Heights University Hospital

All Charges

Charge

Type

Setting

Price

RT TELE-ISODOSE PLAN INTERMED

Facility

$429.45

Service Code	HCPCS 77310
Hospital Charge Code	4800074
Hospital Revenue Code	333
Min. Negotiated Rate	$55.83
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$128.84
Rate for Payer: Aetna Medicare Advantage	$128.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.51
Rate for Payer: Cigna Commercial	$214.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.83
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.42
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TELE-ISODOSE PLAN INTERMED

Facility

$429.45

Service Code	HCPCS 77310
Hospital Charge Code	4800074
Hospital Revenue Code	333
Min. Negotiated Rate	$64.42
Max. Negotiated Rate	$64.42
Rate for Payer: Qualcare PPO/HMO/WC	$64.42

RT TELE-ISODOSE PLAN SIMPLE

Facility

$400.00

Service Code	HCPCS 77305
Hospital Charge Code	4800066
Hospital Revenue Code	333
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$120.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TELE-ISODOSE PLAN SIMPLE

Facility

$400.00

Service Code	HCPCS 77305
Hospital Charge Code	4800066
Hospital Revenue Code	333
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

RT TREATMENT DEVICE COMPLEX

Facility

$1,020.80

Service Code	HCPCS 77334
Hospital Charge Code	4800165
Hospital Revenue Code	333
Min. Negotiated Rate	$153.12
Max. Negotiated Rate	$153.12
Rate for Payer: Qualcare PPO/HMO/WC	$153.12

RT TREATMENT DEVICE COMPLEX

Facility

$1,020.80

Service Code	HCPCS 77334
Hospital Charge Code	4800165
Hospital Revenue Code	333
Min. Negotiated Rate	$132.70
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$306.24
Rate for Payer: Aetna Medicare Advantage	$306.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.30
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.70
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.12
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TREATMENT DEVICE INTERMED

Facility

$451.85

Service Code	HCPCS 77333
Hospital Charge Code	4800157
Hospital Revenue Code	333
Min. Negotiated Rate	$58.74
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$135.56
Rate for Payer: Aetna Medicare Advantage	$135.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.22
Rate for Payer: Cigna Commercial	$320.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.74
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.78
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TREATMENT DEVICE INTERMED

Facility

$451.85

Service Code	HCPCS 77333
Hospital Charge Code	4800157
Hospital Revenue Code	333
Min. Negotiated Rate	$67.78
Max. Negotiated Rate	$67.78
Rate for Payer: Qualcare PPO/HMO/WC	$67.78

RT TREATMENT DEVICE SIMPLE

Facility

$331.55

Service Code	HCPCS 77332
Hospital Charge Code	4800140
Hospital Revenue Code	333
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

RT TREATMENT DEVICE SIMPLE

Facility

$331.55

Service Code	HCPCS 77332
Hospital Charge Code	4800140
Hospital Revenue Code	333
Min. Negotiated Rate	$43.10
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$99.47
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$320.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.10
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TX DELIVERY COMPLEX (11-19)

Facility

$842.25

Service Code	HCPCS 77414
Hospital Charge Code	4800256
Hospital Revenue Code	333
Min. Negotiated Rate	$109.49
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$252.68
Rate for Payer: Aetna Medicare Advantage	$252.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.77
Rate for Payer: Cigna Commercial	$421.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.49
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.34
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TX DELIVERY COMPLEX (11-19)

Facility

$842.25

Service Code	HCPCS 77414
Hospital Charge Code	4800256
Hospital Revenue Code	333
Min. Negotiated Rate	$126.34
Max. Negotiated Rate	$126.34
Rate for Payer: Qualcare PPO/HMO/WC	$126.34

RT TX DELIVERY COMPLEX 20+

Facility

$449.30

Service Code	HCPCS 77416
Hospital Charge Code	4800505
Hospital Revenue Code	333
Min. Negotiated Rate	$58.41
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$134.79
Rate for Payer: Aetna Medicare Advantage	$134.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.57
Rate for Payer: Cigna Commercial	$224.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.41
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.39
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TX DELIVERY COMPLEX 20+

