Heights University Hospital

All Charges

Charge

Type

Setting

Price

PT DIATHERMY THRPY

Facility

$120.75

Service Code	HCPCS 97024GP
Hospital Charge Code	422597024
Hospital Revenue Code	420
Min. Negotiated Rate	$18.11
Max. Negotiated Rate	$18.11
Rate for Payer: Qualcare PPO/HMO/WC	$18.11

PT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GP
Hospital Charge Code	9000266
Hospital Revenue Code	420
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

PT ELEC STIM MANUAL EA 15 MIN

Facility

$116.85

Service Code	HCPCS 97032GP
Hospital Charge Code	9000266
Hospital Revenue Code	420
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

PT ELECTRIC STIM UNATTENDED

Facility

$91.25

Service Code	HCPCS G0283GP
Hospital Charge Code	9100177
Hospital Revenue Code	420
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

PT ELECTRIC STIM UNATTENDED

Facility

$91.25

Service Code	HCPCS G0283GP
Hospital Charge Code	9100177
Hospital Revenue Code	420
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

PT EM 11-15-11

Facility

$35,160.00

Hospital Charge Code	270657058
Hospital Revenue Code	278
Min. Negotiated Rate	$5,274.00
Max. Negotiated Rate	$8,508.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,032.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,508.72
Rate for Payer: Qualcare PPO/HMO/WC	$5,274.00

PT EM 11-15-11

Facility

$35,160.00

Hospital Charge Code	270657058
Hospital Revenue Code	278
Min. Negotiated Rate	$5,274.00
Max. Negotiated Rate	$17,580.00
Rate for Payer: Aetna Commercial	$10,548.00
Rate for Payer: Aetna Medicare Advantage	$10,548.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,965.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,965.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,032.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,965.80
Rate for Payer: Cigna Commercial	$17,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,508.72
Rate for Payer: Qualcare PPO/HMO/WC	$5,274.00

PT ER 11-13-11

Facility

$27,147.50

Hospital Charge Code	270656692
Hospital Revenue Code	278
Min. Negotiated Rate	$4,072.12
Max. Negotiated Rate	$13,573.75
Rate for Payer: Aetna Commercial	$8,144.25
Rate for Payer: Aetna Medicare Advantage	$8,144.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,922.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,922.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,922.61
Rate for Payer: Cigna Commercial	$13,573.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,569.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,072.12

PT ER 11-13-11

Facility

$27,147.50

Hospital Charge Code	270656692
Hospital Revenue Code	278
Min. Negotiated Rate	$4,072.12
Max. Negotiated Rate	$6,569.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,429.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,569.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,072.12

PT E-STIM ATTENDED EA 15 MIN

Facility

$247.00

Service Code	HCPCS 97032GP
Hospital Charge Code	422597032
Hospital Revenue Code	420
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

PT E-STIM ATTENDED EA 15 MIN

Facility

$247.00

Service Code	HCPCS 97032GP
Hospital Charge Code	422597032
Hospital Revenue Code	420
Min. Negotiated Rate	$32.11
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
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	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.11
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT E-STIM UNATTENDED

Facility

$206.00

Service Code	HCPCS 97014GP
Hospital Charge Code	422597014
Hospital Revenue Code	420
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

PT E-STIM UNATTENDED

Facility

$206.00

Service Code	HCPCS 97014GP
Hospital Charge Code	422597014
Hospital Revenue Code	420
Min. Negotiated Rate	$26.78
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$61.80
Rate for Payer: Aetna Medicare Advantage	$61.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.53
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	$52.53
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT EVAL HIGH COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97163GP
Hospital Charge Code	9109162
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT EVAL HIGH COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97163GP
Hospital Charge Code	422597163
Hospital Revenue Code	424
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

PT EVAL HIGH COMPLEX 45 MIN

Facility

$394.00

Service Code	HCPCS 97163
Hospital Charge Code	409297163
Hospital Revenue Code	424
Min. Negotiated Rate	$51.22
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$118.20
Rate for Payer: Aetna Medicare Advantage	$118.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.47
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	$100.47
Rate for Payer: Cigna Commercial	$108.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.22
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT EVAL HIGH COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97163GP
Hospital Charge Code	9109162
Hospital Revenue Code	424
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

PT EVAL HIGH COMPLEX 45 MIN

Facility

$394.00

Service Code	HCPCS 97163
Hospital Charge Code	409297163
Hospital Revenue Code	424
Min. Negotiated Rate	$59.10
Max. Negotiated Rate	$59.10
Rate for Payer: Qualcare PPO/HMO/WC	$59.10

PT EVAL HIGH COMPLEX 45 MIN

Facility

$2,400.00

Service Code	HCPCS 97163GP
Hospital Charge Code	422597163
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT EVAL LOW COMPLEX 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97161GP
Hospital Charge Code	9109160
Hospital Revenue Code	424
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

PT EVAL LOW COMPLEX 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97161GP
Hospital Charge Code	422597161
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT EVAL LOW COMPLEX 20 MIN

Facility

$394.00

Service Code	HCPCS 97161
Hospital Charge Code	409297161
Hospital Revenue Code	424
Min. Negotiated Rate	$59.10
Max. Negotiated Rate	$59.10
Rate for Payer: Qualcare PPO/HMO/WC	$59.10

PT EVAL LOW COMPLEX 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97161GP
Hospital Charge Code	9109160
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT EVAL LOW COMPLEX 20 MIN

Facility

$394.00

Service Code	HCPCS 97161
Hospital Charge Code	409297161
Hospital Revenue Code	424
Min. Negotiated Rate	$51.22
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$118.20
Rate for Payer: Aetna Medicare Advantage	$118.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.47
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	$100.47
Rate for Payer: Cigna Commercial	$108.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.22
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT EVAL LOW COMPLEX 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97161GP
Hospital Charge Code	422597161
Hospital Revenue Code	424
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

Know your out-of-pocket cost for care.

All Charges