Heights University Hospital

All Charges

Charge

Type

Setting

Price

NM THRPY INTR-ARTICLR RADIOPHM

Facility

$1,374.25

Service Code	HCPCS 79440
Hospital Charge Code	4501003
Hospital Revenue Code	342
Min. Negotiated Rate	$135.76
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	$135.76
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 THRPY INTR-ARTICLR RADIOPHM

Facility

$1,374.25

Service Code	HCPCS 79440
Hospital Charge Code	4501003
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 NONTHYRD/NONHEMALOGIC

Facility

$1,374.25

Service Code	HCPCS 79101
Hospital Charge Code	4501006
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 NONTHYRD/NONHEMALOGIC

Facility

$1,374.25

Service Code	HCPCS 79101
Hospital Charge Code	4501006
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 THYRD IMAGING W/VASCLR FLOW

Facility

$985.85

Hospital Charge Code	4501011
Hospital Revenue Code	341
Min. Negotiated Rate	$147.88
Max. Negotiated Rate	$147.88
Rate for Payer: Qualcare PPO/HMO/WC	$147.88

NM THYRD IMAGING W/VASCLR FLOW

Facility

$985.85

Hospital Charge Code	4501011
Hospital Revenue Code	341
Min. Negotiated Rate	$128.16
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$295.75
Rate for Payer: Aetna Medicare Advantage	$295.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.39
Rate for Payer: Cigna Commercial	$492.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.16
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.88
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THYRD UPTK STIM/SPPRSS/DSCH

Facility

$1,249.20

Hospital Charge Code	4501012
Hospital Revenue Code	341
Min. Negotiated Rate	$162.40
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$374.76
Rate for Payer: Aetna Medicare Advantage	$374.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.55
Rate for Payer: Cigna Commercial	$624.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.38
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THYRD UPTK STIM/SPPRSS/DSCH

Facility

$1,249.20

Hospital Charge Code	4501012
Hospital Revenue Code	341
Min. Negotiated Rate	$187.38
Max. Negotiated Rate	$187.38
Rate for Payer: Qualcare PPO/HMO/WC	$187.38

NM THYROID IMAGE W UPTAKE MULT

Facility

$1,248.00

Hospital Charge Code	4500899
Hospital Revenue Code	341
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$187.20
Rate for Payer: Qualcare PPO/HMO/WC	$187.20

NM THYROID IMAGE W UPTAKE MULT

Facility

$1,248.00

Hospital Charge Code	4500899
Hospital Revenue Code	341
Min. Negotiated Rate	$162.24
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$374.40
Rate for Payer: Aetna Medicare Advantage	$374.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.24
Rate for Payer: Cigna Commercial	$624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.24
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.20
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THYROID IMAGE W UPTAKE SIN

Facility

$1,148.00

Hospital Charge Code	4500897
Hospital Revenue Code	341
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$172.20
Rate for Payer: Qualcare PPO/HMO/WC	$172.20

NM THYROID IMAGE W UPTAKE SIN

Facility

$1,148.00

Hospital Charge Code	4500897
Hospital Revenue Code	341
Min. Negotiated Rate	$149.24
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$344.40
Rate for Payer: Aetna Medicare Advantage	$344.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$292.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$292.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$292.74
Rate for Payer: Cigna Commercial	$574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.24
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.20
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THYROID IMAGING ONLY

Facility

$788.52

Service Code	HCPCS 78010
Hospital Charge Code	4507005
Hospital Revenue Code	341
Min. Negotiated Rate	$102.51
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$236.56
Rate for Payer: Aetna Medicare Advantage	$236.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.07
Rate for Payer: Cigna Commercial	$394.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.51
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.28
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THYROID IMAGING ONLY

Facility

$788.52

Service Code	HCPCS 78010
Hospital Charge Code	4507005
Hospital Revenue Code	341
Min. Negotiated Rate	$118.28
Max. Negotiated Rate	$118.28
Rate for Payer: Qualcare PPO/HMO/WC	$118.28

NM-THYROID IMAGING W/UPTAKE S

Facility

$2,043.00

Service Code	HCPCS 78014
Hospital Charge Code	4507010
Hospital Revenue Code	341
Min. Negotiated Rate	$202.86
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$612.90
Rate for Payer: Aetna Medicare Advantage	$612.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$202.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.97
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.59
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.45
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM-THYROID IMAGING W/UPTAKE S

Facility

$2,043.00

Service Code	HCPCS 78014
Hospital Charge Code	4507010
Hospital Revenue Code	341
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

NM THYROID METS IMAG W ADD ST

Facility

$1,685.65

Service Code	HCPCS 78016
Hospital Charge Code	4500934
Hospital Revenue Code	341
Min. Negotiated Rate	$252.85
Max. Negotiated Rate	$252.85
Rate for Payer: Qualcare PPO/HMO/WC	$252.85

NM THYROID METS IMAG W ADD ST

Facility

$1,685.65

Service Code	HCPCS 78016
Hospital Charge Code	4500934
Hospital Revenue Code	341
Min. Negotiated Rate	$115.19
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$505.69
Rate for Payer: Aetna Medicare Advantage	$505.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$429.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$429.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$429.84
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.13
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.85
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THYROID METS IMA LIMIT AREA

Facility

$1,248.00

Service Code	HCPCS 78015
Hospital Charge Code	4500900
Hospital Revenue Code	341
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$187.20
Rate for Payer: Qualcare PPO/HMO/WC	$187.20

NM THYROID METS IMA LIMIT AREA

Facility

$1,248.00

Service Code	HCPCS 78015
Hospital Charge Code	4500900
Hospital Revenue Code	341
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$374.40
Rate for Payer: Aetna Medicare Advantage	$374.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.24
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.24
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.20
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THYROID METS IMA WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78018
Hospital Charge Code	4500902
Hospital Revenue Code	341
Min. Negotiated Rate	$183.26
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	$183.26
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 THYROID METS IMA WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78018
Hospital Charge Code	4500902
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 THYROID METS UPTAKE

Facility

$655.25

Service Code	HCPCS 78020
Hospital Charge Code	4500904
Hospital Revenue Code	341
Min. Negotiated Rate	$98.29
Max. Negotiated Rate	$98.29
Rate for Payer: Qualcare PPO/HMO/WC	$98.29

NM THYROID METS UPTAKE

Facility

$655.25

Service Code	HCPCS 78020
Hospital Charge Code	4500904
Hospital Revenue Code	341
Min. Negotiated Rate	$44.88
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$196.57
Rate for Payer: Aetna Medicare Advantage	$196.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.09
Rate for Payer: Cigna Commercial	$89.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.18
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.29
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM THYROID SCAN

Facility

$528.85

Hospital Charge Code	4500047
Hospital Revenue Code	341
Min. Negotiated Rate	$68.75
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$158.66
Rate for Payer: Aetna Medicare Advantage	$158.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.86
Rate for Payer: Cigna Commercial	$264.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.75
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$79.33
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

Know your out-of-pocket cost for care.

All Charges