Heights University Hospital

All Charges

Charge

Type

Setting

Price

NM KIDNEY FUNCT STUDY NON-IMAG

Facility

$1,296.25

Service Code	HCPCS 78725
Hospital Charge Code	4500963
Hospital Revenue Code	341
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$3,540.00
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) NJ Health	$56.10
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: Qualcare PPO/HMO/WC	$194.44
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM-KIDNEY FUNCT W/O PHARMACOL

Facility

$1,892.00

Service Code	HCPCS 78725
Hospital Charge Code	4508030
Hospital Revenue Code	341
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$567.60
Rate for Payer: Aetna Medicare Advantage	$567.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$482.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$482.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$482.46
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.96
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.80
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM-KIDNEY FUNCT W/O PHARMACOL

Facility

$1,892.00

Service Code	HCPCS 78725
Hospital Charge Code	4508030
Hospital Revenue Code	341
Min. Negotiated Rate	$283.80
Max. Negotiated Rate	$283.80
Rate for Payer: Qualcare PPO/HMO/WC	$283.80

NM KIDNEY IMAGING STATIC

Facility

$1,355.00

Service Code	HCPCS 78700
Hospital Charge Code	4500964
Hospital Revenue Code	341
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

NM KIDNEY IMAGING STATIC

Facility

$1,355.00

Service Code	HCPCS 78700
Hospital Charge Code	4500964
Hospital Revenue Code	341
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$406.50
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.15
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM KIDNEY IMAGING W/FUNCTION

Facility

$1,296.25

Service Code	HCPCS 78725
Hospital Charge Code	4500965
Hospital Revenue Code	341
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$3,540.00
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) NJ Health	$56.10
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: Qualcare PPO/HMO/WC	$194.44
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM KIDNEY IMAGING W/FUNCTION

Facility

$1,296.25

Service Code	HCPCS 78725
Hospital Charge Code	4500965
Hospital Revenue Code	341
Min. Negotiated Rate	$194.44
Max. Negotiated Rate	$194.44
Rate for Payer: Qualcare PPO/HMO/WC	$194.44

NM KIDNEY SCAN W VASCULAR FLOW

Facility

$1,717.65

Service Code	HCPCS 78701
Hospital Charge Code	4500930
Hospital Revenue Code	341
Min. Negotiated Rate	$121.55
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$515.29
Rate for Payer: Aetna Medicare Advantage	$515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$438.00
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.29
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$257.65
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM KIDNEY SCAN W VASCULAR FLOW

Facility

$1,717.65

Service Code	HCPCS 78701
Hospital Charge Code	4500930
Hospital Revenue Code	341
Min. Negotiated Rate	$257.65
Max. Negotiated Rate	$257.65
Rate for Payer: Qualcare PPO/HMO/WC	$257.65

NM KIDNEY SPECT

Facility

$1,740.00

Service Code	HCPCS 78710
Hospital Charge Code	4500500
Hospital Revenue Code	341
Min. Negotiated Rate	$226.20
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$522.00
Rate for Payer: Aetna Medicare Advantage	$522.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.70
Rate for Payer: Cigna Commercial	$870.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.20
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM KIDNEY SPECT

Facility

$1,740.00

Service Code	HCPCS 78710
Hospital Charge Code	4500500
Hospital Revenue Code	341
Min. Negotiated Rate	$261.00
Max. Negotiated Rate	$261.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.00

NM KIDNEY VASCULAR FLOW

Facility

$1,355.00

Service Code	HCPCS 78700
Hospital Charge Code	4500966
Hospital Revenue Code	341
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

NM KIDNEY VASCULAR FLOW

Facility

$1,355.00

Service Code	HCPCS 78700
Hospital Charge Code	4500966
Hospital Revenue Code	341
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$406.50
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.15
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM KIDNEY W/VASC F/F

Facility

$12,000.00

Service Code	HCPCS 78707
Hospital Charge Code	4500892
Hospital Revenue Code	341
Min. Negotiated Rate	$205.70
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	$205.70
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 KIDNEY W/VASC F/F

Facility

$12,000.00

Service Code	HCPCS 78707
Hospital Charge Code	4500892
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 KIDNEY W/VASC FFMULT W/WOPH

Facility

$12,000.00

Service Code	HCPCS 78709
Hospital Charge Code	4500890
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 KIDNEY W/VASC FFMULT W/WOPH

Facility

$12,000.00

Service Code	HCPCS 78709
Hospital Charge Code	4500890
Hospital Revenue Code	341
Min. Negotiated Rate	$269.28
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	$269.28
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 KIDNEY W/VASC FLOW/FUNC W/P

Facility

$12,000.00

Service Code	HCPCS 78708
Hospital Charge Code	4500888
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 KIDNEY W/VASC FLOW/FUNC W/P

Facility

$12,000.00

Service Code	HCPCS 78708
Hospital Charge Code	4500888
Hospital Revenue Code	341
Min. Negotiated Rate	$224.40
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	$224.40
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 LIVER IMAGING STATIC ONLY

Facility

$1,146.45

Service Code	HCPCS 78201
Hospital Charge Code	4500936
Hospital Revenue Code	341
Min. Negotiated Rate	$99.39
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$343.94
Rate for Payer: Aetna Medicare Advantage	$343.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$292.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$292.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$292.34
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.04
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.97
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM LIVER IMAGING STATIC ONLY

Facility

$1,146.45

Service Code	HCPCS 78201
Hospital Charge Code	4500936
Hospital Revenue Code	341
Min. Negotiated Rate	$171.97
Max. Negotiated Rate	$171.97
Rate for Payer: Qualcare PPO/HMO/WC	$171.97

NM LIVER IMAGING W/VASCLR FLOW

Facility

$1,528.45

Service Code	HCPCS 78202
Hospital Charge Code	4500968
Hospital Revenue Code	341
Min. Negotiated Rate	$229.27
Max. Negotiated Rate	$229.27
Rate for Payer: Qualcare PPO/HMO/WC	$229.27

NM LIVER IMAGING W/VASCLR FLOW

Facility

$1,528.45

Service Code	HCPCS 78202
Hospital Charge Code	4500968
Hospital Revenue Code	341
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$458.54
Rate for Payer: Aetna Medicare Advantage	$458.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$389.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$389.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$389.75
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.70
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$229.27
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM LIVER IMAG SPECT W/VASC FLW

Facility

$1,528.45

Service Code	HCPCS 78206
Hospital Charge Code	4500967
Hospital Revenue Code	341
Min. Negotiated Rate	$198.70
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$458.54
Rate for Payer: Aetna Medicare Advantage	$458.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$389.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$389.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$389.75
Rate for Payer: Cigna Commercial	$764.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.70
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$229.27
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM LIVER IMAG SPECT W/VASC FLW

Facility

$1,528.45

Service Code	HCPCS 78206
Hospital Charge Code	4500967
Hospital Revenue Code	341
Min. Negotiated Rate	$229.27
Max. Negotiated Rate	$229.27
Rate for Payer: Qualcare PPO/HMO/WC	$229.27

Know your out-of-pocket cost for care.

All Charges