Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

NM TC99 SULPHUR COLL DOSE UP T

Facility

$200.85

Service Code	HCPCS A9541
Hospital Charge Code	4500306
Hospital Revenue Code	343
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$30.13
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

NM TC99 SULPHUR COLL DOSE UP T

Facility

$200.85

Service Code	HCPCS A9541
Hospital Charge Code	4500306
Hospital Revenue Code	343
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$166.43
Rate for Payer: Aetna Commercial	$60.26
Rate for Payer: Aetna Medicare Advantage	$60.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.22
Rate for Payer: Cigna Commercial	$100.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.11
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

NM TESTICULAR IMAGING

Facility

$2,151.25

Service Code	HCPCS 78761
Hospital Charge Code	4500997
Hospital Revenue Code	341
Min. Negotiated Rate	$322.69
Max. Negotiated Rate	$322.69
Rate for Payer: Qualcare PPO/HMO/WC	$322.69

NM TESTICULAR IMAGING

Facility

$2,151.25

Service Code	HCPCS 78761
Hospital Charge Code	4500997
Hospital Revenue Code	341
Min. Negotiated Rate	$104.72
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$645.38
Rate for Payer: Aetna Medicare Advantage	$645.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$548.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$548.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$548.57
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$322.69
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM TESTICULAR SCAN

Facility

$12,000.00

Service Code	HCPCS 78761
Hospital Charge Code	4500377
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 TESTICULAR SCAN

Facility

$12,000.00

Service Code	HCPCS 78761
Hospital Charge Code	4500377
Hospital Revenue Code	341
Min. Negotiated Rate	$104.72
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	$104.72
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 THERAPY CHRONIC LEUKEMIA

Facility

$1,374.25

Service Code	HCPCS 79101
Hospital Charge Code	4500999
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERAPY CHRONIC LEUKEMIA

Facility

$1,374.25

Service Code	HCPCS 79101
Hospital Charge Code	4500999
Hospital Revenue Code	342
Min. Negotiated Rate	$178.65
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$412.27
Rate for Payer: Aetna Medicare Advantage	$412.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.43
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.65
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THERAPY INTERSTITAL COLLOID

Facility

$1,374.25

Service Code	HCPCS 79300
Hospital Charge Code	4501002
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERAPY INTERSTITAL COLLOID

Facility

$1,374.25

Service Code	HCPCS 79300
Hospital Charge Code	4501002
Hospital Revenue Code	342
Min. Negotiated Rate	$178.65
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$412.27
Rate for Payer: Aetna Medicare Advantage	$412.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.43
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.65
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THERAPY INTRACAVITY COLLOID

Facility

$1,374.25

Service Code	HCPCS 79200
Hospital Charge Code	4501004
Hospital Revenue Code	342
Min. Negotiated Rate	$92.56
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$412.27
Rate for Payer: Aetna Medicare Advantage	$412.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.43
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.65
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THERAPY INTRACAVITY COLLOID

Facility

$1,374.25

Service Code	HCPCS 79200
Hospital Charge Code	4501004
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERAPY RADIOPHARMA OTHER

Facility

$1,374.25

Service Code	HCPCS 79999
Hospital Charge Code	4501008
Hospital Revenue Code	342
Min. Negotiated Rate	$178.65
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$412.27
Rate for Payer: Aetna Medicare Advantage	$412.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.43
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.65
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THERAPY RADIOPHARMA OTHER

Facility

$1,374.25

Service Code	HCPCS 79999
Hospital Charge Code	4501008
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERAPY THYROID METASTASES

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4501009
Hospital Revenue Code	342
Min. Negotiated Rate	$200.89
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$585.38
Rate for Payer: Aetna Medicare Advantage	$585.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.57
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.69
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THERAPY THYROID METASTASES

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4501010
Hospital Revenue Code	342
Min. Negotiated Rate	$200.89
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$585.38
Rate for Payer: Aetna Medicare Advantage	$585.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.57
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.69
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THERAPY THYROID METASTASES

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4501009
Hospital Revenue Code	342
Min. Negotiated Rate	$292.69
Max. Negotiated Rate	$292.69
Rate for Payer: Qualcare PPO/HMO/WC	$292.69

NM THERAPY THYROID METASTASES

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4501010
Hospital Revenue Code	342
Min. Negotiated Rate	$292.69
Max. Negotiated Rate	$292.69
Rate for Payer: Qualcare PPO/HMO/WC	$292.69

NM THERPY HYPERTHYROID INITIAL

Facility

$1,374.25

Service Code	HCPCS 79105
Hospital Charge Code	4501000
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERPY HYPERTHYROID INITIAL

Facility

$1,374.25

Service Code	HCPCS 79105
Hospital Charge Code	4501000
Hospital Revenue Code	342
Min. Negotiated Rate	$178.65
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$412.27
Rate for Payer: Aetna Medicare Advantage	$412.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.43
Rate for Payer: Cigna Commercial	$687.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.65
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THERPY HYPERTHYROID SUBSQNT

Facility

$1,374.25

Service Code	HCPCS 79105
Hospital Charge Code	4501001
Hospital Revenue Code	342
Min. Negotiated Rate	$178.65
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$412.27
Rate for Payer: Aetna Medicare Advantage	$412.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.43
Rate for Payer: Cigna Commercial	$687.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.65
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THERPY HYPERTHYROID SUBSQNT

Facility

$1,374.25

Service Code	HCPCS 79105
Hospital Charge Code	4501001
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THRPY ABLTON THYRD CARCNOMA

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4500998
Hospital Revenue Code	342
Min. Negotiated Rate	$200.89
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$585.38
Rate for Payer: Aetna Medicare Advantage	$585.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.57
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.66
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.69
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THRPY ABLTON THYRD CARCNOMA

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4500998
Hospital Revenue Code	342
Min. Negotiated Rate	$292.69
Max. Negotiated Rate	$292.69
Rate for Payer: Qualcare PPO/HMO/WC	$292.69

Know your out-of-pocket cost for care.

All Charges