Heights University Hospital

All Charges

Charge

Type

Setting

Price

RT SIMULATION COMPLEX

Facility

$1,394.60

Service Code	HCPCS 77290
Hospital Charge Code	4800041
Hospital Revenue Code	333
Min. Negotiated Rate	$209.19
Max. Negotiated Rate	$209.19
Rate for Payer: Qualcare PPO/HMO/WC	$209.19

RT SIMULATION INTERMED

Facility

$858.90

Service Code	HCPCS 77285
Hospital Charge Code	4800033
Hospital Revenue Code	333
Min. Negotiated Rate	$111.66
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$257.67
Rate for Payer: Aetna Medicare Advantage	$257.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.02
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.66
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.84
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT SIMULATION INTERMED

Facility

$858.90

Service Code	HCPCS 77285
Hospital Charge Code	4800033
Hospital Revenue Code	333
Min. Negotiated Rate	$128.84
Max. Negotiated Rate	$128.84
Rate for Payer: Qualcare PPO/HMO/WC	$128.84

RT SIMULATION SIMPLE

Facility

$545.30

Service Code	HCPCS 77280
Hospital Charge Code	4800025
Hospital Revenue Code	333
Min. Negotiated Rate	$81.80
Max. Negotiated Rate	$81.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.80

RT SIMULATION SIMPLE

Facility

$545.30

Service Code	HCPCS 77280
Hospital Charge Code	4800025
Hospital Revenue Code	333
Min. Negotiated Rate	$70.89
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$163.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.05
Rate for Payer: Cigna Commercial	$320.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.89
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.80
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT SM153 PER 50 mCi

Facility

$1,932.20

Hospital Charge Code	4800692
Hospital Revenue Code	636
Min. Negotiated Rate	$289.83
Max. Negotiated Rate	$966.10
Rate for Payer: Aetna Commercial	$579.66
Rate for Payer: Aetna Medicare Advantage	$579.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.71
Rate for Payer: Cigna Commercial	$966.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.59
Rate for Payer: Qualcare PPO/HMO/WC	$289.83

RT SM153 PER 50 mCi

Facility

$1,932.20

Hospital Charge Code	4800692
Hospital Revenue Code	636
Min. Negotiated Rate	$289.83
Max. Negotiated Rate	$467.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.59
Rate for Payer: Qualcare PPO/HMO/WC	$289.83

RT SM153 RADIONUCLIDE THERAPY

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800690
Hospital Revenue Code	342
Min. Negotiated Rate	$214.95
Max. Negotiated Rate	$214.95
Rate for Payer: Qualcare PPO/HMO/WC	$214.95

RT SM153 RADIONUCLIDE THERAPY

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800690
Hospital Revenue Code	342
Min. Negotiated Rate	$186.29
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$429.90
Rate for Payer: Aetna Medicare Advantage	$429.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.42
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.29
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.95
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

RT SPECIAL PLAN HEMI/TOTAL BDY

Facility

$649.00

Service Code	HCPCS 77321
Hospital Charge Code	4800090
Hospital Revenue Code	333
Min. Negotiated Rate	$84.37
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Better Health Medicaid	$417.12
Rate for Payer: Aetna Commercial	$194.70
Rate for Payer: Aetna Medicare Advantage	$194.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.50
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.37
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.35
Rate for Payer: UnitedHealthcare Commercial	$4,435.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$425.46

RT SPECIAL PLAN HEMI/TOTAL BDY

Facility

$649.00

Service Code	HCPCS 77321
Hospital Charge Code	4800090
Hospital Revenue Code	333
Min. Negotiated Rate	$97.35
Max. Negotiated Rate	$97.35
Rate for Payer: Qualcare PPO/HMO/WC	$97.35

RT SPECIAL RAD DOSIMETRY-TLD'S

Facility

$794.90

Service Code	HCPCS 77331
Hospital Charge Code	4800108
Hospital Revenue Code	333
Min. Negotiated Rate	$103.34
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$238.47
Rate for Payer: Aetna Medicare Advantage	$238.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.70
Rate for Payer: Cigna Commercial	$320.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.34
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.23
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT SPECIAL RAD DOSIMETRY-TLD'S

