Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

NM MISC DIAGNOSTIC PROCEDURE

Facility

$506.20

Service Code	HCPCS 78999
Hospital Charge Code	4500970
Hospital Revenue Code	341
Min. Negotiated Rate	$75.93
Max. Negotiated Rate	$75.93
Rate for Payer: Qualcare PPO/HMO/WC	$75.93

NM MISC DIAGNOSTIC PROCEDURE

Facility

$506.20

Service Code	HCPCS 78999
Hospital Charge Code	4500970
Hospital Revenue Code	341
Min. Negotiated Rate	$65.81
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$151.86
Rate for Payer: Aetna Medicare Advantage	$151.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.08
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.81
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.93
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM MODERATE SEDATION

Facility

$1,937.60

Service Code	HCPCS 99144
Hospital Charge Code	4508035
Hospital Revenue Code	370
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$290.64
Rate for Payer: Qualcare PPO/HMO/WC	$290.64

NM MODERATE SEDATION

Facility

$1,937.60

Service Code	HCPCS 99144
Hospital Charge Code	4508035
Hospital Revenue Code	370
Min. Negotiated Rate	$251.89
Max. Negotiated Rate	$968.80
Rate for Payer: Aetna Commercial	$581.28
Rate for Payer: Aetna Medicare Advantage	$581.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.09
Rate for Payer: Cigna Commercial	$968.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.89
Rate for Payer: Oxford Commercial	$968.80
Rate for Payer: Qualcare PPO/HMO/WC	$290.64
Rate for Payer: UnitedHealthcare Commercial	$968.80

NM MUGA (MULTIGATED SCAN)

Facility

$12,000.00

Service Code	HCPCS 78472
Hospital Charge Code	4500393
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 MUGA (MULTIGATED SCAN)

Facility

$12,000.00

Service Code	HCPCS 78472
Hospital Charge Code	4500393
Hospital Revenue Code	341
Min. Negotiated Rate	$187.00
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	$187.00
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 MUGA MULTI REST STRESS WO

Facility

$3,975.25

Service Code	HCPCS 78473
Hospital Charge Code	4500922
Hospital Revenue Code	341
Min. Negotiated Rate	$596.29
Max. Negotiated Rate	$596.29
Rate for Payer: Qualcare PPO/HMO/WC	$596.29

NM MUGA MULTI REST STRESS WO

Facility

$3,975.25

Service Code	HCPCS 78473
Hospital Charge Code	4500922
Hospital Revenue Code	341
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$3,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$596.29
Rate for Payer: Aetna Commercial	$1,192.58
Rate for Payer: Aetna Medicare Advantage	$1,192.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.69
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$516.78
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM MUSCULOSKELETAL OTHER

Facility

$1,415.50

Service Code	HCPCS 78399
Hospital Charge Code	4500971
Hospital Revenue Code	341
Min. Negotiated Rate	$184.01
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$424.65
Rate for Payer: Aetna Medicare Advantage	$424.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.95
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.01
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.32
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM MUSCULOSKELETAL OTHER

Facility

$1,415.50

Service Code	HCPCS 78399
Hospital Charge Code	4500971
Hospital Revenue Code	341
Min. Negotiated Rate	$212.32
Max. Negotiated Rate	$212.32
Rate for Payer: Qualcare PPO/HMO/WC	$212.32

NM MYOCARDIAL HOT SPOT

Facility

$869.65

Service Code	HCPCS 78466
Hospital Charge Code	4500344
Hospital Revenue Code	341
Min. Negotiated Rate	$130.45
Max. Negotiated Rate	$130.45
Rate for Payer: Qualcare PPO/HMO/WC	$130.45

NM MYOCARDIAL HOT SPOT

Facility

$869.65

Service Code	HCPCS 78466
Hospital Charge Code	4500344
Hospital Revenue Code	341
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$260.89
Rate for Payer: Aetna Medicare Advantage	$260.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.76
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.05
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$130.45
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM MYOCARDIAL PERF W EJEC FRA

Facility

$12,000.00

Service Code	HCPCS 78452
Hospital Charge Code	4500872
Hospital Revenue Code	341
Min. Negotiated Rate	$314.16
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	$314.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$3,083.08
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 MYOCARDIAL PERF W EJEC FRA

Facility

$12,000.00

Service Code	HCPCS 78452
Hospital Charge Code	4500872
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 MYOCARDIAL PERF W WALL MOTI

Facility

$12,000.00

Service Code	HCPCS 78452
Hospital Charge Code	4500880
Hospital Revenue Code	341
Min. Negotiated Rate	$314.16
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	$314.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$3,083.08
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 MYOCARDIAL PERF W WALL MOTI

Facility

$12,000.00

Service Code	HCPCS 78452
Hospital Charge Code	4500880
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 MYOCARDIAL PLANAR REST OR E

Facility

$12,000.00

Service Code	HCPCS 78454
Hospital Charge Code	4500526
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	$3,083.08
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 MYOCARDIAL PLANAR REST OR E

Facility

$12,000.00

Service Code	HCPCS 78454
Hospital Charge Code	4500526
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 MYOCARDIAL PLANAR STREE &

Facility

$12,000.00

Service Code	HCPCS 78454
Hospital Charge Code	4500351
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	$3,083.08
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 MYOCARDIAL PLANAR STREE &

Facility

$12,000.00

Service Code	HCPCS 78454
Hospital Charge Code	4500351
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 MYOCARDIAL SPECT REST OR EX

Facility

$12,000.00

Service Code	HCPCS 78452
Hospital Charge Code	4500476
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 MYOCARDIAL SPECT REST OR EX

Facility

$12,000.00

Service Code	HCPCS 78452
Hospital Charge Code	4500476
Hospital Revenue Code	341
Min. Negotiated Rate	$314.16
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	$314.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$3,083.08
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 MYOCARDIAL SPECT STRESS &

Facility

$12,000.00

Service Code	HCPCS 78452
Hospital Charge Code	4500484
Hospital Revenue Code	341
Min. Negotiated Rate	$314.16
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	$314.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$3,083.08
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 MYOCARDIAL SPECT STRESS &

Facility

$12,000.00

Service Code	HCPCS 78452
Hospital Charge Code	4500484
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

Know your out-of-pocket cost for care.

All Charges