Heights University Hospital

All Charges

Charge

Type

Setting

Price

NM TC99 LABELED RBC DOSE UP TO

Facility

$128.75

Service Code	HCPCS A9560
Hospital Charge Code	4500304
Hospital Revenue Code	343
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$207.57
Rate for Payer: Aetna Commercial	$38.62
Rate for Payer: Aetna Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.83
Rate for Payer: Cigna Commercial	$64.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.74
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

NM TC99 LABELED RBC DOSE UP TO

Facility

$128.75

Service Code	HCPCS A9560
Hospital Charge Code	4500304
Hospital Revenue Code	343
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$19.31
Rate for Payer: Qualcare PPO/HMO/WC	$19.31

NM TC99M ALBUMIN AGGRPERVIAL

Facility

$2,093.50

Service Code	HCPCS A9524
Hospital Charge Code	4509025
Hospital Revenue Code	343
Min. Negotiated Rate	$105.54
Max. Negotiated Rate	$1,046.75
Rate for Payer: Aetna Commercial	$628.05
Rate for Payer: Aetna Medicare Advantage	$628.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.84
Rate for Payer: Cigna Commercial	$1,046.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.15
Rate for Payer: Qualcare PPO/HMO/WC	$314.02

NM TC99M ALBUMIN AGGRPERVIAL

Facility

$2,093.50

Service Code	HCPCS A9524
Hospital Charge Code	4509025
Hospital Revenue Code	343
Min. Negotiated Rate	$314.02
Max. Negotiated Rate	$314.02
Rate for Payer: Qualcare PPO/HMO/WC	$314.02

NM TC 99M DISOFENIN UP TO 15 M

Facility

$61.00

Service Code	HCPCS A9510
Hospital Charge Code	4508045
Hospital Revenue Code	343
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

NM TC 99M DISOFENIN UP TO 15 M

Facility

$61.00

Service Code	HCPCS A9510
Hospital Charge Code	4508045
Hospital Revenue Code	343
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$129.03
Rate for Payer: Aetna Commercial	$18.30
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$129.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

NM TC99 MERTIATIDE MAG 3 DOSE

Facility

$481.65

Hospital Charge Code	4500765
Hospital Revenue Code	343
Min. Negotiated Rate	$62.61
Max. Negotiated Rate	$240.82
Rate for Payer: Aetna Commercial	$144.50
Rate for Payer: Aetna Medicare Advantage	$144.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.82
Rate for Payer: Cigna Commercial	$240.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.25

NM TC99 MERTIATIDE MAG 3 DOSE

Facility

$481.65

Hospital Charge Code	4500765
Hospital Revenue Code	343
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$72.25
Rate for Payer: Qualcare PPO/HMO/WC	$72.25

NM TC99 MM/STUDY DOSE TO 30

Facility

$177.50

Service Code	HCPCS A9503
Hospital Charge Code	4501023
Hospital Revenue Code	343
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.62

NM TC99 MM/STUDY DOSE TO 30

Facility

$177.50

Service Code	HCPCS A9503
Hospital Charge Code	4501023
Hospital Revenue Code	343
Min. Negotiated Rate	$23.07
Max. Negotiated Rate	$119.68
Rate for Payer: Aetna Commercial	$53.25
Rate for Payer: Aetna Medicare Advantage	$53.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.26
Rate for Payer: Cigna Commercial	$88.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.07
Rate for Payer: Qualcare PPO/HMO/WC	$26.62

NM TC99M PENTETATE PER VIAL

Facility

$80.00

Service Code	HCPCS A9567
Hospital Charge Code	4509035
Hospital Revenue Code	343
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$41.14
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

NM TC99M PENTETATE PER VIAL

Facility

$80.00

Service Code	HCPCS A9567
Hospital Charge Code	4509035
Hospital Revenue Code	343
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

NM TC-99M SUCCIMER,UP TO 10 MC

Facility

$803.00

Hospital Charge Code	4508060
Hospital Revenue Code	343
Min. Negotiated Rate	$104.39
Max. Negotiated Rate	$401.50
Rate for Payer: Aetna Commercial	$240.90
Rate for Payer: Aetna Medicare Advantage	$240.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.76
Rate for Payer: Cigna Commercial	$401.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.39
Rate for Payer: Qualcare PPO/HMO/WC	$120.45

NM TC-99M SUCCIMER,UP TO 10 MC

Facility

$803.00

Hospital Charge Code	4508060
Hospital Revenue Code	343
Min. Negotiated Rate	$120.45
Max. Negotiated Rate	$120.45
Rate for Payer: Qualcare PPO/HMO/WC	$120.45

NM TC99 MYOVIEW, PER DOSE

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	4500659
Hospital Revenue Code	343
Min. Negotiated Rate	$96.94
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$309.25
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.01
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

NM TC99 MYOVIEW, PER DOSE

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	4500659
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

NM TC99 OXIDRONATE HDP DOSE UP

Facility

$105.65

Service Code	HCPCS A9561
Hospital Charge Code	4500308
Hospital Revenue Code	343
Min. Negotiated Rate	$13.73
Max. Negotiated Rate	$82.28
Rate for Payer: Aetna Commercial	$31.70
Rate for Payer: Aetna Medicare Advantage	$31.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.94
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.73
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

NM TC99 OXIDRONATE HDP DOSE UP

Facility

$105.65

Service Code	HCPCS A9561
Hospital Charge Code	4500308
Hospital Revenue Code	343
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

NM TC99 PENTETATE DTPA DOSE UP

Facility

$65.65

Service Code	HCPCS A9539
Hospital Charge Code	4500300
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 PENTETATE DTPA DOSE UP

Facility

$65.65

Service Code	HCPCS A9539
Hospital Charge Code	4500300
Hospital Revenue Code	343
Min. Negotiated Rate	$8.53
Max. Negotiated Rate	$33.66
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) NJ Health	$33.66
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 PERTECHNETATE PER MCI

Facility

$62.10

Hospital Charge Code	4500309
Hospital Revenue Code	343
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

NM TC99 PERTECHNETATE PER MCI

Facility

$62.10

Hospital Charge Code	4500309
Hospital Revenue Code	343
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

NM TC99 PYP DOSE UP TO 25MCI

Facility

$116.85

Hospital Charge Code	4500298
Hospital Revenue Code	343
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

NM TC99 PYP DOSE UP TO 25MCI

Facility

$116.85

Hospital Charge Code	4500298
Hospital Revenue Code	343
Min. Negotiated Rate	$15.19
Max. Negotiated Rate	$58.42
Rate for Payer: Aetna Commercial	$35.05
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.19
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

NM TC99 SESTAMIBI, DOSE

Facility

$456.64

Service Code	HCPCS A9500
Hospital Charge Code	4500658
Hospital Revenue Code	343
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$68.50
Rate for Payer: Qualcare PPO/HMO/WC	$68.50

Know your out-of-pocket cost for care.

All Charges