Facility

$794.90

Service Code	HCPCS 77331
Hospital Charge Code	4800108
Hospital Revenue Code	333
Min. Negotiated Rate	$119.23
Max. Negotiated Rate	$119.23
Rate for Payer: Qualcare PPO/HMO/WC	$119.23

RT SPECIAL TREATMENT PROCEDURE

Facility

$2,681.00

Service Code	HCPCS 77470
Hospital Charge Code	4800760
Hospital Revenue Code	333
Min. Negotiated Rate	$348.53
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$804.30
Rate for Payer: Aetna Medicare Advantage	$804.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$683.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$683.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$683.65
Rate for Payer: Cigna Commercial	$1,315.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.53
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$402.15
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT SPECIAL TREATMENT PROCEDURE

Facility

$2,681.00

Service Code	HCPCS 77470
Hospital Charge Code	4800760
Hospital Revenue Code	333
Min. Negotiated Rate	$402.15
Max. Negotiated Rate	$402.15
Rate for Payer: Qualcare PPO/HMO/WC	$402.15

RT SR89 PER mCi

Facility

$1,607.05

Hospital Charge Code	4800660
Hospital Revenue Code	636
Min. Negotiated Rate	$241.06
Max. Negotiated Rate	$388.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.91
Rate for Payer: Qualcare PPO/HMO/WC	$241.06

RT SR89 PER mCi

Facility

$1,607.05

Hospital Charge Code	4800660
Hospital Revenue Code	636
Min. Negotiated Rate	$241.06
Max. Negotiated Rate	$803.52
Rate for Payer: Aetna Commercial	$482.12
Rate for Payer: Aetna Medicare Advantage	$482.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$409.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$409.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$409.80
Rate for Payer: Cigna Commercial	$803.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.91
Rate for Payer: Qualcare PPO/HMO/WC	$241.06

RT SR89 RADIONUCLIDE THERAPY

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800678
Hospital Revenue Code	342
Min. Negotiated Rate	$186.29
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$429.90
Rate for Payer: Aetna Medicare Advantage	$429.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.42
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.29
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.95
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

RT SR89 RADIONUCLIDE THERAPY

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800678
Hospital Revenue Code	342
Min. Negotiated Rate	$214.95
Max. Negotiated Rate	$214.95
Rate for Payer: Qualcare PPO/HMO/WC	$214.95

RT SR90 TREATMENT

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800694
Hospital Revenue Code	342
Min. Negotiated Rate	$214.95
Max. Negotiated Rate	$214.95
Rate for Payer: Qualcare PPO/HMO/WC	$214.95

RT SR90 TREATMENT

Facility

$1,433.00

Service Code	HCPCS 79101
Hospital Charge Code	4800694
Hospital Revenue Code	342
Min. Negotiated Rate	$186.29
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$429.90
Rate for Payer: Aetna Medicare Advantage	$429.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.42
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.29
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.95
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

RT TECH BLOOD IRRADIATION

Facility

$320.00

Service Code	HCPCS 86945
Hospital Charge Code	4800652
Hospital Revenue Code	302
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$96.00
Rate for Payer: Aetna Medicare Advantage	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.60
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00
Rate for Payer: UnitedHealthcare Commercial	$114.00

RT TECH BLOOD IRRADIATION

Facility

$320.00

Service Code	HCPCS 86945
Hospital Charge Code	4800652
Hospital Revenue Code	302
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

RT TELE-ISODOSE PLAN COMPLEX

Facility

$773.80

Service Code	HCPCS 77315
Hospital Charge Code	4800082
Hospital Revenue Code	333
Min. Negotiated Rate	$100.59
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$232.14
Rate for Payer: Aetna Medicare Advantage	$232.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.32
Rate for Payer: Cigna Commercial	$386.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.59
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.07
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TELE-ISODOSE PLAN COMPLEX

Facility

$773.80

Service Code	HCPCS 77315
Hospital Charge Code	4800082
Hospital Revenue Code	333
Min. Negotiated Rate	$116.07
Max. Negotiated Rate	$116.07
Rate for Payer: Qualcare PPO/HMO/WC	$116.07

Know your out-of-pocket cost for care.

All Charges