Heights University Hospital

All Charges

Charge

Type

Setting

Price

MR ANGIO LOWER EXTREMITY

Facility

$2,354.00

Service Code	HCPCS 73725
Hospital Charge Code	94061123
Hospital Revenue Code	616
Min. Negotiated Rate	$353.10
Max. Negotiated Rate	$353.10
Rate for Payer: Qualcare PPO/HMO/WC	$353.10

MR ANGIO LOWER EXTREMITY

Facility

$2,354.00

Service Code	HCPCS 73725
Hospital Charge Code	94061123
Hospital Revenue Code	616
Min. Negotiated Rate	$306.02
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$706.20
Rate for Payer: Aetna Medicare Advantage	$706.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$600.27
Rate for Payer: Cigna Commercial	$384.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.02
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$353.10
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR ANGIO PELVIS

Facility

$2,354.00

Service Code	HCPCS 72198
Hospital Charge Code	94061097
Hospital Revenue Code	618
Min. Negotiated Rate	$306.02
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$706.20
Rate for Payer: Aetna Medicare Advantage	$706.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$600.27
Rate for Payer: Cigna Commercial	$383.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.02
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$353.10
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR ANGIO PELVIS

Facility

$2,354.00

Service Code	HCPCS 72198
Hospital Charge Code	94061097
Hospital Revenue Code	618
Min. Negotiated Rate	$353.10
Max. Negotiated Rate	$353.10
Rate for Payer: Qualcare PPO/HMO/WC	$353.10

MRA PELVIS W/ CONT

Facility

$1,944.80

Service Code	HCPCS 72198
Hospital Charge Code	2400230
Hospital Revenue Code	618
Min. Negotiated Rate	$252.82
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$583.44
Rate for Payer: Aetna Medicare Advantage	$583.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.92
Rate for Payer: Cigna Commercial	$383.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.82
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$291.72
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA PELVIS W/ CONT

Facility

$1,944.80

Service Code	HCPCS 72198
Hospital Charge Code	2400230
Hospital Revenue Code	618
Min. Negotiated Rate	$291.72
Max. Negotiated Rate	$291.72
Rate for Payer: Qualcare PPO/HMO/WC	$291.72

MRA PELVIS W & W/O CONT

Facility

$1,944.80

Service Code	HCPCS 72198
Hospital Charge Code	2400232
Hospital Revenue Code	618
Min. Negotiated Rate	$291.72
Max. Negotiated Rate	$291.72
Rate for Payer: Qualcare PPO/HMO/WC	$291.72

MRA PELVIS W & W/O CONT

Facility

$1,944.80

Service Code	HCPCS 72198
Hospital Charge Code	2400232
Hospital Revenue Code	618
Min. Negotiated Rate	$252.82
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$583.44
Rate for Payer: Aetna Medicare Advantage	$583.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.92
Rate for Payer: Cigna Commercial	$383.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.82
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$291.72
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA SPINAL CANAL W/OR W/O CONT

Facility

$1,354.45

Service Code	HCPCS 72159
Hospital Charge Code	2400216
Hospital Revenue Code	618
Min. Negotiated Rate	$176.08
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$406.33
Rate for Payer: Aetna Medicare Advantage	$406.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.38
Rate for Payer: Cigna Commercial	$385.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.08
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.17
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA SPINAL CANAL W/OR W/O CONT

Facility

$1,354.45

Service Code	HCPCS 72159
Hospital Charge Code	2400216
Hospital Revenue Code	618
Min. Negotiated Rate	$203.17
Max. Negotiated Rate	$203.17
Rate for Payer: Qualcare PPO/HMO/WC	$203.17

MRA UPPER EXT W CONTRAST

Facility

$2,043.00

Service Code	HCPCS 73225
Hospital Charge Code	2408005
Hospital Revenue Code	618
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

