Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

NM-THYROID UPTAKE ONLY

Facility

$688.00

Service Code	HCPCS 78000
Hospital Charge Code	4508001
Hospital Revenue Code	341
Min. Negotiated Rate	$89.44
Max. Negotiated Rate	$3,540.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Aetna Commercial	$206.40
Rate for Payer: Aetna Medicare Advantage	$206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.44
Rate for Payer: Cigna Commercial	$344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.44
Rate for Payer: Qualcare PPO/HMO/WC	$103.20
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM-THYROID UPTAKE ONLY

Facility

$688.00

Service Code	HCPCS 78000
Hospital Charge Code	4508001
Hospital Revenue Code	341
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$103.20
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

NM THYROID UPTAKE; SGL

Facility

$433.65

Hospital Charge Code	4500039
Hospital Revenue Code	341
Min. Negotiated Rate	$65.05
Max. Negotiated Rate	$65.05
Rate for Payer: Qualcare PPO/HMO/WC	$65.05

NM THYROID UPTAKE; SGL

Facility

$433.65

Hospital Charge Code	4500039
Hospital Revenue Code	341
Min. Negotiated Rate	$56.37
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$130.09
Rate for Payer: Aetna Medicare Advantage	$130.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.58
Rate for Payer: Cigna Commercial	$216.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.37
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.05
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM TL201 (EA mCi)

Facility

$100.00

Hospital Charge Code	4500666
Hospital Revenue Code	343
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$30.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

NM TL201 (EA mCi)

Facility

$100.00

Hospital Charge Code	4500666
Hospital Revenue Code	343
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

NM TUMOR LCLZATN/WHLE BDY 2+DY

Facility

$3,872.85

Service Code	HCPCS 78804
Hospital Charge Code	4501013
Hospital Revenue Code	341
Min. Negotiated Rate	$367.83
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$1,161.86
Rate for Payer: Aetna Medicare Advantage	$1,161.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$987.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$987.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$367.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$987.58
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$503.47
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$580.93
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM TUMOR LCLZATN/WHLE BDY 2+DY

Facility

$3,872.85

Service Code	HCPCS 78804
Hospital Charge Code	4501013
Hospital Revenue Code	341
Min. Negotiated Rate	$580.93
Max. Negotiated Rate	$580.93
Rate for Payer: Qualcare PPO/HMO/WC	$580.93

NM TUMOR LOCALIZATION LIMITED

Facility

$12,000.00

Service Code	HCPCS 78800
Hospital Charge Code	4500690
Hospital Revenue Code	341
Min. Negotiated Rate	$256.19
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	$256.19
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 TUMOR LOCALIZATION LIMITED

Facility

$12,000.00

Service Code	HCPCS 78800
Hospital Charge Code	4500690
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 TUMOR LOCALIZATION MULTIPLE

Facility

$1,776.85

Service Code	HCPCS 78801
Hospital Charge Code	4500682
Hospital Revenue Code	341
Min. Negotiated Rate	$266.53
Max. Negotiated Rate	$266.53
Rate for Payer: Qualcare PPO/HMO/WC	$266.53

NM TUMOR LOCALIZATION MULTIPLE

Facility

$1,776.85

Service Code	HCPCS 78801
Hospital Charge Code	4500682
Hospital Revenue Code	341
Min. Negotiated Rate	$230.99
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$533.05
Rate for Payer: Aetna Medicare Advantage	$533.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$453.10
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.99
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$266.53
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM TUMOR LOCALIZATION (SPECT)

Facility

$12,000.00

Service Code	HCPCS 78803
Hospital Charge Code	4500708
Hospital Revenue Code	341
Min. Negotiated Rate	$178.02
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	$178.02
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 TUMOR LOCALIZATION (SPECT)

Facility

$12,000.00

Service Code	HCPCS 78803
Hospital Charge Code	4500708
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 TUMOR LOCALIZ - WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78802
Hospital Charge Code	4500674
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 TUMOR LOCALIZ - WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78802
Hospital Charge Code	4500674
Hospital Revenue Code	341
Min. Negotiated Rate	$112.20
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	$112.20
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 TUMOR LOCALIZ WHOLE ZEVALIN

Facility

$2,248.00

Service Code	HCPCS 78802
Hospital Charge Code	4500685
Hospital Revenue Code	341
Min. Negotiated Rate	$337.20
Max. Negotiated Rate	$337.20
Rate for Payer: Qualcare PPO/HMO/WC	$337.20

NM TUMOR LOCALIZ WHOLE ZEVALIN

Facility

$2,248.00

Service Code	HCPCS 78802
Hospital Charge Code	4500685
Hospital Revenue Code	341
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$674.40
Rate for Payer: Aetna Medicare Advantage	$674.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.24
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.24
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.20
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM TUMOR WHOLE BODY 2+DAYS IMG

Facility

$12,000.00

Service Code	HCPCS 78804
Hospital Charge Code	406078804
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 TUMOR WHOLE BODY 2+DAYS IMG

Facility

$12,000.00

Service Code	HCPCS 78804
Hospital Charge Code	406078804
Hospital Revenue Code	341
Min. Negotiated Rate	$367.83
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	$367.83
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 URETERAL REFLUX STUDY

Facility

$1,148.00

Service Code	HCPCS 78740
Hospital Charge Code	4500609
Hospital Revenue Code	341
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$172.20
Rate for Payer: Qualcare PPO/HMO/WC	$172.20

NM URETERAL REFLUX STUDY

Facility

$1,148.00

Service Code	HCPCS 78740
Hospital Charge Code	4500609
Hospital Revenue Code	341
Min. Negotiated Rate	$93.50
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) NJ Health	$93.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$292.74
Rate for Payer: Cigna Commercial	$952.02
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 URNARY BLDDER RESIDUAL STDY

Facility

$217.60

Service Code	HCPCS 78730
Hospital Charge Code	4501016
Hospital Revenue Code	341
Min. Negotiated Rate	$28.29
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$65.28
Rate for Payer: Aetna Medicare Advantage	$65.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.49
Rate for Payer: Cigna Commercial	$84.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.29
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.64
Rate for Payer: UnitedHealthcare Commercial	$3,540.00

NM URNARY BLDDER RESIDUAL STDY

Facility

$217.60

Service Code	HCPCS 78730
Hospital Charge Code	4501016
Hospital Revenue Code	341
Min. Negotiated Rate	$32.64
Max. Negotiated Rate	$32.64
Rate for Payer: Qualcare PPO/HMO/WC	$32.64

Know your out-of-pocket cost for care.

All Charges