Heights University Hospital

All Charges

Charge

Type

Setting

Price

RT INPT CONSULT MOD SEVERITY

Facility

$644.00

Service Code	HCPCS 99253
Hospital Charge Code	4800835
Hospital Revenue Code	949
Min. Negotiated Rate	$96.60
Max. Negotiated Rate	$96.60
Rate for Payer: Qualcare PPO/HMO/WC	$96.60

RT INPT CONSULT SIMPLE

Facility

$234.00

Service Code	HCPCS 99251
Hospital Charge Code	4800825
Hospital Revenue Code	949
Min. Negotiated Rate	$30.42
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.42
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

RT INPT CONSULT SIMPLE

Facility

$234.00

Service Code	HCPCS 99251
Hospital Charge Code	4800825
Hospital Revenue Code	949
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

RT INPT FOLLOW UP EXTENDED

Facility

$330.25

Service Code	HCPCS 99233
Hospital Charge Code	4800820
Hospital Revenue Code	949
Min. Negotiated Rate	$49.54
Max. Negotiated Rate	$49.54
Rate for Payer: Qualcare PPO/HMO/WC	$49.54

RT INPT FOLLOW UP EXTENDED

Facility

$330.25

Service Code	HCPCS 99233
Hospital Charge Code	4800820
Hospital Revenue Code	949
Min. Negotiated Rate	$42.93
Max. Negotiated Rate	$1,558.00
Rate for Payer: Aetna Commercial	$99.08
Rate for Payer: Aetna Medicare Advantage	$99.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.21
Rate for Payer: Cigna Commercial	$115.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.93
Rate for Payer: Oxford Commercial	$1,373.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.54
Rate for Payer: UnitedHealthcare Commercial	$1,558.00

RT INTERST RADIOELM TO PROSTAT

Facility

$10,881.00

Service Code	HCPCS 55875
Hospital Charge Code	4800805
Hospital Revenue Code	761
Min. Negotiated Rate	$1,632.15
Max. Negotiated Rate	$1,632.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,632.15

RT INTERST RADIOELM TO PROSTAT

Facility

$10,881.00

Service Code	HCPCS 55875
Hospital Charge Code	4800805
Hospital Revenue Code	761
Min. Negotiated Rate	$1,414.53
Max. Negotiated Rate	$12,768.54
Rate for Payer: Aetna Commercial	$3,264.30
Rate for Payer: Aetna Medicare Advantage	$3,264.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,774.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,774.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,774.66
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,414.53
Rate for Payer: Oxford Commercial	$5,440.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,632.15
Rate for Payer: UnitedHealthcare Commercial	$5,440.50

RT LARYNGOSCOPY

Facility

$377.00

Service Code	HCPCS 31575
Hospital Charge Code	4800810
Hospital Revenue Code	360
Min. Negotiated Rate	$56.55
Max. Negotiated Rate	$56.55
Rate for Payer: Qualcare PPO/HMO/WC	$56.55

RT LARYNGOSCOPY

Facility

$377.00

Service Code	HCPCS 31575
Hospital Charge Code	4800810
Hospital Revenue Code	360
Min. Negotiated Rate	$49.01
Max. Negotiated Rate	$1,864.00
Rate for Payer: Aetna Better Health Medicaid	$518.60
Rate for Payer: Aetna Commercial	$113.10
Rate for Payer: Aetna Medicare Advantage	$113.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.14
Rate for Payer: Cigna Commercial	$475.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.01
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.55
Rate for Payer: UnitedHealthcare Commercial	$1,686.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$528.97
Rate for Payer: Wellpoint Medicaid Managed Care	$518.60

RT MTP PLATE MED 5

Facility

$7,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270684669
Hospital Revenue Code	278
Min. Negotiated Rate	$1,152.00
Max. Negotiated Rate	$3,840.00
Rate for Payer: Aetna Commercial	$2,304.00
Rate for Payer: Aetna Medicare Advantage	$2,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,958.40
Rate for Payer: Cigna Commercial	$3,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00

RT MTP PLATE MED 5

Facility

$7,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270684669
Hospital Revenue Code	278
Min. Negotiated Rate	$1,152.00
Max. Negotiated Rate	$1,858.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00

