Heights University Hospital

All Charges

Charge

Type

Setting

Price

TELETX ISODOSE PLAN COMPLEX-PC

Facility

$414.75

Service Code	HCPCS 7731526
Hospital Charge Code	85000515
Hospital Revenue Code	333
Min. Negotiated Rate	$62.21
Max. Negotiated Rate	$62.21
Rate for Payer: Qualcare PPO/HMO/WC	$62.21

TELETX ISODOSE PLAN COMPLEX-PC

Facility

$414.75

Service Code	HCPCS 7731526
Hospital Charge Code	85000515
Hospital Revenue Code	333
Min. Negotiated Rate	$53.92
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$124.42
Rate for Payer: Aetna Medicare Advantage	$124.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.76
Rate for Payer: Cigna Commercial	$207.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.92
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.21
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

TELETX ISODOSE PLAN COMPLEX-TC

Facility

$361.05

Service Code	HCPCS 77315TC
Hospital Charge Code	85000510
Hospital Revenue Code	333
Min. Negotiated Rate	$46.94
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$108.31
Rate for Payer: Aetna Medicare Advantage	$108.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.07
Rate for Payer: Cigna Commercial	$180.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.94
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.16
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

TELETX ISODOSE PLAN COMPLEX-TC

Facility

$361.05

Service Code	HCPCS 77315TC
Hospital Charge Code	85000510
Hospital Revenue Code	333
Min. Negotiated Rate	$54.16
Max. Negotiated Rate	$54.16
Rate for Payer: Qualcare PPO/HMO/WC	$54.16

TELETX ISODOSE PLAN INTERMED-P

Facility

$280.25

Service Code	HCPCS 7731026
Hospital Charge Code	85000500
Hospital Revenue Code	333
Min. Negotiated Rate	$36.43
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$84.08
Rate for Payer: Aetna Medicare Advantage	$84.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.46
Rate for Payer: Cigna Commercial	$140.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.43
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.04
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

TELETX ISODOSE PLAN INTERMED-P

Facility

$280.25

Service Code	HCPCS 7731026
Hospital Charge Code	85000500
Hospital Revenue Code	333
Min. Negotiated Rate	$42.04
Max. Negotiated Rate	$42.04
Rate for Payer: Qualcare PPO/HMO/WC	$42.04

TELETX ISODOSE PLAN INTERMED-T

Facility

$219.75

Service Code	HCPCS 77310TC
Hospital Charge Code	85000495
Hospital Revenue Code	333
Min. Negotiated Rate	$32.96
Max. Negotiated Rate	$32.96
Rate for Payer: Qualcare PPO/HMO/WC	$32.96

TELETX ISODOSE PLAN INTERMED-T

Facility

$219.75

Service Code	HCPCS 77310TC
Hospital Charge Code	85000495
Hospital Revenue Code	333
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna Medicare Advantage	$65.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.04
Rate for Payer: Cigna Commercial	$109.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.57
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.96
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

TELETX ISODOSE PLAN SIMPLE-GL

Facility

$711.65

Service Code	HCPCS 77305
Hospital Charge Code	85000475
Hospital Revenue Code	333
Min. Negotiated Rate	$92.51
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$213.50
Rate for Payer: Aetna Medicare Advantage	$213.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.47
Rate for Payer: Cigna Commercial	$355.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.51
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.75
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

TELETX ISODOSE PLAN SIMPLE-GL

Facility

$711.65

Service Code	HCPCS 77305
Hospital Charge Code	85000475
Hospital Revenue Code	333
Min. Negotiated Rate	$106.75
Max. Negotiated Rate	$106.75
Rate for Payer: Qualcare PPO/HMO/WC	$106.75

TELETX ISODOSE PLAN SIMPLE-PC

Facility

$186.20

Service Code	HCPCS 7730526
Hospital Charge Code	85000485
Hospital Revenue Code	333
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$27.93
Rate for Payer: Qualcare PPO/HMO/WC	$27.93

TELETX ISODOSE PLAN SIMPLE-PC

Facility

$186.20

Service Code	HCPCS 7730526
Hospital Charge Code	85000485
Hospital Revenue Code	333
Min. Negotiated Rate	$24.21
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$55.86
Rate for Payer: Aetna Medicare Advantage	$55.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.48
Rate for Payer: Cigna Commercial	$93.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.21
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.93
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

TELETX ISODOSE PLAN SIMPLE-TC

Facility

$165.25

Service Code	HCPCS 77305TC
Hospital Charge Code	85000480
Hospital Revenue Code	333
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$49.58
Rate for Payer: Aetna Medicare Advantage	$49.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.14
Rate for Payer: Cigna Commercial	$82.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.48
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.79
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

TELETX ISODOSE PLAN SIMPLE-TC

Facility

$165.25

Service Code	HCPCS 77305TC
Hospital Charge Code	85000480
Hospital Revenue Code	333
Min. Negotiated Rate	$24.79
Max. Negotiated Rate	$24.79
Rate for Payer: Qualcare PPO/HMO/WC	$24.79

TELFA 2 X 2 PER ***********

Facility

$9.00

Hospital Charge Code	8001745
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TELFA 2 X 2 PER ***********

Facility

$9.00

Hospital Charge Code	8001745
Hospital Revenue Code	279
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

TELFA 2 X 3

Facility

$2.45

Hospital Charge Code	270350035
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.32
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$1.23

TELFA 2 X 3

Facility

$2.45

Hospital Charge Code	270350035
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TELFA 3X4 EA

Facility

$5.00

Hospital Charge Code	270350045
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TELFA 3X4 EA

Facility

$5.00

Hospital Charge Code	270350045
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.50
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$2.50

TELFA 3 X 4 PER *************

Facility

$9.00

Hospital Charge Code	8001752
Hospital Revenue Code	279
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$4.50

TELFA 3 X 4 PER *************

Facility

$9.00

Hospital Charge Code	8001752
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TELFA 3 X 8 PER ************

Facility

$11.00

Hospital Charge Code	8001760
Hospital Revenue Code	279
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

TELFA 3 X 8 PER ************

Facility

$11.00

Hospital Charge Code	8001760
Hospital Revenue Code	279
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.43
Rate for Payer: Oxford Commercial	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$5.50

TELMISARTAN 40 MG TAB

Facility

$9.55

Hospital Charge Code	60629883
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.24
Rate for Payer: Oxford Commercial	$4.78
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$4.78

Know your out-of-pocket cost for care.

All Charges