Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 MYOCARD IMAG METAB EVAL

Facility

$18,188.25

Service Code	HCPCS 78459
Hospital Charge Code	4501028
Hospital Revenue Code	404
Min. Negotiated Rate	$227.65
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$5,456.48
Rate for Payer: Aetna Medicare Advantage	$5,456.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,638.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,638.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,638.00
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,364.47
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET MYOCARD IMAG METAB EVAL

Facility

$18,188.25

Service Code	HCPCS 78459
Hospital Charge Code	4501028
Hospital Revenue Code	404
Min. Negotiated Rate	$2,728.24
Max. Negotiated Rate	$2,728.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24

PET MYOCARD IMAG MPL REST/STRE

Facility

$18,188.25

Service Code	HCPCS 78492
Hospital Charge Code	4501030
Hospital Revenue Code	404
Min. Negotiated Rate	$2,728.24
Max. Negotiated Rate	$2,728.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24

PET MYOCARD IMAG MPL REST/STRE

Facility

$18,188.25

Service Code	HCPCS 78492
Hospital Charge Code	4501030
Hospital Revenue Code	404
Min. Negotiated Rate	$263.67
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$5,456.48
Rate for Payer: Aetna Medicare Advantage	$5,456.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,638.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,638.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$263.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,638.00
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,364.47
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET MYOCARD IMAG SGL REST/STRE

Facility

$18,188.25

Service Code	HCPCS 78491
Hospital Charge Code	4501029
Hospital Revenue Code	404
Min. Negotiated Rate	$218.79
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$5,456.48
Rate for Payer: Aetna Medicare Advantage	$5,456.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,638.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,638.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,638.00
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,364.47
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET MYOCARD IMAG SGL REST/STRE

Facility

$18,188.25

Service Code	HCPCS 78491
Hospital Charge Code	4501029
Hospital Revenue Code	404
Min. Negotiated Rate	$2,728.24
Max. Negotiated Rate	$2,728.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.24

PETONEAL LAVAGE

Facility

$5,762.80

Service Code	HCPCS 49084
Hospital Charge Code	1600000344
Hospital Revenue Code	360
Min. Negotiated Rate	$749.16
Max. Negotiated Rate	$3,687.00
Rate for Payer: Aetna Commercial	$1,728.84
Rate for Payer: Aetna Medicare Advantage	$1,728.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,469.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,469.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,469.51
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.16
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$864.42
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

PETONEAL LAVAGE

Facility

$5,762.80

Service Code	HCPCS 49084
Hospital Charge Code	1600000344
Hospital Revenue Code	360
Min. Negotiated Rate	$864.42
Max. Negotiated Rate	$864.42
Rate for Payer: Qualcare PPO/HMO/WC	$864.42

PETROLATUM/30GM

Facility

$2.00

Hospital Charge Code	60633644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

PETROLATUM/30GM

Facility

$2.00

Hospital Charge Code	60633644
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.60
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$1.00

PETROLATUM JELLY(368G)

Facility

$6.70

Service Code	NDC 904573182
Hospital Charge Code	6063943229
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.01
Rate for Payer: Aetna Medicare Advantage	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.87
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$3.35

PETROLATUM JELLY(368G)

Facility

$6.70

Service Code	NDC 904573182
Hospital Charge Code	6063943229
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

PETROLATUM MINERL OIL OIN100GM

Facility

$36.52

Service Code	NDC 54162050002
Hospital Charge Code	60628315
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$18.26
Rate for Payer: Aetna Commercial	$10.96
Rate for Payer: Aetna Medicare Advantage	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.31
Rate for Payer: Cigna Commercial	$18.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.75
Rate for Payer: Oxford Commercial	$18.26
Rate for Payer: Qualcare PPO/HMO/WC	$5.48
Rate for Payer: UnitedHealthcare Commercial	$18.26

PETROLATUM MINERL OIL OIN100GM

Facility

$36.52

Service Code	NDC 54162050002
Hospital Charge Code	60628315
Hospital Revenue Code	250
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$5.48

PETROLATUM OINTMENT 454G TOP

Facility

$39.70

Hospital Charge Code	60629147
Hospital Revenue Code	250
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$5.96

PETROLATUM OINTMENT 454G TOP

Facility

$39.70

Hospital Charge Code	60629147
Hospital Revenue Code	250
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$19.85
Rate for Payer: Aetna Commercial	$11.91
Rate for Payer: Aetna Medicare Advantage	$11.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.12
Rate for Payer: Cigna Commercial	$19.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.16
Rate for Payer: Oxford Commercial	$19.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.96
Rate for Payer: UnitedHealthcare Commercial	$19.85

PETROLATUM OINT OPH 3.5GM

Facility

$15.40

Hospital Charge Code	6009997
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

PETROLATUM OINT OPH 3.5GM

Facility

$15.40

Hospital Charge Code	6009997
Hospital Revenue Code	251
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

PETROLATUM TOPICAL 100% OINT

Facility

$4.00

Service Code	NDC 168005345
Hospital Charge Code	6004170
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PETROLATUM TOPICAL 100% OINT

Facility

$4.00

Service Code	NDC 168005345
Hospital Charge Code	6004170
Hospital Revenue Code	251
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$2.00

PET W CT ATTENU CORR WHL BODY

Facility

$13,724.25

Service Code	HCPCS 78816
Hospital Charge Code	4501027
Hospital Revenue Code	404
Min. Negotiated Rate	$2,058.64
Max. Negotiated Rate	$2,058.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64

PET W CT ATTENU CORR WHL BODY

Facility

$13,724.25

Service Code	HCPCS 78816
Hospital Charge Code	4501027
Hospital Revenue Code	404
Min. Negotiated Rate	$1,784.15
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$4,117.27
Rate for Payer: Aetna Medicare Advantage	$4,117.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,499.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,499.68
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	$3,499.68
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.15
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,058.64
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET W CT ATTENU LOC IM LIM ARE

Facility

$13,649.25

Service Code	HCPCS 78814
Hospital Charge Code	4501025
Hospital Revenue Code	404
Min. Negotiated Rate	$1,774.40
Max. Negotiated Rate	$11,611.00
Rate for Payer: Aetna Commercial	$4,094.78
Rate for Payer: Aetna Medicare Advantage	$4,094.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,480.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,480.56
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	$3,480.56
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,774.40
Rate for Payer: Oxford Commercial	$10,230.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,047.39
Rate for Payer: UnitedHealthcare Commercial	$11,611.00

PET W CT ATTENU LOC IM LIM ARE

Facility

$13,649.25

Service Code	HCPCS 78814
Hospital Charge Code	4501025
Hospital Revenue Code	404
Min. Negotiated Rate	$2,047.39
Max. Negotiated Rate	$2,047.39
Rate for Payer: Qualcare PPO/HMO/WC	$2,047.39

Know your out-of-pocket cost for care.

All Charges