Heights University Hospital

All Charges

Charge

Type

Setting

Price

NM SALIVARY GLND/IMAG.W SERIAL

Facility

$1,448.92

Service Code	HCPCS 78231
Hospital Charge Code	4508010
Hospital Revenue Code	341
Min. Negotiated Rate	$91.63
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Better Health Medicaid	$115.56
Rate for Payer: Aetna Commercial	$434.68
Rate for Payer: Aetna Medicare Advantage	$434.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.47
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	$369.47
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.36
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.34
Rate for Payer: UnitedHealthcare Commercial	$3,540.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$117.87

NM SALIVARY GLND IMG W/SER IMG

Facility

$1,336.60

Service Code	HCPCS 78232
Hospital Charge Code	4500996
Hospital Revenue Code	341
Min. Negotiated Rate	$91.63
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	$91.63
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 SALIVARY GLND IMG W/SER IMG

Facility

$1,336.60

Service Code	HCPCS 78232
Hospital Charge Code	4500996
Hospital Revenue Code	341
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$200.49
Rate for Payer: Qualcare PPO/HMO/WC	$200.49

NM SCHILLING PART 1

Facility

$442.45

Service Code	HCPCS 78270
Hospital Charge Code	4500062
Hospital Revenue Code	341
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$66.37
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

NM SCHILLING PART 1

Facility

$442.45

Service Code	HCPCS 78270
Hospital Charge Code	4500062
Hospital Revenue Code	341
Min. Negotiated Rate	$57.52
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$132.74
Rate for Payer: Aetna Medicare Advantage	$132.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.82
Rate for Payer: Cigna Commercial	$221.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.52
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.37
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM SCHILLING PART II

Facility

$408.85

Service Code	HCPCS 78271
Hospital Charge Code	4500070
Hospital Revenue Code	341
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$61.33
Rate for Payer: Qualcare PPO/HMO/WC	$61.33

NM SCHILLING PART II

Facility

$408.85

Service Code	HCPCS 78271
Hospital Charge Code	4500070
Hospital Revenue Code	341
Min. Negotiated Rate	$53.15
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$122.66
Rate for Payer: Aetna Medicare Advantage	$122.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.26
Rate for Payer: Cigna Commercial	$204.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.15
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.33
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM SHUNT CARDIAC

Facility

$996.85

Service Code	HCPCS 78428
Hospital Charge Code	4500534
Hospital Revenue Code	341
Min. Negotiated Rate	$149.53
Max. Negotiated Rate	$149.53
Rate for Payer: Qualcare PPO/HMO/WC	$149.53

NM SHUNT CARDIAC

Facility

$996.85

Service Code	HCPCS 78428
Hospital Charge Code	4500534
Hospital Revenue Code	341
Min. Negotiated Rate	$115.94
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$299.06
Rate for Payer: Aetna Medicare Advantage	$299.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.20
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.59
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.53
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM SHUNT CEREBRAL

Facility

$737.65

Service Code	HCPCS 78645
Hospital Charge Code	4500583
Hospital Revenue Code	341
Min. Negotiated Rate	$95.89
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$221.29
Rate for Payer: Aetna Medicare Advantage	$221.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$223.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.10
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.89
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$110.65
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM SHUNT CEREBRAL

Facility

$737.65

Service Code	HCPCS 78645
Hospital Charge Code	4500583
Hospital Revenue Code	341
Min. Negotiated Rate	$110.65
Max. Negotiated Rate	$110.65
Rate for Payer: Qualcare PPO/HMO/WC	$110.65

NM SPLEEN IMA ONLY W WO VASC F

Facility

$1,146.45

Service Code	HCPCS 78185
Hospital Charge Code	4500908
Hospital Revenue Code	341
Min. Negotiated Rate	$102.85
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	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$292.34
Rate for Payer: Cigna Commercial	$952.02
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 SPLEEN IMA ONLY W WO VASC F

Facility

$1,146.45

Service Code	HCPCS 78185
Hospital Charge Code	4500908
Hospital Revenue Code	341
Min. Negotiated Rate	$171.97
Max. Negotiated Rate	$171.97
Rate for Payer: Qualcare PPO/HMO/WC	$171.97

