Heights University Hospital

All Charges

Charge

Type

Setting

Price

RT HI >12 SOURCE POSITION/CATH

Facility

$4,881.95

Service Code	HCPCS 77784
Hospital Charge Code	4800355
Hospital Revenue Code	333
Min. Negotiated Rate	$634.65
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$1,464.59
Rate for Payer: Aetna Medicare Advantage	$1,464.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.90
Rate for Payer: Cigna Commercial	$2,440.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$634.65
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.29
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT HI >12 SOURCE POSITION/CATH

Facility

$4,881.95

Service Code	HCPCS 77784
Hospital Charge Code	4800355
Hospital Revenue Code	333
Min. Negotiated Rate	$732.29
Max. Negotiated Rate	$732.29
Rate for Payer: Qualcare PPO/HMO/WC	$732.29

RT HI 1-4 SOURCE POSITION/CATH

Facility

$3,531.55

Service Code	HCPCS 77781
Hospital Charge Code	4800322
Hospital Revenue Code	333
Min. Negotiated Rate	$529.73
Max. Negotiated Rate	$529.73
Rate for Payer: Qualcare PPO/HMO/WC	$529.73

RT HI 1-4 SOURCE POSITION/CATH

Facility

$3,531.55

Service Code	HCPCS 77781
Hospital Charge Code	4800322
Hospital Revenue Code	333
Min. Negotiated Rate	$459.10
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$1,059.46
Rate for Payer: Aetna Medicare Advantage	$1,059.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$900.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$900.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$900.55
Rate for Payer: Cigna Commercial	$1,765.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.10
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$529.73
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT HI 5-8 SOURCE POSITION/CATH

Facility

$3,747.20

Service Code	HCPCS 77782
Hospital Charge Code	4800330
Hospital Revenue Code	333
Min. Negotiated Rate	$562.08
Max. Negotiated Rate	$562.08
Rate for Payer: Qualcare PPO/HMO/WC	$562.08

RT HI 5-8 SOURCE POSITION/CATH

Facility

$3,747.20

Service Code	HCPCS 77782
Hospital Charge Code	4800330
Hospital Revenue Code	333
Min. Negotiated Rate	$487.14
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$1,124.16
Rate for Payer: Aetna Medicare Advantage	$1,124.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$955.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$955.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$955.54
Rate for Payer: Cigna Commercial	$1,873.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.14
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.08
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT HI 9-12 SOURCE POSITION/CAT

Facility

$3,906.60

Service Code	HCPCS 77783
Hospital Charge Code	4800348
Hospital Revenue Code	333
Min. Negotiated Rate	$507.86
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$1,171.98
Rate for Payer: Aetna Medicare Advantage	$1,171.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$996.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$996.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$996.18
Rate for Payer: Cigna Commercial	$1,953.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$507.86
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.99
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT HI 9-12 SOURCE POSITION/CAT

Facility

$3,906.60

Service Code	HCPCS 77783
Hospital Charge Code	4800348
Hospital Revenue Code	333
Min. Negotiated Rate	$585.99
Max. Negotiated Rate	$585.99
Rate for Payer: Qualcare PPO/HMO/WC	$585.99

RT I 125 SEEDS (10)****

Facility

$847.00

Service Code	HCPCS 79900
Hospital Charge Code	4800728
Hospital Revenue Code	342
Min. Negotiated Rate	$110.11
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$254.10
Rate for Payer: Aetna Medicare Advantage	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.99
Rate for Payer: Cigna Commercial	$423.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.11
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.05
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

RT I 125 SEEDS (10)****

Facility

$847.00

Service Code	HCPCS 79900
Hospital Charge Code	4800728
Hospital Revenue Code	342
Min. Negotiated Rate	$127.05
Max. Negotiated Rate	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$127.05

RT I 125 SEEDS (5)****

Facility

$424.00

Service Code	HCPCS 79900
Hospital Charge Code	4800710
Hospital Revenue Code	342
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$63.60

RT I 125 SEEDS (5)****

Facility

$424.00

Service Code	HCPCS 79900
Hospital Charge Code	4800710
Hospital Revenue Code	342
Min. Negotiated Rate	$55.12
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$127.20
Rate for Payer: Aetna Medicare Advantage	$127.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.12
Rate for Payer: Cigna Commercial	$212.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.12
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.60
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