RT NEW PT VS LEVEL 1 - 10 MIN

Facility

$216.00

Service Code	HCPCS 99201
Hospital Charge Code	4800770
Hospital Revenue Code	510
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna Commercial	$64.80
Rate for Payer: Aetna Medicare Advantage	$64.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.08
Rate for Payer: Cigna Commercial	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.08
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

RT NEW PT VS LEVEL 1 - 10 MIN

Facility

$216.00

Service Code	HCPCS 99201
Hospital Charge Code	4800770
Hospital Revenue Code	510
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

RT NEW PT VS LEVEL 2 - 20 MIN

Facility

$416.00

Service Code	HCPCS 99202
Hospital Charge Code	4800775
Hospital Revenue Code	510
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$124.80
Rate for Payer: Aetna Commercial	$124.80
Rate for Payer: Aetna Medicare Advantage	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.08
Rate for Payer: Cigna Commercial	$44.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.08
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

RT NEW PT VS LEVEL 2 - 20 MIN

Facility

$416.00

Service Code	HCPCS 99202
Hospital Charge Code	4800775
Hospital Revenue Code	510
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Qualcare PPO/HMO/WC	$62.40

RT NEW PT VS LEVEL 3 - 30 MIN

Facility

$542.00

Service Code	HCPCS 99203
Hospital Charge Code	4800421
Hospital Revenue Code	510
Min. Negotiated Rate	$70.46
Max. Negotiated Rate	$162.60
Rate for Payer: Aetna Commercial	$162.60
Rate for Payer: Aetna Medicare Advantage	$162.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.21
Rate for Payer: Cigna Commercial	$77.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.46
Rate for Payer: Qualcare PPO/HMO/WC	$81.30

RT NEW PT VS LEVEL 3 - 30 MIN

Facility

$542.00

Service Code	HCPCS 99203
Hospital Charge Code	4800421
Hospital Revenue Code	510
Min. Negotiated Rate	$81.30
Max. Negotiated Rate	$81.30
Rate for Payer: Qualcare PPO/HMO/WC	$81.30

RT NEW PT VS LEVEL 4 - 45 MIN

Facility

$675.00

Service Code	HCPCS 99204
Hospital Charge Code	4800439
Hospital Revenue Code	510
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$101.25
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

RT NEW PT VS LEVEL 4 - 45 MIN

Facility

$675.00

Service Code	HCPCS 99204
Hospital Charge Code	4800439
Hospital Revenue Code	510
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$126.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.75
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

RT NEW PT VS LEVEL 5 - 60 MIN

Facility

$857.00

Service Code	HCPCS 99205
Hospital Charge Code	4800413
Hospital Revenue Code	510
Min. Negotiated Rate	$128.55
Max. Negotiated Rate	$128.55
Rate for Payer: Qualcare PPO/HMO/WC	$128.55

RT NEW PT VS LEVEL 5 - 60 MIN

Facility

$857.00

Service Code	HCPCS 99205
Hospital Charge Code	4800413
Hospital Revenue Code	510
Min. Negotiated Rate	$111.41
Max. Negotiated Rate	$257.10
Rate for Payer: Aetna Commercial	$257.10
Rate for Payer: Aetna Medicare Advantage	$257.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.53
Rate for Payer: Cigna Commercial	$173.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.41
Rate for Payer: Qualcare PPO/HMO/WC	$128.55

RT NEW PT VS LEVEL LOW SEVRITY

Facility

$294.00

Service Code	HCPCS 99242
Hospital Charge Code	4800411
Hospital Revenue Code	510
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

RT NEW PT VS LEVEL LOW SEVRITY

Facility

$294.00

Service Code	HCPCS 99242
Hospital Charge Code	4800411
Hospital Revenue Code	510
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: Aetna Medicare Advantage	$88.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.97
Rate for Payer: Cigna Commercial	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.22
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

RT NEW PT VS LEVEL SIMPLE

Facility

$294.00

Service Code	HCPCS 99241
Hospital Charge Code	4800410
Hospital Revenue Code	510
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: Aetna Medicare Advantage	$88.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.97
Rate for Payer: Cigna Commercial	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.22
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

RT NEW PT VS LEVEL SIMPLE

Facility

$294.00

Service Code	HCPCS 99241
Hospital Charge Code	4800410
Hospital Revenue Code	510
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$44.10
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

Know your out-of-pocket cost for care.

All Charges