Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

TCU OT EVALUATION

Facility

$81.00

Service Code	HCPCS 97003GO
Hospital Charge Code	1008030
Hospital Revenue Code	434
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

TCU OT EVALUATION

Facility

$81.00

Service Code	HCPCS 97003GO
Hospital Charge Code	1008030
Hospital Revenue Code	434
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$24.30
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
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	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.53
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU OT:GROUP TX

Facility

$103.00

Service Code	HCPCS 97150GO
Hospital Charge Code	1008280
Hospital Revenue Code	433
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$30.90
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU OT:GROUP TX

Facility

$103.00

Service Code	HCPCS 97150GO
Hospital Charge Code	1008280
Hospital Revenue Code	433
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

TCU OT:MODALITY 15 MIN

Facility

$60.00

Hospital Charge Code	1008415
Hospital Revenue Code	432
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$18.00
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU OT:MODALITY 15 MIN

Facility

$60.00

Hospital Charge Code	1008415
Hospital Revenue Code	432
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

TCU PARAFFIN

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	1008145
Hospital Revenue Code	430
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

TCU PARAFFIN

Facility

$266.00

Service Code	HCPCS 97018GP
Hospital Charge Code	1008150
Hospital Revenue Code	420
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.58
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU PARAFFIN

Facility

$266.00

Service Code	HCPCS 97018GP
Hospital Charge Code	1008150
Hospital Revenue Code	420
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

TCU PARAFFIN

Facility

$266.00

Service Code	HCPCS 97018GO
Hospital Charge Code	1008145
Hospital Revenue Code	430
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
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	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.58
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU PT:CO-TX (GRP) 1/4 HR

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008235
Hospital Revenue Code	423
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

TCU PT:CO-TX (GRP) 1/4 HR

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008235
Hospital Revenue Code	423
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) 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 PT:CO-TX (IND) 1/4 HR

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008225
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

TCU PT:CO-TX (IND) 1/4 HR

Facility

$434.00

Service Code	HCPCS 97110GP
Hospital Charge Code	1008225
Hospital Revenue Code	420
Min. Negotiated Rate	$65.10
Max. Negotiated Rate	$65.10
Rate for Payer: Qualcare PPO/HMO/WC	$65.10

TCU PT:GROUP TX

Facility

$103.00

Service Code	HCPCS 97150GP
Hospital Charge Code	1008285
Hospital Revenue Code	423
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$30.90
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU PT:GROUP TX

Facility

$840.00

Service Code	HCPCS 97001GP
Hospital Charge Code	1008025
Hospital Revenue Code	424
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$252.00
Rate for Payer: Aetna Medicare Advantage	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.20
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	$214.20
Rate for Payer: Cigna Commercial	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.00
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU PT:GROUP TX

Facility

$840.00

Service Code	HCPCS 97001GP
Hospital Charge Code	1008025
Hospital Revenue Code	424
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$126.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.00

TCU PT:GROUP TX

Facility

$103.00

Service Code	HCPCS 97150GP
Hospital Charge Code	1008285
Hospital Revenue Code	423
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

TCU RE-EVALUATION OT

Facility

$103.00

Service Code	HCPCS 97004GO
Hospital Charge Code	1008115
Hospital Revenue Code	434
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$30.90
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
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	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.39
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU RE-EVALUATION OT

Facility

$103.00

Service Code	HCPCS 97004GO
Hospital Charge Code	1008115
Hospital Revenue Code	434
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

TCU REEVALUATION PT

Facility

$164.00

Service Code	HCPCS 97002GP
Hospital Charge Code	1008110
Hospital Revenue Code	424
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$49.20
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
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	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.32
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$686.00

TCU REEVALUATION PT

Facility

$164.00

Service Code	HCPCS 97002GP
Hospital Charge Code	1008110
Hospital Revenue Code	424
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

TCU SPLINT/CAST FABRICATION

Facility

$458.00

Hospital Charge Code	1008410
Hospital Revenue Code	430
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

TCU SPLINT/CAST FABRICATION

Facility

$458.00

Hospital Charge Code	1008410
Hospital Revenue Code	430
Min. Negotiated Rate	$59.54
Max. Negotiated Rate	$686.00
Rate for Payer: Aetna Commercial	$137.40
Rate for Payer: Aetna Medicare Advantage	$137.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.79
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	$116.79
Rate for Payer: Cigna Commercial	$229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.54
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$686.00

Know your out-of-pocket cost for care.

All Charges