Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

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

MYOCARD STRAIN IMAGE SPCKL TKG

Facility

$5,900.00

Service Code	HCPCS 93356
Hospital Charge Code	403193356
Hospital Revenue Code	480
Min. Negotiated Rate	$10.82
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$1,770.00
Rate for Payer: Aetna Medicare Advantage	$1,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,504.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,504.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,504.50
Rate for Payer: Cigna Commercial	$10.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$767.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

MYOCARD STRAIN IMAGE SPCKL TKG

Facility

$5,900.00

Service Code	HCPCS 93356
Hospital Charge Code	403193356
Hospital Revenue Code	480
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00

MYOCHRYSINE INJ/50MG/CC

Facility

$248.00

Hospital Charge Code	60634263
Hospital Revenue Code	636
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$60.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.02
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

MYOCHRYSINE INJ/50MG/CC

Facility

$248.00

Hospital Charge Code	60634263
Hospital Revenue Code	636
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$74.40
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.02
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

MYOCRD PERF IMG (SPECT) MULT

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	94053005
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

MYOCRD PERF IMG (SPECT) MULT

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	5308015
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

MYOCRD PERF IMG (SPECT) MULT

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	5308015
Hospital Revenue Code	341
Min. Negotiated Rate	$314.16
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$3,196.41
Rate for Payer: Aetna Medicare Advantage	$3,196.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,716.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,716.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$314.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,716.95
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.11
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCRD PERF IMG (SPECT) MULT

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	94053005
Hospital Revenue Code	341
Min. Negotiated Rate	$314.16
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$3,196.41
Rate for Payer: Aetna Medicare Advantage	$3,196.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,716.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,716.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$314.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,716.95
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.11
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCRD PERF IMG (SPECT)SINGLE

Facility

$6,851.00

Service Code	HCPCS 78451
Hospital Charge Code	74116001
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,055.30
Rate for Payer: Aetna Medicare Advantage	$2,055.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,747.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,747.01
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	$1,747.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.63
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.65
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCRD PERF IMG (SPECT)SINGLE

Facility

$6,851.00

Service Code	HCPCS 78451
Hospital Charge Code	74116001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,027.65
Max. Negotiated Rate	$1,027.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.65

MYOCRD PERF IMG (SPECT)SINGLE

Facility

$6,851.00

Service Code	HCPCS 78451
Hospital Charge Code	74115001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,027.65
Max. Negotiated Rate	$1,027.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.65

MYOCRD PERF IMG (SPECT)SINGLE

Facility

$6,851.00

Service Code	HCPCS 78451
Hospital Charge Code	74117001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,027.65
Max. Negotiated Rate	$1,027.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.65

MYOCRD PERF IMG (SPECT)SINGLE

Facility

$6,851.00

Service Code	HCPCS 78451
Hospital Charge Code	74115001
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,055.30
Rate for Payer: Aetna Medicare Advantage	$2,055.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,747.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,747.01
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	$1,747.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.63
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.65
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCRD PERF IMG (SPECT)SINGLE

Facility

$6,851.00

Service Code	HCPCS 78451
Hospital Charge Code	74117001
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,055.30
Rate for Payer: Aetna Medicare Advantage	$2,055.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,747.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,747.01
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	$1,747.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.63
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.65
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCRD PERF IMG (SPECT) SINGLE

Facility

$6,315.40

Service Code	HCPCS 78451
Hospital Charge Code	5305016
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,894.62
Rate for Payer: Aetna Medicare Advantage	$1,894.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,610.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,610.43
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	$1,610.43
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$821.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$947.31
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

MYOCRD PERF IMG (SPECT) SINGLE

Facility

$6,315.40

Service Code	HCPCS 78451
Hospital Charge Code	5305016
Hospital Revenue Code	341
Min. Negotiated Rate	$947.31
Max. Negotiated Rate	$947.31
Rate for Payer: Qualcare PPO/HMO/WC	$947.31

MYOFLEX CREAM

Facility

$25.39

Service Code	NDC 45802035653
Hospital Charge Code	60635110
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna Commercial	$7.62
Rate for Payer: Aetna Medicare Advantage	$7.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.47
Rate for Payer: Cigna Commercial	$12.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$12.70
Rate for Payer: Qualcare PPO/HMO/WC	$3.81
Rate for Payer: UnitedHealthcare Commercial	$12.70

MYOFLEX CREAM

Facility

$25.39

Service Code	NDC 45802035653
Hospital Charge Code	60635110
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$3.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.81

MYOGLOBIN QUANT, URINE

Facility

$122.50

Service Code	HCPCS 83874
Hospital Charge Code	3003472
Hospital Revenue Code	301
Min. Negotiated Rate	$18.38
Max. Negotiated Rate	$18.38
Rate for Payer: Qualcare PPO/HMO/WC	$18.38

MYOGLOBIN QUANT, URINE

Facility

$122.50

Service Code	HCPCS 83874
Hospital Charge Code	3003472
Hospital Revenue Code	301
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.34
Rate for Payer: Cigna Commercial	$12.92
Rate for Payer: Cigna Medicare Advantage	$6.46
Rate for Payer: Clover Medicare Advantage	$12.27
Rate for Payer: EmblemHealth Commercial	$38.76
Rate for Payer: Humana Medicare Advantage	$13.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.70
Rate for Payer: Wellcare Medicare Advantage	$12.92

MYOGLOBIN SERUM

Facility

$390.00

Service Code	HCPCS 83874
Hospital Charge Code	39900342
Hospital Revenue Code	301
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.34
Rate for Payer: Cigna Commercial	$12.92
Rate for Payer: Cigna Medicare Advantage	$6.46
Rate for Payer: Clover Medicare Advantage	$12.27
Rate for Payer: EmblemHealth Commercial	$38.76
Rate for Payer: Humana Medicare Advantage	$13.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.70
Rate for Payer: Wellcare Medicare Advantage	$12.92

MYOGLOBIN SERUM

Facility

$390.00

Service Code	HCPCS 83874
Hospital Charge Code	39900342
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MYOGLOBIN (SERUM)

Facility

$122.50

Service Code	HCPCS 83874
Hospital Charge Code	3030251
Hospital Revenue Code	301
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.34
Rate for Payer: Cigna Commercial	$12.92
Rate for Payer: Cigna Medicare Advantage	$6.46
Rate for Payer: Clover Medicare Advantage	$12.27
Rate for Payer: EmblemHealth Commercial	$38.76
Rate for Payer: Humana Medicare Advantage	$13.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.38
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.92
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$13.70
Rate for Payer: Wellcare Medicare Advantage	$12.92

Know your out-of-pocket cost for care.

All Charges