NM SR89 PROVISION OF PRODUCT**

Facility

$4,539.00

Service Code	HCPCS A9600
Hospital Charge Code	4500633
Hospital Revenue Code	342
Min. Negotiated Rate	$440.53
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,361.70
Rate for Payer: Aetna Medicare Advantage	$1,361.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,157.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,157.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,157.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$590.07
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$680.85
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM SR89 PROVISION OF PRODUCT**

Facility

$4,539.00

Service Code	HCPCS A9600
Hospital Charge Code	4500633
Hospital Revenue Code	342
Min. Negotiated Rate	$680.85
Max. Negotiated Rate	$680.85
Rate for Payer: Qualcare PPO/HMO/WC	$680.85

NM SR89 THERAPY****

Facility

$361.00

Service Code	HCPCS 79400
Hospital Charge Code	4500641
Hospital Revenue Code	342
Min. Negotiated Rate	$46.93
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$108.30
Rate for Payer: Aetna Medicare Advantage	$108.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.06
Rate for Payer: Cigna Commercial	$180.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.93
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.15
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM SR89 THERAPY****

Facility

$361.00

Service Code	HCPCS 79400
Hospital Charge Code	4500641
Hospital Revenue Code	342
Min. Negotiated Rate	$54.15
Max. Negotiated Rate	$54.15
Rate for Payer: Qualcare PPO/HMO/WC	$54.15

NM TC99 ALBUMIN 0019N350A1 DOS

Facility

$267.25

Service Code	HCPCS A9540
Hospital Charge Code	4500864
Hospital Revenue Code	343
Min. Negotiated Rate	$40.09
Max. Negotiated Rate	$40.09
Rate for Payer: Qualcare PPO/HMO/WC	$40.09

NM TC99 ALBUMIN 0019N350A1 DOS

Facility

$267.25

Service Code	HCPCS A9540
Hospital Charge Code	4500864
Hospital Revenue Code	343
Min. Negotiated Rate	$34.74
Max. Negotiated Rate	$133.62
Rate for Payer: Aetna Commercial	$80.17
Rate for Payer: Aetna Medicare Advantage	$80.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.15
Rate for Payer: Cigna Commercial	$133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.74
Rate for Payer: Qualcare PPO/HMO/WC	$40.09

NM TC99 ARCITUMOMAB DOSE UP TO

Facility

$65.65

Hospital Charge Code	4500856
Hospital Revenue Code	343
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

NM TC99 ARCITUMOMAB DOSE UP TO

Facility

$65.65

Hospital Charge Code	4500856
Hospital Revenue Code	343
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$19.70
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.53
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

NM TC99 CERETEC DOSE UP TO 25M

Facility

$96.85

Service Code	HCPCS A9521
Hospital Charge Code	4500849
Hospital Revenue Code	343
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$1,303.61
Rate for Payer: Aetna Commercial	$29.05
Rate for Payer: Aetna Medicare Advantage	$29.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,303.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.70
Rate for Payer: Cigna Commercial	$48.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.59
Rate for Payer: Qualcare PPO/HMO/WC	$14.53

NM TC99 CERETEC DOSE UP TO 25M

Facility

$96.85

Service Code	HCPCS A9521
Hospital Charge Code	4500849
Hospital Revenue Code	343
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$14.53
Rate for Payer: Qualcare PPO/HMO/WC	$14.53

NM TC99 DEPREOTIDE DOSE UP TO

Facility

$102.50

Hospital Charge Code	4500299
Hospital Revenue Code	343
Min. Negotiated Rate	$15.38
Max. Negotiated Rate	$15.38
Rate for Payer: Qualcare PPO/HMO/WC	$15.38

NM TC99 DEPREOTIDE DOSE UP TO

Facility

$102.50

Hospital Charge Code	4500299
Hospital Revenue Code	343
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$51.25
Rate for Payer: Aetna Commercial	$30.75
Rate for Payer: Aetna Medicare Advantage	$30.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.14
Rate for Payer: Cigna Commercial	$51.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.32
Rate for Payer: Qualcare PPO/HMO/WC	$15.38

Know your out-of-pocket cost for care.

All Charges