Heights University Hospital

All Charges

Charge

Type

Setting

Price

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,416.25

Service Code	HCPCS C1760
Hospital Charge Code	270662371N
Hospital Revenue Code	278
Min. Negotiated Rate	$212.44
Max. Negotiated Rate	$342.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.73
Rate for Payer: Qualcare PPO/HMO/WC	$212.44

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,185.00

Service Code	HCPCS C1760
Hospital Charge Code	270662371S
Hospital Revenue Code	278
Min. Negotiated Rate	$177.75
Max. Negotiated Rate	$286.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,185.00

Service Code	HCPCS C1760
Hospital Charge Code	270662371
Hospital Revenue Code	278
Min. Negotiated Rate	$177.75
Max. Negotiated Rate	$286.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,185.00

Service Code	HCPCS C1760
Hospital Charge Code	270662371
Hospital Revenue Code	278
Min. Negotiated Rate	$177.75
Max. Negotiated Rate	$592.50
Rate for Payer: Aetna Commercial	$355.50
Rate for Payer: Aetna Medicare Advantage	$355.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$302.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$302.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$302.18
Rate for Payer: Cigna Commercial	$592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,416.25

Service Code	HCPCS C1760
Hospital Charge Code	270662371N
Hospital Revenue Code	278
Min. Negotiated Rate	$212.44
Max. Negotiated Rate	$708.12
Rate for Payer: Aetna Commercial	$424.88
Rate for Payer: Aetna Medicare Advantage	$424.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.14
Rate for Payer: Cigna Commercial	$708.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.73
Rate for Payer: Qualcare PPO/HMO/WC	$212.44

MYOCARDIAL PERF RESTING

Facility

$3,189.00

Service Code	HCPCS 78453
Hospital Charge Code	74116003
Hospital Revenue Code	341
Min. Negotiated Rate	$134.64
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$956.70
Rate for Payer: Aetna Medicare Advantage	$956.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$813.20
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.57
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$478.35
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCARDIAL PERF RESTING

Facility

$6,289.55

Service Code	HCPCS 78453
Hospital Charge Code	94053010
Hospital Revenue Code	341
Min. Negotiated Rate	$943.43
Max. Negotiated Rate	$943.43
Rate for Payer: Qualcare PPO/HMO/WC	$943.43

MYOCARDIAL PERF RESTING

Facility

$3,189.00

Service Code	HCPCS 78453
Hospital Charge Code	74115003
Hospital Revenue Code	341
Min. Negotiated Rate	$478.35
Max. Negotiated Rate	$478.35
Rate for Payer: Qualcare PPO/HMO/WC	$478.35

MYOCARDIAL PERF RESTING

Facility

$3,189.00

Service Code	HCPCS 78453
Hospital Charge Code	74116003
Hospital Revenue Code	341
Min. Negotiated Rate	$478.35
Max. Negotiated Rate	$478.35
Rate for Payer: Qualcare PPO/HMO/WC	$478.35

MYOCARDIAL PERF RESTING

Facility

$3,189.00

Service Code	HCPCS 78453
Hospital Charge Code	74117003
Hospital Revenue Code	341
Min. Negotiated Rate	$478.35
Max. Negotiated Rate	$478.35
Rate for Payer: Qualcare PPO/HMO/WC	$478.35

MYOCARDIAL PERF RESTING

Facility

$3,189.00

Service Code	HCPCS 78453
Hospital Charge Code	74117003
Hospital Revenue Code	341
Min. Negotiated Rate	$134.64
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$956.70
Rate for Payer: Aetna Medicare Advantage	$956.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$813.20
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.57
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$478.35
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCARDIAL PERF RESTING

Facility

$3,189.00

Service Code	HCPCS 78453
Hospital Charge Code	74115003
Hospital Revenue Code	341
Min. Negotiated Rate	$134.64
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$956.70
Rate for Payer: Aetna Medicare Advantage	$956.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$813.20
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.57
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$478.35
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCARDIAL PERF RESTING

Facility

$6,289.55

Service Code	HCPCS 78453
Hospital Charge Code	94053010
Hospital Revenue Code	341
Min. Negotiated Rate	$134.64
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,886.87
Rate for Payer: Aetna Medicare Advantage	$1,886.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,603.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,603.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,603.84
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$817.64
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$943.43
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCARDIAL PERF SPECT

