Hospital Charge Code	74203131
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

OT SHORT ARM SPNT STAT-LT

Facility

$0.01

Service Code	HCPCS 29125GO
Hospital Charge Code	74203131
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 STRAPPING CHEST-TORAX

Facility

$458.00

Service Code	HCPCS 29200GO
Hospital Charge Code	74203017
Hospital Revenue Code	430
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

Know your out-of-pocket cost for care.

All Charges