Heights University Hospital

All Charges

Charge

Type

Setting

Price

TCM VARICELLA

Facility

$91.00

Service Code	HCPCS 90716
Hospital Charge Code	93950095
Hospital Revenue Code	636
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$95.20
Rate for Payer: Aetna Commercial	$27.30
Rate for Payer: Aetna Medicare Advantage	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.20
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

TCM VARICELLA

Facility

$91.00

Service Code	HCPCS 90716
Hospital Charge Code	93950095
Hospital Revenue Code	636
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$22.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.02
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

TCM WART REMOVAL

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	93950027
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

TCM WART REMOVAL

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	93950027
Hospital Revenue Code	761
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$477.79
Rate for Payer: Aetna Commercial	$111.60
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.36
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$186.00

TCM ZOSTAVAX

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	93950107
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$29.40
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

TCM ZOSTAVAX

Facility

$98.00

Service Code	HCPCS 90736
Hospital Charge Code	93950107
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$23.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

TCU ADL TRAINING EA 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008320
Hospital Revenue Code	430
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$42.60
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
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	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU ADL TRAINING EA 15 MINUTES

Facility

$142.00

Service Code	HCPCS 97535GO
Hospital Charge Code	1008320
Hospital Revenue Code	430
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

TCU COLD/HEAT APPLICATION

Facility

$0.01

Service Code	HCPCS 97010GP
Hospital Charge Code	1008120
Hospital Revenue Code	420
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
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	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU COLD/HEAT APPLICATION

Facility

$0.01

Service Code	HCPCS 97010GP
Hospital Charge Code	1008120
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

TCU DYNAMIC EXTENSION SPLINT

Facility

$106.00

Hospital Charge Code	1008395
Hospital Revenue Code	270
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$31.80
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.78
Rate for Payer: Oxford Commercial	$53.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$53.00

TCU DYNAMIC EXTENSION SPLINT

Facility

$106.00

Hospital Charge Code	1008395
Hospital Revenue Code	270
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TCU ELASTICIZED BANDAGE

Facility

$40.00

Hospital Charge Code	1008385
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$12.00
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$20.00

TCU ELASTICIZED BANDAGE

Facility

$40.00

Hospital Charge Code	1008385
Hospital Revenue Code	270
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

TCU MANUAL THERPY EACH 15M

Facility

$147.00

Service Code	HCPCS 97140GP
Hospital Charge Code	1008265
Hospital Revenue Code	420
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$22.05
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

TCU MANUAL THERPY EACH 15M

Facility

$147.00

Service Code	HCPCS 97140GP
Hospital Charge Code	1008265
Hospital Revenue Code	420
Min. Negotiated Rate	$19.11
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$44.10
Rate for Payer: Aetna Medicare Advantage	$44.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.48
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	$37.48
Rate for Payer: Cigna Commercial	$73.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.11
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.05
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU MASSAGE EA 15 MINUTES

Facility

$328.00

Service Code	HCPCS 97124GO
Hospital Charge Code	1008255
Hospital Revenue Code	430
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$98.40
Rate for Payer: Aetna Medicare Advantage	$98.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.64
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	$83.64
Rate for Payer: Cigna Commercial	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.64
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.20
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU MASSAGE EA 15 MINUTES

Facility

$328.00

Service Code	HCPCS 97124GO
Hospital Charge Code	1008255
Hospital Revenue Code	430
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$49.20
Rate for Payer: Qualcare PPO/HMO/WC	$49.20

TCU MASSAGE EA 15 MINUTES

Facility

$328.00

Service Code	HCPCS 97124GP
Hospital Charge Code	1008260
Hospital Revenue Code	420
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$49.20
Rate for Payer: Qualcare PPO/HMO/WC	$49.20

TCU MASSAGE EA 15 MINUTES

Facility

$328.00

Service Code	HCPCS 97124GP
Hospital Charge Code	1008260
Hospital Revenue Code	420
Min. Negotiated Rate	$42.64
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$98.40
Rate for Payer: Aetna Medicare Advantage	$98.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.64
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	$83.64
Rate for Payer: Cigna Commercial	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.64
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.20
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU OT:ADL 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	1008035
Hospital Revenue Code	430
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$130.20
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
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	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.42
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU OT:ADL 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GO
Hospital Charge Code	1008035
Hospital Revenue Code	430
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

TCU OT:CO-TX (GRP) 15 MIN

Facility

$27.00

Service Code	HCPCS 97150GO
Hospital Charge Code	1008275
Hospital Revenue Code	430
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$8.10
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
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	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.51
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU OT:CO-TX (GRP) 15 MIN

Facility

$27.00

Service Code	HCPCS 97150GO
Hospital Charge Code	1008275
Hospital Revenue Code	430
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

TCU OT:CO-TX (IND) 15 MIN

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008230
Hospital Revenue Code	420
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$130.20
Rate for Payer: Aetna Medicare Advantage	$130.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.67
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	$110.67
Rate for Payer: Cigna Commercial	$217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.42
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.10
Rate for Payer: UnitedHealthcare Commercial	$686.00

Know your out-of-pocket cost for care.

All Charges