Heights University Hospital

All Charges

Charge

Type

Setting

Price

NM LIVER RED CELL TAG

Facility

$903.25

Service Code	HCPCS 78140
Hospital Charge Code	4500401
Hospital Revenue Code	341
Min. Negotiated Rate	$135.49
Max. Negotiated Rate	$135.49
Rate for Payer: Qualcare PPO/HMO/WC	$135.49

NM LIVER RED CELL TAG

Facility

$903.25

Service Code	HCPCS 78140
Hospital Charge Code	4500401
Hospital Revenue Code	341
Min. Negotiated Rate	$113.14
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$270.98
Rate for Payer: Aetna Medicare Advantage	$270.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.33
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.42
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.49
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM LIVER SCAN STATIC

Facility

$12,000.00

Service Code	HCPCS 78215
Hospital Charge Code	4500104
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 LIVER SCAN STATIC

Facility

$12,000.00

Service Code	HCPCS 78215
Hospital Charge Code	4500104
Hospital Revenue Code	341
Min. Negotiated Rate	$74.80
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	$74.80
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-LIVER SCAN W/ VASCULAR FLOW

Facility

$1,743.32

Service Code	HCPCS 78202
Hospital Charge Code	4508005
Hospital Revenue Code	341
Min. Negotiated Rate	$261.50
Max. Negotiated Rate	$261.50
Rate for Payer: Qualcare PPO/HMO/WC	$261.50

NM-LIVER SCAN W/ VASCULAR FLOW

Facility

$1,743.32

Service Code	HCPCS 78202
Hospital Charge Code	4508005
Hospital Revenue Code	341
Min. Negotiated Rate	$123.42
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$523.00
Rate for Payer: Aetna Medicare Advantage	$523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$444.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$444.55
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	$444.55
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.63
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.50
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM LIVER SPECT

Facility

$2,315.25

Service Code	HCPCS 78205
Hospital Charge Code	4500450
Hospital Revenue Code	341
Min. Negotiated Rate	$300.98
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$694.58
Rate for Payer: Aetna Medicare Advantage	$694.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$590.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$590.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$590.39
Rate for Payer: Cigna Commercial	$1,157.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.98
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$347.29
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM LIVER SPECT

Facility

$2,315.25

Service Code	HCPCS 78205
Hospital Charge Code	4500450
Hospital Revenue Code	341
Min. Negotiated Rate	$347.29
Max. Negotiated Rate	$347.29
Rate for Payer: Qualcare PPO/HMO/WC	$347.29

NM LIVER SPECT W VAS FLOW

Facility

$12,000.00

Service Code	HCPCS 78206
Hospital Charge Code	4507001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,560.00
Max. Negotiated Rate	$6,000.00
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) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
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 SPECT W VAS FLOW

Facility

$12,000.00

Service Code	HCPCS 78206
Hospital Charge Code	4507001
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 LOCALIZE INFLAM PROCE WB

Facility

$12,000.00

Service Code	HCPCS 78806
Hospital Charge Code	4500286
Hospital Revenue Code	341
Min. Negotiated Rate	$1,560.00
Max. Negotiated Rate	$6,000.00
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) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
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 LOCALIZE INFLAM PROCE WB

Facility

$12,000.00

Service Code	HCPCS 78806
Hospital Charge Code	4500286
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 LOCALIZE INFLAM PROC LTD

Facility

$12,000.00

Service Code	HCPCS 78805
Hospital Charge Code	4500932
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 LOCALIZE INFLAM PROC LTD

Facility

$12,000.00

Service Code	HCPCS 78805
Hospital Charge Code	4500932
Hospital Revenue Code	341
Min. Negotiated Rate	$1,560.00
Max. Negotiated Rate	$6,000.00
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) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
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 LUNG PERFUSION PARTICULATE

Facility

$12,000.00

Service Code	HCPCS 78580
Hospital Charge Code	4500112
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 LUNG PERFUSION PARTICULATE

Facility

$12,000.00

Service Code	HCPCS 78580
Hospital Charge Code	4500112
Hospital Revenue Code	341
Min. Negotiated Rate	$156.48
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	$156.48
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 LUNG VENTILATION MULTI SCAN

Facility

$383.25

Hospital Charge Code	4500310
Hospital Revenue Code	341
Min. Negotiated Rate	$49.82
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$114.97
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.82
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM LUNG VENTILATION MULTI SCAN

Facility

$383.25

Hospital Charge Code	4500310
Hospital Revenue Code	341
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

NM LYMPHATIC & LYMPH GLND IMAG

Facility

$12,000.00

Service Code	HCPCS 78195
Hospital Charge Code	4500884
Hospital Revenue Code	341
Min. Negotiated Rate	$154.28
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	$154.28
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 LYMPHATIC & LYMPH GLND IMAG

Facility

$12,000.00

Service Code	HCPCS 78195
Hospital Charge Code	4500884
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 LYMPHATIC UNLISTED PROCEDUR

Facility

$1,388.55

Service Code	HCPCS 78199
Hospital Charge Code	4500969
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 LYMPHATIC UNLISTED PROCEDUR

Facility

$1,388.55

Service Code	HCPCS 78199
Hospital Charge Code	4500969
Hospital Revenue Code	341
Min. Negotiated Rate	$208.28
Max. Negotiated Rate	$208.28
Rate for Payer: Qualcare PPO/HMO/WC	$208.28

NM MECKLES BOWEL IMAGING

Facility

$12,000.00

Service Code	HCPCS 78290
Hospital Charge Code	4500385
Hospital Revenue Code	341
Min. Negotiated Rate	$134.08
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	$134.08
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 MECKLES BOWEL IMAGING

Facility

$12,000.00

Service Code	HCPCS 78290
Hospital Charge Code	4500385
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 METASTRON PER MCI

Facility

$15,184.00

Hospital Charge Code	4509040
Hospital Revenue Code	344
Min. Negotiated Rate	$1,973.92
Max. Negotiated Rate	$7,592.00
Rate for Payer: Aetna Commercial	$4,555.20
Rate for Payer: Aetna Medicare Advantage	$4,555.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,871.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,871.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,871.92
Rate for Payer: Cigna Commercial	$7,592.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,973.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,277.60

Know your out-of-pocket cost for care.

All Charges