Heights University Hospital

All Charges

Charge

Type

Setting

Price

OT VASOPNEUMATIC DEVICES

Facility

$91.25

Hospital Charge Code	9100040
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

OT VASOPNEUMATIC DEVICES

Facility

$214.00

Service Code	HCPCS 97016GO
Hospital Charge Code	74203029
Hospital Revenue Code	430
Min. Negotiated Rate	$27.82
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$64.20
Rate for Payer: Aetna Medicare Advantage	$64.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.57
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	$54.57
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.82
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT VASOPNEUMATIC DEVICES

Facility

$91.25

Hospital Charge Code	9100040
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 VASOPNEUMATIC DEVICES

Facility

$214.00

Service Code	HCPCS 97016GO
Hospital Charge Code	74203029
Hospital Revenue Code	430
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

OT WHEELCHAIR MGMT 15 MIN

Facility

$164.50

Service Code	HCPCS 97542GO
Hospital Charge Code	74203067
Hospital Revenue Code	430
Min. Negotiated Rate	$24.68
Max. Negotiated Rate	$24.68
Rate for Payer: Qualcare PPO/HMO/WC	$24.68

OT WHEELCHAIR MGMT 15 MIN

Facility

$164.50

Service Code	HCPCS 97542GO
Hospital Charge Code	74203067
Hospital Revenue Code	430
Min. Negotiated Rate	$21.39
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$49.35
Rate for Payer: Aetna Medicare Advantage	$49.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.95
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	$41.95
Rate for Payer: Cigna Commercial	$82.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.39
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.68
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT WHIRLPOOL/FLUIDOTHERAP

Facility

$185.00

Service Code	HCPCS 97022GO
Hospital Charge Code	74203033
Hospital Revenue Code	430
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

OT WHIRLPOOL/FLUIDOTHERAP

Facility

$185.00

Service Code	HCPCS 97022GO
Hospital Charge Code	74203033
Hospital Revenue Code	430
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
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	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT WORK HARD COND ADD HRS

Facility

$170.00

Service Code	HCPCS 97546GO
Hospital Charge Code	74203071
Hospital Revenue Code	430
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

OT WORK HARD COND ADD HRS

Facility

$170.00

Service Code	HCPCS 97546GO
Hospital Charge Code	74203071
Hospital Revenue Code	430
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
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	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT WORK HARD CONDITIO 2HR

Facility

$601.00

Service Code	HCPCS 97545GO
Hospital Charge Code	74203069
Hospital Revenue Code	430
Min. Negotiated Rate	$90.15
Max. Negotiated Rate	$90.15
Rate for Payer: Qualcare PPO/HMO/WC	$90.15

OT WORK HARD CONDITIO 2HR

Facility

$601.00

Service Code	HCPCS 97545GO
Hospital Charge Code	74203069
Hospital Revenue Code	430
Min. Negotiated Rate	$78.13
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$180.30
Rate for Payer: Aetna Medicare Advantage	$180.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.25
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	$153.25
Rate for Payer: Cigna Commercial	$300.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.13
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.15
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT WOUND CARE/APPLIC OF DRSG

Facility

$153.65

Hospital Charge Code	9100093
Hospital Revenue Code	430
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$686.00
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	$90.00
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	$19.97
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$686.00

OT WOUND CARE/APPLIC OF DRSG

Facility

$153.65

Hospital Charge Code	9100093
Hospital Revenue Code	430
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

OUTFLOW TUBING

Facility

$115.50

Hospital Charge Code	270662372
Hospital Revenue Code	270
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$17.32
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

OUTFLOW TUBING

Facility

$115.50

Hospital Charge Code	270662372
Hospital Revenue Code	270
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Commercial	$34.65
Rate for Payer: Aetna Medicare Advantage	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.45
Rate for Payer: Cigna Commercial	$57.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.02
Rate for Payer: Oxford Commercial	$57.75
Rate for Payer: Qualcare PPO/HMO/WC	$17.32
Rate for Payer: UnitedHealthcare Commercial	$57.75

OUTPATIENT ADULT AND CHILD

Facility

$665.20

Service Code	HCPCS 99213
Hospital Charge Code	485099216
Hospital Revenue Code	919
Min. Negotiated Rate	$99.78
Max. Negotiated Rate	$99.78
Rate for Payer: Qualcare PPO/HMO/WC	$99.78

OUTPATIENT ADULT AND CHILD

Facility

$665.20

Service Code	HCPCS 99213
Hospital Charge Code	485099216
Hospital Revenue Code	919
Min. Negotiated Rate	$62.15
Max. Negotiated Rate	$199.56
Rate for Payer: Aetna Commercial	$199.56
Rate for Payer: Aetna Medicare Advantage	$199.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.63
Rate for Payer: Cigna Commercial	$62.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.48
Rate for Payer: Qualcare PPO/HMO/WC	$99.78

OVAAN CYSTECTOMY UL/BL

Facility

$44,316.79

Service Code	HCPCS 59825
Hospital Charge Code	1600000426
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$22,158.40
Rate for Payer: Aetna Commercial	$13,295.04
Rate for Payer: Aetna Medicare Advantage	$13,295.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,300.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,300.78
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	$11,300.78
Rate for Payer: Cigna Commercial	$22,158.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,761.18
Rate for Payer: Qualcare PPO/HMO/WC	$6,647.52

OVAAN CYSTECTOMY UL/BL

Facility

$44,316.79

Service Code	HCPCS 59825
Hospital Charge Code	1600000426
Hospital Revenue Code	360
Min. Negotiated Rate	$6,647.52
Max. Negotiated Rate	$6,647.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,647.52

OVA AND PARASITES DIRECT SMEAR

Facility

$100.00

Service Code	HCPCS 87177
Hospital Charge Code	3035156A
Hospital Revenue Code	309
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

OVA AND PARASITES DIRECT SMEAR

Facility

$100.00

Service Code	HCPCS 87177
Hospital Charge Code	3035156A
Hospital Revenue Code	309
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$28.84
Rate for Payer: Aetna Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.61
Rate for Payer: Cigna Commercial	$8.90
Rate for Payer: Cigna Medicare Advantage	$4.45
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.43
Rate for Payer: Wellcare Medicare Advantage	$8.90

OVA AND PARISITE IDENTIFICATIO

Facility

$122.60

Service Code	HCPCS 87209
Hospital Charge Code	3990161B
Hospital Revenue Code	309
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$58.26
Rate for Payer: Aetna Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.88
Rate for Payer: Cigna Commercial	$17.98
Rate for Payer: Cigna Medicare Advantage	$8.99
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.94
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.39
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$19.06
Rate for Payer: Wellcare Medicare Advantage	$17.98

OVA AND PARISITE IDENTIFICATIO

Facility

$60.70

Service Code	HCPCS 87177
Hospital Charge Code	3990161A
Hospital Revenue Code	309
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$28.84
Rate for Payer: Aetna Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.61
Rate for Payer: Cigna Commercial	$8.90
Rate for Payer: Cigna Medicare Advantage	$4.45
Rate for Payer: Clover Medicare Advantage	$8.46
Rate for Payer: EmblemHealth Commercial	$26.70
Rate for Payer: Humana Medicare Advantage	$9.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.11
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.90
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$9.43
Rate for Payer: Wellcare Medicare Advantage	$8.90

OVA AND PARISITE IDENTIFICATIO

Facility

$60.70

Service Code	HCPCS 87177
Hospital Charge Code	3990161A
Hospital Revenue Code	309
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$9.11
Rate for Payer: Qualcare PPO/HMO/WC	$9.11

Know your out-of-pocket cost for care.

All Charges