Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

NM GENITOURINARY OTHER

Facility

$1,296.25

Service Code	HCPCS 78799
Hospital Charge Code	4500961
Hospital Revenue Code	341
Min. Negotiated Rate	$194.44
Max. Negotiated Rate	$194.44
Rate for Payer: Qualcare PPO/HMO/WC	$194.44

NM GENITOURINARY OTHER

Facility

$1,296.25

Service Code	HCPCS 78799
Hospital Charge Code	4500961
Hospital Revenue Code	341
Min. Negotiated Rate	$168.51
Max. Negotiated Rate	$3,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.44
Rate for Payer: Aetna Commercial	$388.88
Rate for Payer: Aetna Medicare Advantage	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.54
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.51
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GEN.OF AUTOMATED DATA<30MIN

Facility

$156.85

Hospital Charge Code	4500724
Hospital Revenue Code	340
Min. Negotiated Rate	$20.39
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$47.05
Rate for Payer: Aetna Medicare Advantage	$47.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.00
Rate for Payer: Cigna Commercial	$78.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.39
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.53
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GEN.OF AUTOMATED DATA<30MIN

Facility

$156.85

Hospital Charge Code	4500724
Hospital Revenue Code	340
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$23.53
Rate for Payer: Qualcare PPO/HMO/WC	$23.53

NM GEN.OF AUTOMATED DATA>30MIN

Facility

$272.85

Hospital Charge Code	4500716
Hospital Revenue Code	340
Min. Negotiated Rate	$35.47
Max. Negotiated Rate	$3,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.93
Rate for Payer: Aetna Commercial	$81.86
Rate for Payer: Aetna Medicare Advantage	$81.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.58
Rate for Payer: Cigna Commercial	$136.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.47
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM GEN.OF AUTOMATED DATA>30MIN

Facility

$272.85

Hospital Charge Code	4500716
Hospital Revenue Code	340
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$40.93
Rate for Payer: Qualcare PPO/HMO/WC	$40.93

NM HEART INFARCT PLANAR W EFF

Facility

$1,768.00

Service Code	HCPCS 78468
Hospital Charge Code	4500918
Hospital Revenue Code	341
Min. Negotiated Rate	$151.47
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$530.40
Rate for Payer: Aetna Medicare Advantage	$530.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.84
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.84
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$265.20
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM HEART INFARCT PLANAR W EFF

Facility

$1,768.00

Service Code	HCPCS 78468
Hospital Charge Code	4500918
Hospital Revenue Code	341
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$265.20
Rate for Payer: Qualcare PPO/HMO/WC	$265.20

NM HEART INFRACT PLANAR SPECT

Facility

$2,513.65

Service Code	HCPCS 78469
Hospital Charge Code	4500920
Hospital Revenue Code	341
Min. Negotiated Rate	$218.30
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$754.10
Rate for Payer: Aetna Medicare Advantage	$754.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$640.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$640.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$640.98
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.77
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$377.05
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM HEART INFRACT PLANAR SPECT

Facility

$2,513.65

Service Code	HCPCS 78469
Hospital Charge Code	4500920
Hospital Revenue Code	341
Min. Negotiated Rate	$377.05
Max. Negotiated Rate	$377.05
Rate for Payer: Qualcare PPO/HMO/WC	$377.05

NM HEMOTOPOIETIC UNLISTED PROC

Facility

$1,388.55

Service Code	HCPCS 78199
Hospital Charge Code	4500962
Hospital Revenue Code	341
Min. Negotiated Rate	$180.51
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$416.56
Rate for Payer: Aetna Medicare Advantage	$416.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.08
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.51
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$208.28
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM HEMOTOPOIETIC UNLISTED PROC

Facility

$1,388.55

Service Code	HCPCS 78199
Hospital Charge Code	4500962
Hospital Revenue Code	341
Min. Negotiated Rate	$208.28
Max. Negotiated Rate	$208.28
Rate for Payer: Qualcare PPO/HMO/WC	$208.28

NM HEPATOBIL IMAG W GALLBALLAD

Facility

$12,000.00

Service Code	HCPCS 78226
Hospital Charge Code	4500910
Hospital Revenue Code	341
Min. Negotiated Rate	$274.52
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	$274.52
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 HEPATOBIL IMAG W GALLBALLAD

Facility

$12,000.00

Service Code	HCPCS 78226
Hospital Charge Code	4500910
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 HEPATO W GALL W PHAMA INTER

Facility

$12,000.00

Service Code	HCPCS 78227
Hospital Charge Code	4500336
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 HEPATO W GALL W PHAMA INTER

Facility

$12,000.00

Service Code	HCPCS 78227
Hospital Charge Code	4500336
Hospital Revenue Code	341
Min. Negotiated Rate	$376.13
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	$376.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$1,293.03
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 I-123 EA 100 UCI UP TO 999U

Facility

$215.25

Hospital Charge Code	4500807
Hospital Revenue Code	343
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$32.29
Rate for Payer: Qualcare PPO/HMO/WC	$32.29

NM I-123 EA 100 UCI UP TO 999U

Facility

$215.25

Hospital Charge Code	4500807
Hospital Revenue Code	343
Min. Negotiated Rate	$27.98
Max. Negotiated Rate	$107.62
Rate for Payer: Aetna Commercial	$64.58
Rate for Payer: Aetna Medicare Advantage	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.89
Rate for Payer: Cigna Commercial	$107.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.98
Rate for Payer: Qualcare PPO/HMO/WC	$32.29

NM I-123 MIBG PER 10 MCI

Facility

$9,923.00

Service Code	HCPCS A9582
Hospital Charge Code	4509045
Hospital Revenue Code	344
Min. Negotiated Rate	$1,289.99
Max. Negotiated Rate	$2,976.90
Rate for Payer: Aetna Commercial	$2,976.90
Rate for Payer: Aetna Medicare Advantage	$2,976.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,530.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,530.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,015.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,530.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,289.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.45

NM I-123 MIBG PER 10 MCI

Facility

$9,923.00

Service Code	HCPCS A9582
Hospital Charge Code	4509045
Hospital Revenue Code	344
Min. Negotiated Rate	$1,488.45
Max. Negotiated Rate	$1,488.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.45

NM I-131 MIBG 0.5MCI

Facility

$6,202.00

Hospital Charge Code	4509020
Hospital Revenue Code	343
Min. Negotiated Rate	$806.26
Max. Negotiated Rate	$3,101.00
Rate for Payer: Aetna Commercial	$1,860.60
Rate for Payer: Aetna Medicare Advantage	$1,860.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.51
Rate for Payer: Cigna Commercial	$3,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$806.26
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

NM I-131 MIBG 0.5MCI

Facility

$6,202.00

Hospital Charge Code	4509020
Hospital Revenue Code	343
Min. Negotiated Rate	$930.30
Max. Negotiated Rate	$930.30
Rate for Payer: Qualcare PPO/HMO/WC	$930.30

NM I 131 THERAPY INITIAL

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4500013
Hospital Revenue Code	342
Min. Negotiated Rate	$200.89
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$585.38
Rate for Payer: Aetna Medicare Advantage	$585.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.57
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.69
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM I 131 THERAPY INITIAL

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4500013
Hospital Revenue Code	342
Min. Negotiated Rate	$292.69
Max. Negotiated Rate	$292.69
Rate for Payer: Qualcare PPO/HMO/WC	$292.69

Know your out-of-pocket cost for care.

All Charges