Heights University Hospital

All Charges

Charge

Type

Setting

Price

PT HYDROTHERAPY EA 15 MIN

Facility

$96.00

Service Code	HCPCS 97036GP
Hospital Charge Code	422597036
Hospital Revenue Code	420
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

PT HYDROTHERAPY EA 15 MIN

Facility

$96.00

Service Code	HCPCS 97036GP
Hospital Charge Code	422597036
Hospital Revenue Code	420
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$28.80
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.48
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	$24.48
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT-INDIV THERAPY SESSION DBL**

Facility

$150.00

Service Code	HCPCS 97110
Hospital Charge Code	9000050
Hospital Revenue Code	429
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

PT-INDIV THERAPY SESSION DBL**

Facility

$150.00

Service Code	HCPCS 97110
Hospital Charge Code	9000050
Hospital Revenue Code	429
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
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	$38.25
Rate for Payer: Cigna Commercial	$32.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT INFRARED THRPY

Facility

$102.50

Service Code	HCPCS 97026GP
Hospital Charge Code	422597026
Hospital Revenue Code	420
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$30.75
Rate for Payer: Aetna Medicare Advantage	$30.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.14
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	$26.14
Rate for Payer: Cigna Commercial	$51.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.32
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.38
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT INFRARED THRPY

Facility

$102.50

Service Code	HCPCS 97026GP
Hospital Charge Code	422597026
Hospital Revenue Code	420
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$15.38
Rate for Payer: Qualcare PPO/HMO/WC	$15.38

PT INSERT NEEDLE 1 OR 2 MUSCLE

Facility

$152.09

Service Code	HCPCS 20560GP
Hospital Charge Code	422520560
Hospital Revenue Code	420
Min. Negotiated Rate	$19.77
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$45.63
Rate for Payer: Aetna Medicare Advantage	$45.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.78
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	$38.78
Rate for Payer: Cigna Commercial	$76.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.77
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.81
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT INSERT NEEDLE 1 OR 2 MUSCLE

Facility

$152.09

Service Code	HCPCS 20560GP
Hospital Charge Code	422520560
Hospital Revenue Code	420
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$22.81
Rate for Payer: Qualcare PPO/HMO/WC	$22.81

PT INSERT NEEDLE 3+ MUSCLE(S)

Facility

$152.08

Service Code	HCPCS 20561GP
Hospital Charge Code	422520561
Hospital Revenue Code	420
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$22.81
Rate for Payer: Qualcare PPO/HMO/WC	$22.81

PT INSERT NEEDLE 3+ MUSCLE(S)

Facility

$152.08

Service Code	HCPCS 20561GP
Hospital Charge Code	422520561
Hospital Revenue Code	420
Min. Negotiated Rate	$19.77
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$45.62
Rate for Payer: Aetna Medicare Advantage	$45.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.78
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	$38.78
Rate for Payer: Cigna Commercial	$76.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.77
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.81
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT INSTRUCT/HOME PROGRAM EA 15

Facility

$384.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008325
Hospital Revenue Code	430
Min. Negotiated Rate	$49.92
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$115.20
Rate for Payer: Aetna Medicare Advantage	$115.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.92
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	$97.92
Rate for Payer: Cigna Commercial	$192.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.92
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT INSTRUCT/HOME PROGRAM EA 15

Facility

$384.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008325
Hospital Revenue Code	430
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

PT INSTRUCTION/HOME PROG 15 MI

Facility

$508.00

Service Code	HCPCS 97535GP
Hospital Charge Code	1008335
Hospital Revenue Code	420
Min. Negotiated Rate	$76.20
Max. Negotiated Rate	$76.20
Rate for Payer: Qualcare PPO/HMO/WC	$76.20

PT INSTRUCTION/HOME PROG 15 MI

Facility

$508.00

Service Code	HCPCS 97535GP
Hospital Charge Code	1008335
Hospital Revenue Code	420
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$152.40
Rate for Payer: Aetna Medicare Advantage	$152.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.54
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	$129.54
Rate for Payer: Cigna Commercial	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.04
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.20
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT IONTOPHOPRESIS EA 15 MIN

Facility

$77.65

Service Code	HCPCS 97033GP
Hospital Charge Code	9000423
Hospital Revenue Code	420
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

PT IONTOPHOPRESIS EA 15 MIN

Facility

$77.65

Service Code	HCPCS 97033GP
Hospital Charge Code	9000423
Hospital Revenue Code	420
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$23.30
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
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	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.09
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT IONTOPHORESIS EA 15 MIN

Facility

$373.00

Service Code	HCPCS 97033GP
Hospital Charge Code	422597033
Hospital Revenue Code	420
Min. Negotiated Rate	$55.95
Max. Negotiated Rate	$55.95
Rate for Payer: Qualcare PPO/HMO/WC	$55.95

PT IONTOPHORESIS EA 15 MIN

Facility

$373.00

Service Code	HCPCS 97033GP
Hospital Charge Code	422597033
Hospital Revenue Code	420
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$111.90
Rate for Payer: Aetna Medicare Advantage	$111.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.11
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	$95.11
Rate for Payer: Cigna Commercial	$186.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.49
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.95
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT JOINT MOBILIZATION EA 15 MI

Facility

$141.65

Service Code	HCPCS 97140GP
Hospital Charge Code	9100070
Hospital Revenue Code	420
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$42.49
Rate for Payer: Aetna Medicare Advantage	$42.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.12
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	$36.12
Rate for Payer: Cigna Commercial	$70.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.41
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.25
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT JOINT MOBILIZATION EA 15 MI

Facility

$193.00

Service Code	HCPCS 97140
Hospital Charge Code	409297140
Hospital Revenue Code	420
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$57.90
Rate for Payer: Aetna Medicare Advantage	$57.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.22
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	$49.22
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.09
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.95
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT JOINT MOBILIZATION EA 15 MI

Facility

$193.00

Service Code	HCPCS 97140
Hospital Charge Code	409297140
Hospital Revenue Code	420
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

PT JOINT MOBILIZATION EA 15 MI

Facility

$141.65

Service Code	HCPCS 97140GP
Hospital Charge Code	9100070
Hospital Revenue Code	420
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

PT JS 11-29-11

Facility

$30,720.00

Hospital Charge Code	270657059
Hospital Revenue Code	278
Min. Negotiated Rate	$4,608.00
Max. Negotiated Rate	$7,434.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,434.24
Rate for Payer: Qualcare PPO/HMO/WC	$4,608.00

PT JS 11-29-11

Facility

$30,720.00

Hospital Charge Code	270657059
Hospital Revenue Code	278
Min. Negotiated Rate	$4,608.00
Max. Negotiated Rate	$15,360.00
Rate for Payer: Aetna Commercial	$9,216.00
Rate for Payer: Aetna Medicare Advantage	$9,216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,833.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,833.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,833.60
Rate for Payer: Cigna Commercial	$15,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,434.24
Rate for Payer: Qualcare PPO/HMO/WC	$4,608.00

PT-KINETRON/ORTHROTRON****

Facility

$93.60

Service Code	HCPCS 97110
Hospital Charge Code	9000134
Hospital Revenue Code	420
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$28.08
Rate for Payer: Aetna Medicare Advantage	$28.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.87
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	$23.87
Rate for Payer: Cigna Commercial	$32.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.17
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.04
Rate for Payer: UnitedHealthcare Commercial	$686.00

Know your out-of-pocket cost for care.

All Charges