Heights University Hospital

All Charges

Charge

Type

Setting

Price

BRACHIAL DRAPE

Facility

$65.00

Hospital Charge Code	2709003648
Hospital Revenue Code	272
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$19.50
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$32.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$32.50

BRACHIAL DRAPE

Facility

$65.00

Hospital Charge Code	2709003648
Hospital Revenue Code	272
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

BRACHIAL DRAPE XRAY

Facility

$90.00

Hospital Charge Code	2709006572
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

BRACHIAL DRAPE XRAY

Facility

$90.00

Hospital Charge Code	2709006572
Hospital Revenue Code	272
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$27.00
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$45.00

BRACHYTX ISODOSE CALC COMP-GL

Facility

$1,887.22

Service Code	HCPCS 77328
Hospital Charge Code	85000565
Hospital Revenue Code	333
Min. Negotiated Rate	$245.34
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$566.17
Rate for Payer: Aetna Medicare Advantage	$566.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$481.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$481.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$481.24
Rate for Payer: Cigna Commercial	$943.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.34
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE CALC COMP-GL

Facility

$1,887.22

Service Code	HCPCS 77328
Hospital Charge Code	85000565
Hospital Revenue Code	333
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$283.08
Rate for Payer: Qualcare PPO/HMO/WC	$283.08

BRACHYTX ISODOSE CALC COMP-PC

Facility

$556.65

Service Code	HCPCS 7732826
Hospital Charge Code	85000575
Hospital Revenue Code	333
Min. Negotiated Rate	$72.36
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$167.00
Rate for Payer: Aetna Medicare Advantage	$167.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.95
Rate for Payer: Cigna Commercial	$278.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.50
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE CALC COMP-PC

Facility

$556.65

Service Code	HCPCS 7732826
Hospital Charge Code	85000575
Hospital Revenue Code	333
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$83.50
Rate for Payer: Qualcare PPO/HMO/WC	$83.50

BRACHYTX ISODOSE CALC COMP-TC

Facility

$1,000.20

Service Code	HCPCS 77328TC
Hospital Charge Code	85000570
Hospital Revenue Code	333
Min. Negotiated Rate	$150.03
Max. Negotiated Rate	$150.03
Rate for Payer: Qualcare PPO/HMO/WC	$150.03

BRACHYTX ISODOSE CALC COMP-TC

Facility

$1,000.20

Service Code	HCPCS 77328TC
Hospital Charge Code	85000570
Hospital Revenue Code	333
Min. Negotiated Rate	$130.03
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$300.06
Rate for Payer: Aetna Medicare Advantage	$300.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.05
Rate for Payer: Cigna Commercial	$500.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.03
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.03
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE CALC INTERM-P

Facility

$370.45

Service Code	HCPCS 7732726
Hospital Charge Code	85000560
Hospital Revenue Code	333
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$55.57
Rate for Payer: Qualcare PPO/HMO/WC	$55.57

BRACHYTX ISODOSE CALC INTERM-P

Facility

$370.45

Service Code	HCPCS 7732726
Hospital Charge Code	85000560
Hospital Revenue Code	333
Min. Negotiated Rate	$48.16
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$111.14
Rate for Payer: Aetna Medicare Advantage	$111.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.46
Rate for Payer: Cigna Commercial	$185.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.16
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.57
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE CALC INTERM-T

Facility

$794.55

Service Code	HCPCS 77327TC
Hospital Charge Code	85000555
Hospital Revenue Code	333
Min. Negotiated Rate	$103.29
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$238.37
Rate for Payer: Aetna Medicare Advantage	$238.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.61
Rate for Payer: Cigna Commercial	$397.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.29
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.18
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE CALC INTERM-T

Facility

$794.55

Service Code	HCPCS 77327TC
Hospital Charge Code	85000555
Hospital Revenue Code	333
Min. Negotiated Rate	$119.18
Max. Negotiated Rate	$119.18
Rate for Payer: Qualcare PPO/HMO/WC	$119.18