Facility

$449.30

Service Code	HCPCS 77416
Hospital Charge Code	4800505
Hospital Revenue Code	333
Min. Negotiated Rate	$67.39
Max. Negotiated Rate	$67.39
Rate for Payer: Qualcare PPO/HMO/WC	$67.39

RT TX DELIVERY COMPLEX (6-10)

Facility

$821.80

Service Code	HCPCS 77413
Hospital Charge Code	4800249
Hospital Revenue Code	333
Min. Negotiated Rate	$123.27
Max. Negotiated Rate	$123.27
Rate for Payer: Qualcare PPO/HMO/WC	$123.27

RT TX DELIVERY COMPLEX (6-10)

Facility

$821.80

Service Code	HCPCS 77413
Hospital Charge Code	4800249
Hospital Revenue Code	333
Min. Negotiated Rate	$106.83
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$246.54
Rate for Payer: Aetna Medicare Advantage	$246.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.56
Rate for Payer: Cigna Commercial	$410.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.83
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.27
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TX DELIVERY INTERM (11-19)

Facility

$682.90

Service Code	HCPCS 77409
Hospital Charge Code	4800231
Hospital Revenue Code	333
Min. Negotiated Rate	$102.44
Max. Negotiated Rate	$102.44
Rate for Payer: Qualcare PPO/HMO/WC	$102.44

RT TX DELIVERY INTERM (11-19)

Facility

$682.90

Service Code	HCPCS 77409
Hospital Charge Code	4800231
Hospital Revenue Code	333
Min. Negotiated Rate	$88.78
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$204.87
Rate for Payer: Aetna Medicare Advantage	$204.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.14
Rate for Payer: Cigna Commercial	$341.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.78
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.44
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TX DELIVERY INTERM (6-10)

Facility

$663.05

Service Code	HCPCS 77408
Hospital Charge Code	4800223
Hospital Revenue Code	333
Min. Negotiated Rate	$99.46
Max. Negotiated Rate	$99.46
Rate for Payer: Qualcare PPO/HMO/WC	$99.46

RT TX DELIVERY INTERM (6-10)

Facility

$663.05

Service Code	HCPCS 77408
Hospital Charge Code	4800223
Hospital Revenue Code	333
Min. Negotiated Rate	$86.20
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$198.91
Rate for Payer: Aetna Medicare Advantage	$198.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.08
Rate for Payer: Cigna Commercial	$331.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.20
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.46
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TX DELIVERY SIMPLE (11-19)

Facility

$440.35

Service Code	HCPCS 77404
Hospital Charge Code	4800215
Hospital Revenue Code	333
Min. Negotiated Rate	$57.25
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$132.10
Rate for Payer: Aetna Medicare Advantage	$132.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.29
Rate for Payer: Cigna Commercial	$220.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.25
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.05
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TX DELIVERY SIMPLE (11-19)

Facility

$440.35

Service Code	HCPCS 77404
Hospital Charge Code	4800215
Hospital Revenue Code	333
Min. Negotiated Rate	$66.05
Max. Negotiated Rate	$66.05
Rate for Payer: Qualcare PPO/HMO/WC	$66.05

RT TX DELIVERY SIMPLE (1-5)

Facility

$375.05

Service Code	HCPCS 77402
Hospital Charge Code	4800504
Hospital Revenue Code	333
Min. Negotiated Rate	$56.26
Max. Negotiated Rate	$56.26
Rate for Payer: Qualcare PPO/HMO/WC	$56.26

RT TX DELIVERY SIMPLE (1-5)

Facility

$375.05

Service Code	HCPCS 77402
Hospital Charge Code	4800504
Hospital Revenue Code	333
Min. Negotiated Rate	$48.76
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$112.52
Rate for Payer: Aetna Medicare Advantage	$112.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.64
Rate for Payer: Cigna Commercial	$242.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.76
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.26
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

RT TX DELIVERY SIMPLE (6-10)

Facility

$419.85

Service Code	HCPCS 77403
Hospital Charge Code	4800207
Hospital Revenue Code	333
Min. Negotiated Rate	$62.98
Max. Negotiated Rate	$62.98
Rate for Payer: Qualcare PPO/HMO/WC	$62.98

Know your out-of-pocket cost for care.

All Charges