Heights University Hospital

All Charges

Charge

Type

Setting

Price

TCM OSTEO MANIPULTIN 7-8 AREA

Facility

$149.85

Service Code	HCPCS 98928
Hospital Charge Code	93950129
Hospital Revenue Code	761
Min. Negotiated Rate	$22.48
Max. Negotiated Rate	$22.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.48

TCM OSTEO MANIPULTN 9-10 AREA

Facility

$376.35

Service Code	HCPCS 98929
Hospital Charge Code	93950131
Hospital Revenue Code	761
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$56.45
Rate for Payer: Qualcare PPO/HMO/WC	$56.45

TCM OSTEO MANIPULTN 9-10 AREA

Facility

$376.35

Service Code	HCPCS 98929
Hospital Charge Code	93950131
Hospital Revenue Code	761
Min. Negotiated Rate	$48.93
Max. Negotiated Rate	$188.18
Rate for Payer: Aetna Commercial	$112.91
Rate for Payer: Aetna Medicare Advantage	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.97
Rate for Payer: Cigna Commercial	$51.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.93
Rate for Payer: Oxford Commercial	$188.18
Rate for Payer: Qualcare PPO/HMO/WC	$56.45
Rate for Payer: UnitedHealthcare Commercial	$188.18

TCM PEDIATRIX

Facility

$162.00

Service Code	HCPCS 90723
Hospital Charge Code	93950101
Hospital Revenue Code	636
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$115.67
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.31
Rate for Payer: Cigna Commercial	$81.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

TCM PEDIATRIX

Facility

$162.00

Service Code	HCPCS 90723
Hospital Charge Code	93950101
Hospital Revenue Code	636
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$39.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.30

TCM PHONE CONSULT 10-15 MIN

Facility

$75.00

Service Code	HCPCS 99442
Hospital Charge Code	93950203
Hospital Revenue Code	510
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

TCM PHONE CONSULT 10-15 MIN

Facility

$75.00

Service Code	HCPCS 99442
Hospital Charge Code	93950203
Hospital Revenue Code	510
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

TCM PHONE CONSULT 25-30 MIN

Facility

$100.00

Service Code	HCPCS 99443
Hospital Charge Code	93950205
Hospital Revenue Code	510
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

TCM PHONE CONSULT 25-30 MIN

Facility

$100.00

Service Code	HCPCS 99443
Hospital Charge Code	93950205
Hospital Revenue Code	510
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

TCM PHONE CONSULT 5-10 MIN

Facility

$50.00

Service Code	HCPCS 99441
Hospital Charge Code	93950201
Hospital Revenue Code	510
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$15.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

TCM PHONE CONSULT 5-10 MIN

Facility

$50.00

Service Code	HCPCS 99441
Hospital Charge Code	93950201
Hospital Revenue Code	510
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

TCM PNEUMOCOCCAL (ADULT)

Facility

$193.00

Service Code	HCPCS 90732
Hospital Charge Code	93950103
Hospital Revenue Code	636
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$46.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.71
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

TCM PNEUMOCOCCAL (ADULT)

Facility

$193.00

Service Code	HCPCS 90732
Hospital Charge Code	93950103
Hospital Revenue Code	636
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$133.47
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	$54.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.22
Rate for Payer: Cigna Commercial	$133.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.71
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

TCM PPD INTRADERMAL

Facility

$390.00

Service Code	HCPCS 86580
Hospital Charge Code	93950057
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TCM PPD INTRADERMAL

Facility

$390.00

Service Code	HCPCS 86580
Hospital Charge Code	93950057
Hospital Revenue Code	302
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$117.00
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$6.38
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

TCM PREOPERATIVE EVALUATION

Facility

$185.00

Service Code	HCPCS 99243
Hospital Charge Code	93950169
Hospital Revenue Code	510
Min. Negotiated Rate	$24.05
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$55.50
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

TCM PREOPERATIVE EVALUATION

Facility

$185.00

Service Code	HCPCS 99243
Hospital Charge Code	93950169
Hospital Revenue Code	510
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

TCM PREVENTIVE EST PAT 1-4YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	93950189
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE EST PAT 1-4YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	93950189
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE EST PAT <1 YR

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	93950187
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE EST PAT <1 YR

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	93950187
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE EST PAT 65+YRS

Facility

$175.00

Service Code	HCPCS 99397
Hospital Charge Code	93950199
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE EST PAT 65+YRS

Facility

$175.00

Service Code	HCPCS 99397
Hospital Charge Code	93950199
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE EST PT 5-11YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	93950191
Hospital Revenue Code	510
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$52.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

TCM PREVENTIVE EST PT 5-11YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	93950191
Hospital Revenue Code	510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

Know your out-of-pocket cost for care.

All Charges