Heights University Hospital

All Charges

Charge

Type

Setting

Price

PHP OT SERVICE =/>45 MIN CHILD

Facility

$750.00

Service Code	HCPCS G0129
Hospital Charge Code	4510526
Hospital Revenue Code	430
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
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	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$686.00

PHP OT SERVICE =/>45 MIN CHILD

Facility

$750.00

Service Code	HCPCS G0129
Hospital Charge Code	4509526
Hospital Revenue Code	430
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
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	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$686.00

PHP OT SERVICE =/>45 MIN CHILD

Facility

$750.00

Service Code	HCPCS G0129
Hospital Charge Code	4509526
Hospital Revenue Code	430
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

PHP OT SERVICE =/>45 MIN CHILD

Facility

$750.00

Service Code	HCPCS G0129
Hospital Charge Code	4510526
Hospital Revenue Code	430
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

PHP OT SERVICE 45 MIN IOP

Facility

$750.00

Service Code	HCPCS G0129
Hospital Charge Code	4546756
Hospital Revenue Code	430
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

PHP OT SERVICE 45 MIN IOP

Facility

$750.00

Service Code	HCPCS G0129
Hospital Charge Code	4546756
Hospital Revenue Code	430
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
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	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$686.00

PHP OT service 45 min or more

Facility

$900.50

Service Code	HCPCS G0129GO
Hospital Charge Code	84509052
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

PHP OT service 45 min or more

Facility

$900.50

Service Code	HCPCS G0129GO
Hospital Charge Code	84509052
Hospital Revenue Code	430
Min. Negotiated Rate	$135.07
Max. Negotiated Rate	$135.07
Rate for Payer: Qualcare PPO/HMO/WC	$135.07

PH STOOL

Facility

$201.00

Service Code	HCPCS 83986
Hospital Charge Code	38479073
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH STOOL

Facility

$201.00

Service Code	HCPCS 83986
Hospital Charge Code	38479073
Hospital Revenue Code	301
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

PH STOOL

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3007846
Hospital Revenue Code	301
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.65

PH STOOL

Facility

$57.65

Service Code	HCPCS 83986
Hospital Charge Code	3007846
Hospital Revenue Code	301
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$114.00
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Aetna Commercial	$11.60
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: Cigna Medicare Advantage	$1.79
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.65
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$3.79
Rate for Payer: Wellcare Medicare Advantage	$3.58

PH URINE

Facility

$390.00

Service Code	HCPCS 81003
Hospital Charge Code	3003860
Hospital Revenue Code	307
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$7.29
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.24
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: Cigna Medicare Advantage	$1.12
Rate for Payer: Clover Medicare Advantage	$2.14
Rate for Payer: EmblemHealth Commercial	$6.75
Rate for Payer: Humana Medicare Advantage	$2.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.25
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$2.38
Rate for Payer: Wellcare Medicare Advantage	$2.25

PH URINE

Facility

$390.00

Service Code	HCPCS 81003
Hospital Charge Code	3003860
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHYSICAL ASSESSMENT*******

Facility

$120.00

Service Code	HCPCS 90801
Hospital Charge Code	9310061
Hospital Revenue Code	914
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$36.00
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

PHYSICAL ASSESSMENT*******

Facility

$120.00

Service Code	HCPCS 90801
Hospital Charge Code	9310061
Hospital Revenue Code	914
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

PHYSICAL PERFORMANCE TEST

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	84202090
Hospital Revenue Code	420
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$55.84
Rate for Payer: Aetna Medicare Advantage	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.47
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	$47.47
Rate for Payer: Cigna Commercial	$93.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.92
Rate for Payer: UnitedHealthcare Commercial	$686.00

PHYSICAL PERFORMANCE TEST

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	84202090
Hospital Revenue Code	420
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.92

PHYSICAL PERF TEST EA 15MIN CQ

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	409197750Q
Hospital Revenue Code	420
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.92

PHYSICAL PERF TEST EA 15MIN CQ

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	409197750Q
Hospital Revenue Code	420
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$55.84
Rate for Payer: Aetna Medicare Advantage	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.47
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	$47.47
Rate for Payer: Cigna Commercial	$93.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.92
Rate for Payer: UnitedHealthcare Commercial	$686.00

PHYSICS TX PLAN 3D

Facility

$3,149.45

Service Code	HCPCS 77295
Hospital Charge Code	4800138
Hospital Revenue Code	333
Min. Negotiated Rate	$409.43
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$944.84
Rate for Payer: Aetna Medicare Advantage	$944.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.11
Rate for Payer: Cigna Commercial	$3,296.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.43
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.42
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

PHYSICS TX PLAN 3D

Facility

$3,149.45

Service Code	HCPCS 77295
Hospital Charge Code	4800138
Hospital Revenue Code	333
Min. Negotiated Rate	$472.42
Max. Negotiated Rate	$472.42
Rate for Payer: Qualcare PPO/HMO/WC	$472.42

PHYSOSTIGMN SALC INJ 1MG/ML2ML

Facility

$105.00

Hospital Charge Code	6004311
Hospital Revenue Code	250
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

PHYSOSTIGMN SALC INJ 1MG/ML2ML

Facility

$105.00

Hospital Charge Code	6004311
Hospital Revenue Code	250
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$52.50

PHYSOSTIGMN SULF OINT OPH3.5GM

Facility

$19.85

Hospital Charge Code	6004329
Hospital Revenue Code	251
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

Know your out-of-pocket cost for care.

All Charges