BRACHYTX ISODOSE CALC SIMP-PC

Facility

$247.05

Service Code	HCPCS 7732626
Hospital Charge Code	85000545
Hospital Revenue Code	333
Min. Negotiated Rate	$37.06
Max. Negotiated Rate	$37.06
Rate for Payer: Qualcare PPO/HMO/WC	$37.06

BRACHYTX ISODOSE CALC SIMP-PC

Facility

$247.05

Service Code	HCPCS 7732626
Hospital Charge Code	85000545
Hospital Revenue Code	333
Min. Negotiated Rate	$32.12
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$74.11
Rate for Payer: Aetna Medicare Advantage	$74.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.00
Rate for Payer: Cigna Commercial	$123.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.12
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.06
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE CALC SIMP-TC

Facility

$582.60

Service Code	HCPCS 77326TC
Hospital Charge Code	85000540
Hospital Revenue Code	333
Min. Negotiated Rate	$87.39
Max. Negotiated Rate	$87.39
Rate for Payer: Qualcare PPO/HMO/WC	$87.39

BRACHYTX ISODOSE CALC SIMP-TC

Facility

$582.60

Service Code	HCPCS 77326TC
Hospital Charge Code	85000540
Hospital Revenue Code	333
Min. Negotiated Rate	$75.74
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$174.78
Rate for Payer: Aetna Medicare Advantage	$174.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.56
Rate for Payer: Cigna Commercial	$291.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.74
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.39
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE COMPLEX

Facility

$1,867.31

Service Code	HCPCS 77318
Hospital Charge Code	85000895
Hospital Revenue Code	333
Min. Negotiated Rate	$242.75
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$560.19
Rate for Payer: Aetna Medicare Advantage	$560.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.16
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.75
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.10
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE COMPLEX

Facility

$1,867.31

Service Code	HCPCS 77318
Hospital Charge Code	85000895
Hospital Revenue Code	333
Min. Negotiated Rate	$280.10
Max. Negotiated Rate	$280.10
Rate for Payer: Qualcare PPO/HMO/WC	$280.10

BRACHYTX ISODOSE INTERMED

Facility

$1,867.31

Service Code	HCPCS 77317
Hospital Charge Code	85000894
Hospital Revenue Code	333
Min. Negotiated Rate	$280.10
Max. Negotiated Rate	$280.10
Rate for Payer: Qualcare PPO/HMO/WC	$280.10

BRACHYTX ISODOSE INTERMED

Facility

$1,867.31

Service Code	HCPCS 77317
Hospital Charge Code	85000894
Hospital Revenue Code	333
Min. Negotiated Rate	$242.75
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$560.19
Rate for Payer: Aetna Medicare Advantage	$560.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.16
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.75
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.10
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77316
Hospital Charge Code	85000893
Hospital Revenue Code	333
Min. Negotiated Rate	$100.77
Max. Negotiated Rate	$100.77
Rate for Payer: Qualcare PPO/HMO/WC	$100.77

BRACHYTX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77316
Hospital Charge Code	85000893
Hospital Revenue Code	333
Min. Negotiated Rate	$87.33
Max. Negotiated Rate	$4,435.00
Rate for Payer: Aetna Commercial	$201.54
Rate for Payer: Aetna Medicare Advantage	$201.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.31
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.33
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.77
Rate for Payer: UnitedHealthcare Commercial	$4,435.00

BRACHYTX, NON-STR,YTTRIUM-90

Facility

$82,538.65

Service Code	HCPCS C2616
Hospital Charge Code	5701123
Hospital Revenue Code	278
Min. Negotiated Rate	$12,380.80
Max. Negotiated Rate	$19,974.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,507.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,974.35
Rate for Payer: Qualcare PPO/HMO/WC	$12,380.80

Know your out-of-pocket cost for care.

All Charges