Heights University Hospital

All Charges

Charge

Type

Setting

Price

PT PULSE LAVAGE/WOUND DEBR<20c

Facility

$843.00

Service Code	HCPCS 97597
Hospital Charge Code	9100090
Hospital Revenue Code	420
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$126.45
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

PT PULSE LAVAGE/WOUND DEBR<20c

Facility

$843.00

Service Code	HCPCS 97597
Hospital Charge Code	9100090
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
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	$214.97
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.59
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.45
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT PULSE LAVAGE/WOUND DEBR>20C

Facility

$843.00

Service Code	HCPCS 97598
Hospital Charge Code	9100091
Hospital Revenue Code	420
Min. Negotiated Rate	$23.41
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$252.90
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
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	$214.97
Rate for Payer: Cigna Commercial	$23.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.59
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.45
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT PULSE LAVAGE/WOUND DEBR>20C

Facility

$843.00

Service Code	HCPCS 97598
Hospital Charge Code	9100091
Hospital Revenue Code	420
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$126.45
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

PT-RANGE OF MOTION TEST

Facility

$422.00

Hospital Charge Code	9109010
Hospital Revenue Code	920
Min. Negotiated Rate	$54.86
Max. Negotiated Rate	$1,489.00
Rate for Payer: Aetna Commercial	$126.60
Rate for Payer: Aetna Medicare Advantage	$126.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.61
Rate for Payer: Cigna Commercial	$211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.86
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.30
Rate for Payer: UnitedHealthcare Commercial	$1,489.00

PT-RANGE OF MOTION TEST

Facility

$422.00

Hospital Charge Code	9109010
Hospital Revenue Code	920
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$63.30
Rate for Payer: Qualcare PPO/HMO/WC	$63.30

PT RE-EVAL 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97164GP
Hospital Charge Code	422597164
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 RE-EVAL 20 MIN

Facility

$2,400.00

Service Code	HCPCS 97164GP
Hospital Charge Code	422597164
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97164GP
Hospital Charge Code	9109163
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 RE-EVALUATION

Facility

$2,400.00

Service Code	HCPCS 97164GP
Hospital Charge Code	9109163
Hospital Revenue Code	424
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PT REEVALUATION

Facility

$141.65

Service Code	HCPCS 97002GP
Hospital Charge Code	9001018
Hospital Revenue Code	424
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$21.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.25

PT REEVALUATION

Facility

$141.65

Service Code	HCPCS 97002GP
Hospital Charge Code	9001018
Hospital Revenue Code	424
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 REM/BIV CAST ARM/LEG FULL

Facility

$1,485.20

Service Code	HCPCS 29705GP
Hospital Charge Code	422529705
Hospital Revenue Code	420
Min. Negotiated Rate	$222.78
Max. Negotiated Rate	$222.78
Rate for Payer: Qualcare PPO/HMO/WC	$222.78

PT REM/BIV CAST ARM/LEG FULL

Facility

$1,485.20

Service Code	HCPCS 29705GP
Hospital Charge Code	422529705
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$742.60
Rate for Payer: Aetna Commercial	$445.56
Rate for Payer: Aetna Medicare Advantage	$445.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.73
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	$378.73
Rate for Payer: Cigna Commercial	$742.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.08
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.78
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT REM/BIV CST GAUNTLT/BOOT/BD

Facility

$1,485.20

Service Code	HCPCS 29700GP
Hospital Charge Code	422529700
Hospital Revenue Code	420
Min. Negotiated Rate	$222.78
Max. Negotiated Rate	$222.78
Rate for Payer: Qualcare PPO/HMO/WC	$222.78

PT REM/BIV CST GAUNTLT/BOOT/BD

Facility

$1,485.20

Service Code	HCPCS 29700GP
Hospital Charge Code	422529700
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$742.60
Rate for Payer: Aetna Commercial	$445.56
Rate for Payer: Aetna Medicare Advantage	$445.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.73
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	$378.73
Rate for Payer: Cigna Commercial	$742.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.08
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.78
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT REM CAST SPICA/MINER/RISSER

Facility

$1,485.20

Service Code	HCPCS 29710GP
Hospital Charge Code	422529710
Hospital Revenue Code	420
Min. Negotiated Rate	$222.78
Max. Negotiated Rate	$222.78
Rate for Payer: Qualcare PPO/HMO/WC	$222.78

PT REM CAST SPICA/MINER/RISSER

Facility

$1,485.20

Service Code	HCPCS 29710GP
Hospital Charge Code	422529710
Hospital Revenue Code	420
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$742.60
Rate for Payer: Aetna Commercial	$445.56
Rate for Payer: Aetna Medicare Advantage	$445.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.73
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	$378.73
Rate for Payer: Cigna Commercial	$742.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.08
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.78
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT-REM DEVIT TISS WO/ANES

Facility

$573.00

Hospital Charge Code	9109110
Hospital Revenue Code	420
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$171.90
Rate for Payer: Aetna Medicare Advantage	$171.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.12
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	$146.12
Rate for Payer: Cigna Commercial	$286.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.49
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.95
Rate for Payer: UnitedHealthcare Commercial	$686.00

PT-REM DEVIT TISS WO/ANES

Facility

$573.00

Hospital Charge Code	9109110
Hospital Revenue Code	420
Min. Negotiated Rate	$85.95
Max. Negotiated Rate	$85.95
Rate for Payer: Qualcare PPO/HMO/WC	$85.95

PT RPR SPICA/CAST BODY/JACKET

Facility

$869.79

Service Code	HCPCS 29720GP
Hospital Charge Code	422529720
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 RPR SPICA/CAST BODY/JACKET

Facility

$869.79

Service Code	HCPCS 29720GP
Hospital Charge Code	422529720
Hospital Revenue Code	420
Min. Negotiated Rate	$130.47
Max. Negotiated Rate	$130.47
Rate for Payer: Qualcare PPO/HMO/WC	$130.47

PT SCREW 4X50MM

Facility

$2,554.40

Service Code	HCPCS C1713
Hospital Charge Code	270705012
Hospital Revenue Code	278
Min. Negotiated Rate	$383.16
Max. Negotiated Rate	$618.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.16
Rate for Payer: Qualcare PPO/HMO/WC	$383.16

PT SCREW 4X50MM

Facility

$2,554.40

Service Code	HCPCS C1713
Hospital Charge Code	270705012
Hospital Revenue Code	278
Min. Negotiated Rate	$383.16
Max. Negotiated Rate	$1,277.20
Rate for Payer: Aetna Commercial	$766.32
Rate for Payer: Aetna Medicare Advantage	$766.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$651.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$651.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$651.37
Rate for Payer: Cigna Commercial	$1,277.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.16
Rate for Payer: Qualcare PPO/HMO/WC	$383.16

PT SCREW 4X50MM

Facility

$2,554.40

Service Code	HCPCS C1713
Hospital Charge Code	270507725
Hospital Revenue Code	278
Min. Negotiated Rate	$383.16
Max. Negotiated Rate	$1,277.20
Rate for Payer: Aetna Commercial	$766.32
Rate for Payer: Aetna Medicare Advantage	$766.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$651.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$651.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$651.37
Rate for Payer: Cigna Commercial	$1,277.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$618.16
Rate for Payer: Qualcare PPO/HMO/WC	$383.16

Know your out-of-pocket cost for care.

All Charges