RT I 125 SEEDS EACH

Facility

$252.50

Hospital Charge Code	4800736
Hospital Revenue Code	272
Min. Negotiated Rate	$32.83
Max. Negotiated Rate	$126.25
Rate for Payer: Aetna Commercial	$75.75
Rate for Payer: Aetna Medicare Advantage	$75.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.39
Rate for Payer: Cigna Commercial	$126.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.83
Rate for Payer: Oxford Commercial	$126.25
Rate for Payer: Qualcare PPO/HMO/WC	$37.88
Rate for Payer: UnitedHealthcare Commercial	$126.25

RT I 125 SEEDS EACH

Facility

$252.50

Hospital Charge Code	4800736
Hospital Revenue Code	272
Min. Negotiated Rate	$37.88
Max. Negotiated Rate	$37.88
Rate for Payer: Qualcare PPO/HMO/WC	$37.88

RT IB TR W FLIPCUTTER III DRIL

Facility

$5,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270693992
Hospital Revenue Code	278
Min. Negotiated Rate	$791.25
Max. Negotiated Rate	$2,637.50
Rate for Payer: Aetna Commercial	$1,582.50
Rate for Payer: Aetna Medicare Advantage	$1,582.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,345.12
Rate for Payer: Cigna Commercial	$2,637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,276.55
Rate for Payer: Qualcare PPO/HMO/WC	$791.25

RT IB TR W FLIPCUTTER III DRIL

Facility

$5,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270693992
Hospital Revenue Code	278
Min. Negotiated Rate	$791.25
Max. Negotiated Rate	$1,276.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,276.55
Rate for Payer: Qualcare PPO/HMO/WC	$791.25

RT INFUSE/INSTILL RADIOELEMENT

Facility

$515.20

Service Code	HCPCS 77750
Hospital Charge Code	4800765
Hospital Revenue Code	333
Min. Negotiated Rate	$66.98
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$154.56
Rate for Payer: Aetna Medicare Advantage	$154.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.38
Rate for Payer: Cigna Commercial	$918.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.98
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.28
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT INFUSE/INSTILL RADIOELEMENT

Facility

$515.20

Service Code	HCPCS 77750
Hospital Charge Code	4800765
Hospital Revenue Code	333
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$77.28
Rate for Payer: Qualcare PPO/HMO/WC	$77.28

RT INPT CONSULT COMPLEX

Facility

$922.00

Service Code	HCPCS 99254
Hospital Charge Code	4800840
Hospital Revenue Code	949
Min. Negotiated Rate	$119.86
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$276.60
Rate for Payer: Aetna Medicare Advantage	$276.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.11
Rate for Payer: Cigna Commercial	$461.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.86
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.30
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

RT INPT CONSULT COMPLEX

Facility

$922.00

Service Code	HCPCS 99254
Hospital Charge Code	4800840
Hospital Revenue Code	949
Min. Negotiated Rate	$138.30
Max. Negotiated Rate	$138.30
Rate for Payer: Qualcare PPO/HMO/WC	$138.30

RT INPT CONSULT HIGH COMPLEX

Facility

$1,272.00

Service Code	HCPCS 99255
Hospital Charge Code	4800845
Hospital Revenue Code	949
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$190.80
Rate for Payer: Qualcare PPO/HMO/WC	$190.80

RT INPT CONSULT HIGH COMPLEX

Facility

$1,272.00

Service Code	HCPCS 99255
Hospital Charge Code	4800845
Hospital Revenue Code	949
Min. Negotiated Rate	$165.36
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$381.60
Rate for Payer: Aetna Medicare Advantage	$381.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$324.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$324.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$324.36
Rate for Payer: Cigna Commercial	$636.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.36
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$190.80
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

RT INPT CONSULT LOW SEVERITY

Facility

$471.00

Service Code	HCPCS 99252
Hospital Charge Code	4800830
Hospital Revenue Code	949
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$141.30
Rate for Payer: Aetna Medicare Advantage	$141.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.11
Rate for Payer: Cigna Commercial	$235.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.65
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

RT INPT CONSULT LOW SEVERITY

Facility

$471.00

Service Code	HCPCS 99252
Hospital Charge Code	4800830
Hospital Revenue Code	949
Min. Negotiated Rate	$70.65
Max. Negotiated Rate	$70.65
Rate for Payer: Qualcare PPO/HMO/WC	$70.65

RT INPT CONSULT MOD SEVERITY

Facility

$644.00

Service Code	HCPCS 99253
Hospital Charge Code	4800835
Hospital Revenue Code	949
Min. Negotiated Rate	$83.72
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$193.20
Rate for Payer: Aetna Medicare Advantage	$193.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.22
Rate for Payer: Cigna Commercial	$322.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.72
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.60
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

Know your out-of-pocket cost for care.

All Charges