Facility

$2,643.25

Service Code	HCPCS 78454
Hospital Charge Code	94053015
Hospital Revenue Code	341
Min. Negotiated Rate	$396.49
Max. Negotiated Rate	$396.49
Rate for Payer: Qualcare PPO/HMO/WC	$396.49

MYOCARDIAL PERF SPECT

Facility

$4,418.87

Service Code	HCPCS 78454
Hospital Charge Code	74116004
Hospital Revenue Code	341
Min. Negotiated Rate	$662.83
Max. Negotiated Rate	$662.83
Rate for Payer: Qualcare PPO/HMO/WC	$662.83

MYOCARDIAL PERF SPECT

Facility

$2,643.25

Service Code	HCPCS 78454
Hospital Charge Code	94053015
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$792.98
Rate for Payer: Aetna Medicare Advantage	$792.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$674.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$674.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$674.03
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.62
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$396.49
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCARDIAL PERF SPECT

Facility

$4,418.87

Service Code	HCPCS 78454
Hospital Charge Code	74117004
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,325.66
Rate for Payer: Aetna Medicare Advantage	$1,325.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,126.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,126.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,126.81
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.45
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$662.83
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCARDIAL PERF SPECT

Facility

$4,418.87

Service Code	HCPCS 78454
Hospital Charge Code	74115004
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,325.66
Rate for Payer: Aetna Medicare Advantage	$1,325.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,126.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,126.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,126.81
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.45
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$662.83
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCARDIAL PERF SPECT

Facility

$4,418.87

Service Code	HCPCS 78454
Hospital Charge Code	74115004
Hospital Revenue Code	341
Min. Negotiated Rate	$662.83
Max. Negotiated Rate	$662.83
Rate for Payer: Qualcare PPO/HMO/WC	$662.83

MYOCARDIAL PERF SPECT

Facility

$4,418.87

Service Code	HCPCS 78454
Hospital Charge Code	74117004
Hospital Revenue Code	341
Min. Negotiated Rate	$662.83
Max. Negotiated Rate	$662.83
Rate for Payer: Qualcare PPO/HMO/WC	$662.83

MYOCARDIAL PERF SPECT

Facility

$4,418.87

Service Code	HCPCS 78454
Hospital Charge Code	74116004
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,325.66
Rate for Payer: Aetna Medicare Advantage	$1,325.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,126.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,126.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,126.81
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.45
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$662.83
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCARDIAL PER PHARMACOLOGIC

Facility

$3,449.00

Service Code	HCPCS 93017
Hospital Charge Code	74116010
Hospital Revenue Code	482
Min. Negotiated Rate	$351.90
Max. Negotiated Rate	$3,188.00
Rate for Payer: Aetna Commercial	$1,034.70
Rate for Payer: Aetna Medicare Advantage	$1,034.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.50
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.37
Rate for Payer: Oxford Commercial	$2,807.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.35
Rate for Payer: UnitedHealthcare Commercial	$3,188.00

MYOCARDIAL PER PHARMACOLOGIC

Facility

$3,449.00

Service Code	HCPCS 93017
Hospital Charge Code	74116010
Hospital Revenue Code	482
Min. Negotiated Rate	$517.35
Max. Negotiated Rate	$517.35
Rate for Payer: Qualcare PPO/HMO/WC	$517.35

MYOCARDIAL PER PHARMACOLOGIC

Facility

$11,000.00

Service Code	HCPCS 93017
Hospital Charge Code	74115010
Hospital Revenue Code	482
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

MYOCARDIAL PER PHARMACOLOGIC

Facility

$3,449.00

Service Code	HCPCS 93017
Hospital Charge Code	74117010
Hospital Revenue Code	482
Min. Negotiated Rate	$351.90
Max. Negotiated Rate	$3,188.00
Rate for Payer: Aetna Commercial	$1,034.70
Rate for Payer: Aetna Medicare Advantage	$1,034.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.50
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.37
Rate for Payer: Oxford Commercial	$2,807.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.35
Rate for Payer: UnitedHealthcare Commercial	$3,188.00

Know your out-of-pocket cost for care.

All Charges