Heights University Hospital

All Charges

Charge

Type

Setting

Price

PET IMAGE W/CT LMTD - GLOBAL

Facility

$6,849.47

Service Code	HCPCS 78814
Hospital Charge Code	80000001
Hospital Revenue Code	404
Min. Negotiated Rate	$890.43
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$2,054.84
Rate for Payer: Aetna Medicare Advantage	$2,054.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.61
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.43
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.42
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT LMTD - GLOBAL

Facility

$6,849.47

Service Code	HCPCS 78814
Hospital Charge Code	80000001
Hospital Revenue Code	404
Min. Negotiated Rate	$1,027.42
Max. Negotiated Rate	$1,027.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.42

PET IMAGE W/CT LMTD- GLOBAL

Facility

$6,849.47

Service Code	HCPCS 78816
Hospital Charge Code	80000030
Hospital Revenue Code	404
Min. Negotiated Rate	$1,027.42
Max. Negotiated Rate	$1,027.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.42

PET IMAGE W/CT LMTD- GLOBAL

Facility

$6,849.47

Service Code	HCPCS 78816
Hospital Charge Code	80000030
Hospital Revenue Code	404
Min. Negotiated Rate	$890.43
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$2,054.84
Rate for Payer: Aetna Medicare Advantage	$2,054.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,746.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,746.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,746.61
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$890.43
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,027.42
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT LMTD - PC

Facility

$585.90

Service Code	HCPCS 7881426
Hospital Charge Code	80000010
Hospital Revenue Code	404
Min. Negotiated Rate	$87.89
Max. Negotiated Rate	$87.89
Rate for Payer: Qualcare PPO/HMO/WC	$87.89

PET IMAGE W/CT LMTD - PC

Facility

$585.90

Service Code	HCPCS 7881426
Hospital Charge Code	80000010
Hospital Revenue Code	404
Min. Negotiated Rate	$76.17
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$175.77
Rate for Payer: Aetna Medicare Advantage	$175.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.40
Rate for Payer: Cigna Commercial	$292.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.17
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.89
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT LMTD- PC

Facility

$652.85

Service Code	HCPCS 7881626
Hospital Charge Code	80000040
Hospital Revenue Code	404
Min. Negotiated Rate	$84.87
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$195.85
Rate for Payer: Aetna Medicare Advantage	$195.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.48
Rate for Payer: Cigna Commercial	$326.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.87
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.93
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT LMTD- PC

Facility

$652.85

Service Code	HCPCS 7881626
Hospital Charge Code	80000040
Hospital Revenue Code	404
Min. Negotiated Rate	$97.93
Max. Negotiated Rate	$97.93
Rate for Payer: Qualcare PPO/HMO/WC	$97.93

PET IMAGE W/CT LMTD -TC

Facility

$6,147.90

Service Code	HCPCS 78814
Hospital Charge Code	80000005
Hospital Revenue Code	404
Min. Negotiated Rate	$799.23
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$1,844.37
Rate for Payer: Aetna Medicare Advantage	$1,844.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,567.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,567.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,567.71
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$799.23
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$922.18
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT LMTD -TC

Facility

$6,147.90

Service Code	HCPCS 78814
Hospital Charge Code	80000005
Hospital Revenue Code	404
Min. Negotiated Rate	$922.18
Max. Negotiated Rate	$922.18
Rate for Payer: Qualcare PPO/HMO/WC	$922.18

PET IMAGE W/CT LMTD- TC

Facility

$6,147.90

Service Code	HCPCS 78816
Hospital Charge Code	80000035
Hospital Revenue Code	404
Min. Negotiated Rate	$799.23
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$1,844.37
Rate for Payer: Aetna Medicare Advantage	$1,844.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,567.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,567.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,567.71
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$799.23
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$922.18
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT LMTD- TC

Facility

$6,147.90

Service Code	HCPCS 78816
Hospital Charge Code	80000035
Hospital Revenue Code	404
Min. Negotiated Rate	$922.18
Max. Negotiated Rate	$922.18
Rate for Payer: Qualcare PPO/HMO/WC	$922.18

PET IMAGE W/CT LTD - PI

Facility

$40,000.00

Service Code	HCPCS 78816PI
Hospital Charge Code	80000030PI
Hospital Revenue Code	404
Min. Negotiated Rate	$5,200.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT LTD - PI

Facility

$40,000.00

Service Code	HCPCS 78816PI
Hospital Charge Code	80000030PI
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMAGE W/CT LTD- PS

Facility

$40,000.00

Service Code	HCPCS 78816PS
Hospital Charge Code	80000030PS
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMAGE W/CT LTD- PS

Facility

$40,000.00

Service Code	HCPCS 78816PS
Hospital Charge Code	80000030PS
Hospital Revenue Code	404
Min. Negotiated Rate	$5,200.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT SKULL-THIGH-PC

Facility

$648.25

Service Code	HCPCS 7881526
Hospital Charge Code	80000025
Hospital Revenue Code	404
Min. Negotiated Rate	$84.27
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$194.47
Rate for Payer: Aetna Medicare Advantage	$194.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.30
Rate for Payer: Cigna Commercial	$324.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.27
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.24
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT SKULL-THIGH-PC

Facility

$648.25

Service Code	HCPCS 7881526
Hospital Charge Code	80000025
Hospital Revenue Code	404
Min. Negotiated Rate	$97.24
Max. Negotiated Rate	$97.24
Rate for Payer: Qualcare PPO/HMO/WC	$97.24

PET IMAGE W/CT SKULL-THIGH-PI

Facility

$40,000.00

Service Code	HCPCS 78815PI
Hospital Charge Code	80000015PI
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMAGE W/CT SKULL-THIGH-PI

Facility

$40,000.00

Service Code	HCPCS 78815PI
Hospital Charge Code	80000015PI
Hospital Revenue Code	404
Min. Negotiated Rate	$5,200.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMAGE W/CT SKULL-THIGH- TC

Facility

$6,147.90

Service Code	HCPCS 78815
Hospital Charge Code	80000020
Hospital Revenue Code	404
Min. Negotiated Rate	$922.18
Max. Negotiated Rate	$922.18
Rate for Payer: Qualcare PPO/HMO/WC	$922.18

PET IMAGE W/CT SKULL-THIGH- TC

Facility

$6,147.90

Service Code	HCPCS 78815
Hospital Charge Code	80000020
Hospital Revenue Code	404
Min. Negotiated Rate	$799.23
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$1,844.37
Rate for Payer: Aetna Medicare Advantage	$1,844.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,567.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,567.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,567.71
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$799.23
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$922.18
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMGE W/CT SKULL-THIGH -GL

Facility

$40,000.00

Service Code	HCPCS 78815
Hospital Charge Code	80000015
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMGE W/CT SKULL-THIGH -GL

Facility

$40,000.00

Service Code	HCPCS 78815
Hospital Charge Code	80000015
Hospital Revenue Code	404
Min. Negotiated Rate	$2,019.60
Max. Negotiated Rate	$12,000.00
Rate for Payer: Aetna Commercial	$12,000.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET IMGE W/CT SKULL-THIGH- PS

Facility

$40,000.00

Service Code	HCPCS 78815PS
Hospital Charge Code	80000015PS
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

Know your out-of-pocket cost for care.

All Charges