Heights University Hospital

All Charges

Charge

Type

Setting

Price

PT APPL RISSER JACKET BODY

Facility

$1,360.45

Service Code	HCPCS 29010GP
Hospital Charge Code	422529010
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPL SPLINT ARM SHORT DYNAM

Facility

$358.00

Service Code	HCPCS 29126GP
Hospital Charge Code	422529126
Hospital Revenue Code	420
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

PT APPL SPLINT ARM SHORT DYNAM

Facility

$358.00

Service Code	HCPCS 29126GP
Hospital Charge Code	422529126
Hospital Revenue Code	420
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

PT APPL SPLINT ARM SHORT STATC

Facility

$358.00

Service Code	HCPCS 29125GP
Hospital Charge Code	422529125
Hospital Revenue Code	420
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$686.00
Rate for Payer: Cigna Commercial	$179.00
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: 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

PT APPL SPLINT ARM SHORT STATC

Facility

$358.00

Service Code	HCPCS 29125GP
Hospital Charge Code	422529125
Hospital Revenue Code	420
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

PT APPL SPLINT FINGER DYNAM

Facility

$322.82

Service Code	HCPCS 29131GP
Hospital Charge Code	422529131
Hospital Revenue Code	420
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$48.42
Rate for Payer: Qualcare PPO/HMO/WC	$48.42

PT APPL SPLINT FINGER DYNAM

Facility

$322.82

Service Code	HCPCS 29131GP
Hospital Charge Code	422529131
Hospital Revenue Code	420
Min. Negotiated Rate	$41.97
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$96.85
Rate for Payer: Aetna Medicare Advantage	$96.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.32
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	$82.32
Rate for Payer: Cigna Commercial	$161.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.97
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.42
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPL SPLINT FINGER STATIC

Facility

$322.82

Service Code	HCPCS 29130GP
Hospital Charge Code	422529130
Hospital Revenue Code	420
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$48.42
Rate for Payer: Qualcare PPO/HMO/WC	$48.42

PT APPL SPLINT FINGER STATIC

Facility

$322.82

Service Code	HCPCS 29130GP
Hospital Charge Code	422529130
Hospital Revenue Code	420
Min. Negotiated Rate	$41.97
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$96.85
Rate for Payer: Aetna Medicare Advantage	$96.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.32
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	$82.32
Rate for Payer: Cigna Commercial	$161.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.97
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.42
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPL SPLINT LONG LEG

Facility

$869.79

Service Code	HCPCS 29505GP
Hospital Charge Code	422529505
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$260.94
Rate for Payer: Aetna Medicare Advantage	$260.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.80
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	$221.80
Rate for Payer: Cigna Commercial	$434.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.07
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.47
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPL SPLINT LONG LEG

Facility

$869.79

Service Code	HCPCS 29505GP
Hospital Charge Code	422529505
Hospital Revenue Code	420
Min. Negotiated Rate	$130.47
Max. Negotiated Rate	$130.47
Rate for Payer: Qualcare PPO/HMO/WC	$130.47

PT APPL SPLINT SHORT LEG

Facility

$869.79

Service Code	HCPCS 29515GP
Hospital Charge Code	422529515
Hospital Revenue Code	420
Min. Negotiated Rate	$130.47
Max. Negotiated Rate	$130.47
Rate for Payer: Qualcare PPO/HMO/WC	$130.47

PT APPL SPLINT SHORT LEG

Facility

$869.79

Service Code	HCPCS 29515GP
Hospital Charge Code	422529515
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$260.94
Rate for Payer: Aetna Medicare Advantage	$260.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.80
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	$221.80
Rate for Payer: Cigna Commercial	$434.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.07
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.47
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPLY CAST CYLINDER LEG

Facility

$1,360.45

Service Code	HCPCS 29365GP
Hospital Charge Code	422529365
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPLY CAST CYLINDER LEG

Facility

$1,360.45

Service Code	HCPCS 29365GP
Hospital Charge Code	422529365
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$408.13
Rate for Payer: Aetna Medicare Advantage	$408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.91
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	$346.91
Rate for Payer: Cigna Commercial	$680.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPLY CAST FINGER

Facility

$475.00

Service Code	HCPCS 29086GP
Hospital Charge Code	422529086
Hospital Revenue Code	420
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

PT APPLY CAST FINGER

Facility

$475.00

Service Code	HCPCS 29086GP
Hospital Charge Code	422529086
Hospital Revenue Code	420
Min. Negotiated Rate	$61.75
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
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	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.75
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPLY CAST LONG ARM

Facility

$1,360.45

Service Code	HCPCS 29065GP
Hospital Charge Code	422529065
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$408.13
Rate for Payer: Aetna Medicare Advantage	$408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.91
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	$346.91
Rate for Payer: Cigna Commercial	$680.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPLY CAST LONG ARM

Facility

$1,360.45

Service Code	HCPCS 29065GP
Hospital Charge Code	422529065
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPLY CAST RIGID LEG

Facility

$1,360.45

Service Code	HCPCS 29445GP
Hospital Charge Code	422529445
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPLY CAST RIGID LEG

Facility

$1,360.45

Service Code	HCPCS 29445GP
Hospital Charge Code	422529445
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$408.13
Rate for Payer: Aetna Medicare Advantage	$408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.91
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	$346.91
Rate for Payer: Cigna Commercial	$680.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPLY CAST SHORT ARM

Facility

$1,360.45

Service Code	HCPCS 29075GP
Hospital Charge Code	422529075
Hospital Revenue Code	420
Min. Negotiated Rate	$204.07
Max. Negotiated Rate	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$204.07

PT APPLY CAST SHORT ARM

Facility

$1,360.45

Service Code	HCPCS 29075GP
Hospital Charge Code	422529075
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$408.13
Rate for Payer: Aetna Medicare Advantage	$408.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$346.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$346.91
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	$346.91
Rate for Payer: Cigna Commercial	$680.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.86
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.07
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPLY MULTLAY COMPRS ARM/HA

Facility

$869.79

Service Code	HCPCS 29584GP
Hospital Charge Code	422529584
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$260.94
Rate for Payer: Aetna Medicare Advantage	$260.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.80
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	$221.80
Rate for Payer: Cigna Commercial	$434.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.07
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.47
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT APPLY MULTLAY COMPRS ARM/HA

Facility

$869.79

Service Code	HCPCS 29584GP
Hospital Charge Code	422529584
Hospital Revenue Code	420
Min. Negotiated Rate	$130.47
Max. Negotiated Rate	$130.47
Rate for Payer: Qualcare PPO/HMO/WC	$130.47

Know your out-of-pocket cost for care.

All Charges