Heights University Hospital

All Charges

Charge

Type

Setting

Price

NMDA RECEPTOR AB TEST

Facility

$2,650.00

Service Code	HCPCS 86255
Hospital Charge Code	39990240
Hospital Revenue Code	302
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$397.50
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

NMDA RECEPTOR AB TEST

Facility

$2,650.00

Service Code	HCPCS 86255
Hospital Charge Code	39990240
Hospital Revenue Code	302
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$397.50
Rate for Payer: Aetna Commercial	$39.04
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$12.05
Rate for Payer: Cigna Medicare Advantage	$6.03
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$397.50
Rate for Payer: UnitedHealthcare Commercial	$114.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Ambetter Commercial-Exchange	$12.77
Rate for Payer: Wellcare Medicare Advantage	$12.05

NM ENDOCRINE OTHER

Facility

$874.50

Service Code	HCPCS 78099
Hospital Charge Code	4500956
Hospital Revenue Code	341
Min. Negotiated Rate	$131.18
Max. Negotiated Rate	$131.18
Rate for Payer: Qualcare PPO/HMO/WC	$131.18

NM ENDOCRINE OTHER

Facility

$874.50

Service Code	HCPCS 78099
Hospital Charge Code	4500956
Hospital Revenue Code	341
Min. Negotiated Rate	$113.69
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$262.35
Rate for Payer: Aetna Medicare Advantage	$262.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.00
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.69
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.18
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM ESOPHAGEAL MOTILITY

Facility

$1,336.60

Service Code	HCPCS 78258
Hospital Charge Code	4500957
Hospital Revenue Code	341
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$400.98
Rate for Payer: Aetna Medicare Advantage	$400.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.83
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.76
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM ESOPHAGEAL MOTILITY

Facility

$1,336.60

Service Code	HCPCS 78258
Hospital Charge Code	4500957
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM GALLIUM 67 PER mCi

Facility

$72.85

Service Code	HCPCS A9556
Hospital Charge Code	4500823
Hospital Revenue Code	343
Min. Negotiated Rate	$9.47
Max. Negotiated Rate	$143.99
Rate for Payer: Aetna Commercial	$21.86
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.47
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

NM GALLIUM 67 PER mCi

Facility

$72.85

Service Code	HCPCS A9556
Hospital Charge Code	4500823
Hospital Revenue Code	343
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

NM GALLUIM SPECT

Facility

$2,090.45

Service Code	HCPCS 78807
Hospital Charge Code	4500518
Hospital Revenue Code	341
Min. Negotiated Rate	$271.76
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$627.13
Rate for Payer: Aetna Medicare Advantage	$627.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.06
Rate for Payer: Cigna Commercial	$1,045.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.76
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$313.57
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GALLUIM SPECT

Facility

$2,090.45

Service Code	HCPCS 78807
Hospital Charge Code	4500518
Hospital Revenue Code	341
Min. Negotiated Rate	$313.57
Max. Negotiated Rate	$313.57
Rate for Payer: Qualcare PPO/HMO/WC	$313.57

NM GASTRIC EMPTYING STUDY

Facility

$12,000.00

Service Code	HCPCS 78264
Hospital Charge Code	4500732
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM GASTRIC EMPTYING STUDY

Facility

$12,000.00

Service Code	HCPCS 78264
Hospital Charge Code	4500732
Hospital Revenue Code	341
Min. Negotiated Rate	$63.58
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GASTRIC MUCOSA IMAGING

Facility

$1,336.60

Service Code	HCPCS 78261
Hospital Charge Code	4500958
Hospital Revenue Code	341
Min. Negotiated Rate	$78.54
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$400.98
Rate for Payer: Aetna Medicare Advantage	$400.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.83
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.76
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GASTRIC MUCOSA IMAGING

Facility

$1,336.60

Service Code	HCPCS 78261
Hospital Charge Code	4500958
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM GASTRINTESTNAL PROTEIN LOSS

Facility

$1,336.60

Service Code	HCPCS 78282
Hospital Charge Code	4500960
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM GASTRINTESTNAL PROTEIN LOSS

Facility

$1,336.60

Service Code	HCPCS 78282
Hospital Charge Code	4500960
Hospital Revenue Code	341
Min. Negotiated Rate	$67.88
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$400.98
Rate for Payer: Aetna Medicare Advantage	$400.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.83
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.76
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GASTROESOPH REFLUX

Facility

$349.65

Service Code	HCPCS 78262
Hospital Charge Code	4500419
Hospital Revenue Code	341
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$104.89
Rate for Payer: Aetna Medicare Advantage	$104.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.16
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.45
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.45
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GASTROESOPH REFLUX

Facility

$349.65

Service Code	HCPCS 78262
Hospital Charge Code	4500419
Hospital Revenue Code	341
Min. Negotiated Rate	$52.45
Max. Negotiated Rate	$52.45
Rate for Payer: Qualcare PPO/HMO/WC	$52.45

NM GASTROINTES BLOOD LOSS

Facility

$12,000.00

Service Code	HCPCS 78278
Hospital Charge Code	4500328
Hospital Revenue Code	341
Min. Negotiated Rate	$91.63
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$3,600.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GASTROINTES BLOOD LOSS

Facility

$12,000.00

Service Code	HCPCS 78278
Hospital Charge Code	4500328
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM GASTROINTESTINAL OTHER

Facility

$1,336.60

Service Code	HCPCS 78299
Hospital Charge Code	4500959
Hospital Revenue Code	341
Min. Negotiated Rate	$173.76
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$400.98
Rate for Payer: Aetna Medicare Advantage	$400.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.83
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.76
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$200.49
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GASTROINTESTINAL OTHER

Facility

$1,336.60

Service Code	HCPCS 78299
Hospital Charge Code	4500959
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM GATED CARDIAC SGL W RV EF

Facility

$3,351.25

Service Code	HCPCS 78496
Hospital Charge Code	4500926
Hospital Revenue Code	341
Min. Negotiated Rate	$502.69
Max. Negotiated Rate	$502.69
Rate for Payer: Qualcare PPO/HMO/WC	$502.69

NM GATED CARDIAC SGL W RV EF

Facility

$3,351.25

Service Code	HCPCS 78496
Hospital Charge Code	4500926
Hospital Revenue Code	341
Min. Negotiated Rate	$47.53
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,005.38
Rate for Payer: Aetna Medicare Advantage	$1,005.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$854.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$854.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$854.57
Rate for Payer: Cigna Commercial	$47.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$502.69
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GATED CARDIAC SPEC WM & EF

Facility

$3,351.25

Service Code	HCPCS 78494
Hospital Charge Code	4500924
Hospital Revenue Code	341
Min. Negotiated Rate	$294.06
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,005.38
Rate for Payer: Aetna Medicare Advantage	$1,005.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$854.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$854.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$854.57
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$502.69
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

Know your out-of-pocket cost for care.

All Charges