Heights University Hospital

All Charges

Charge

Type

Setting

Price

TC99M SC FILTER/DOSE TO 20 MCI

Facility

$1,340.00

Service Code	HCPCS A9541
Hospital Charge Code	4509070
Hospital Revenue Code	343
Min. Negotiated Rate	$166.43
Max. Negotiated Rate	$670.00
Rate for Payer: Aetna Commercial	$402.00
Rate for Payer: Aetna Medicare Advantage	$402.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$341.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$341.70
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	$341.70
Rate for Payer: Cigna Commercial	$670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.20
Rate for Payer: Qualcare PPO/HMO/WC	$201.00

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	74117066
Hospital Revenue Code	343
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.41
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	74116066
Hospital Revenue Code	343
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	94053150
Hospital Revenue Code	343
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	74116066
Hospital Revenue Code	343
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.41
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$140.00

Service Code	HCPCS A9500
Hospital Charge Code	5309015
Hospital Revenue Code	343
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$100.74
Rate for Payer: Aetna Commercial	$42.00
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	94053150
Hospital Revenue Code	343
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.41
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Service Code	HCPCS A9500
Hospital Charge Code	74115066
Hospital Revenue Code	343
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Service Code	HCPCS A9500
Hospital Charge Code	74115066
Hospital Revenue Code	343
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.41
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$357.00

Hospital Charge Code	74117066
Hospital Revenue Code	343
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

TC99M SESTAMIBI PER STUDY

Facility

$140.00

Service Code	HCPCS A9500
Hospital Charge Code	5309015
Hospital Revenue Code	343
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TC99M SULFUR COLLOID =/< 20MCI

Facility

$1,030.84

Service Code	HCPCS A9541
Hospital Charge Code	4509089
Hospital Revenue Code	343
Min. Negotiated Rate	$134.01
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$309.25
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
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	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.01
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC99M SULFUR COLLOID =/< 20MCI

Facility

$1,030.84

Service Code	HCPCS A9541
Hospital Charge Code	4509089
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74115074
Hospital Revenue Code	343
Min. Negotiated Rate	$96.94
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$309.25
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.01
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	94053151
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	5309020
Hospital Revenue Code	343
Min. Negotiated Rate	$96.94
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$309.25
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.01
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74116074
Hospital Revenue Code	343
Min. Negotiated Rate	$96.94
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$309.25
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.01
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	5309020
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74115074
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74117074
Hospital Revenue Code	343
Min. Negotiated Rate	$96.94
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$309.25
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.01
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74117074
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	94053151
Hospital Revenue Code	343
Min. Negotiated Rate	$96.94
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$309.25
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.01
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC 99M TETROFOSMIN PER DS

Facility

$1,030.84

Service Code	HCPCS A9502
Hospital Charge Code	74116074
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC99 OXIDRONATE UP TO 30MCI

Facility

$97.78

Service Code	HCPCS A9561
Hospital Charge Code	4509084
Hospital Revenue Code	343
Min. Negotiated Rate	$14.67
Max. Negotiated Rate	$14.67
Rate for Payer: Qualcare PPO/HMO/WC	$14.67

TC99 OXIDRONATE UP TO 30MCI

Facility

$97.78

Service Code	HCPCS A9561
Hospital Charge Code	4509084
Hospital Revenue Code	343
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$82.28
Rate for Payer: Aetna Commercial	$29.33
Rate for Payer: Aetna Medicare Advantage	$29.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.93
Rate for Payer: Cigna Commercial	$48.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.71
Rate for Payer: Qualcare PPO/HMO/WC	$14.67

Know your out-of-pocket cost for care.

All Charges