MRA UPPER EXT W CONTRAST

Facility

$2,043.00

Service Code	HCPCS 73225
Hospital Charge Code	2408005
Hospital Revenue Code	618
Min. Negotiated Rate	$265.59
Max. Negotiated Rate	$3,989.00
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	$469.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.97
Rate for Payer: Cigna Commercial	$369.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.59
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.45
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA UPP EXTR W CONTR LT

Facility

$2,043.25

Service Code	HCPCS 73225LT
Hospital Charge Code	2400263
Hospital Revenue Code	618
Min. Negotiated Rate	$306.49
Max. Negotiated Rate	$306.49
Rate for Payer: Qualcare PPO/HMO/WC	$306.49

MRA UPP EXTR W CONTR LT

Facility

$2,043.25

Service Code	HCPCS 73225LT
Hospital Charge Code	2400263
Hospital Revenue Code	618
Min. Negotiated Rate	$265.62
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$612.98
Rate for Payer: Aetna Medicare Advantage	$612.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.03
Rate for Payer: Cigna Commercial	$1,021.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.62
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.49
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA UPP EXTR W/ CONTR RT

Facility

$2,043.25

Service Code	HCPCS 73225RT
Hospital Charge Code	2400264
Hospital Revenue Code	618
Min. Negotiated Rate	$306.49
Max. Negotiated Rate	$306.49
Rate for Payer: Qualcare PPO/HMO/WC	$306.49

MRA UPP EXTR W/ CONTR RT

Facility

$2,043.25

Service Code	HCPCS 73225RT
Hospital Charge Code	2400264
Hospital Revenue Code	618
Min. Negotiated Rate	$265.62
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$612.98
Rate for Payer: Aetna Medicare Advantage	$612.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.03
Rate for Payer: Cigna Commercial	$1,021.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.62
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.49
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA UPP EXTR W/O CONTR LT

Facility

$2,043.25

Service Code	HCPCS 73225LT
Hospital Charge Code	2400261
Hospital Revenue Code	618
Min. Negotiated Rate	$306.49
Max. Negotiated Rate	$306.49
Rate for Payer: Qualcare PPO/HMO/WC	$306.49

MRA UPP EXTR W/O CONTR LT

Facility

$2,043.25

Service Code	HCPCS 73225LT
Hospital Charge Code	2400261
Hospital Revenue Code	618
Min. Negotiated Rate	$265.62
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$612.98
Rate for Payer: Aetna Medicare Advantage	$612.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.03
Rate for Payer: Cigna Commercial	$1,021.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.62
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.49
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA UPP EXTR W/O CONTR RT

Facility

$2,043.25

Service Code	HCPCS 73225RT
Hospital Charge Code	2400262
Hospital Revenue Code	618
Min. Negotiated Rate	$265.62
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$612.98
Rate for Payer: Aetna Medicare Advantage	$612.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.03
Rate for Payer: Cigna Commercial	$1,021.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.62
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.49
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA UPP EXTR W/O CONTR RT

Facility

$2,043.25

Service Code	HCPCS 73225RT
Hospital Charge Code	2400262
Hospital Revenue Code	618
Min. Negotiated Rate	$306.49
Max. Negotiated Rate	$306.49
Rate for Payer: Qualcare PPO/HMO/WC	$306.49

MRA UPP EXTR W/ & W/O CONT RT

Facility

$13,500.00

Service Code	HCPCS 73225RT
Hospital Charge Code	2400266
Hospital Revenue Code	618
Min. Negotiated Rate	$1,755.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,755.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRA UPP EXTR W/ & W/O CONT RT

Facility

$13,500.00

Service Code	HCPCS 73225RT
Hospital Charge Code	2400266
Hospital Revenue Code	618
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MR BREAST BI W/ C

Facility

$13,500.00

Service Code	HCPCS C8906
Hospital Charge Code	2400381
Hospital Revenue Code	614
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MR BREAST BI W/ C

Facility

$13,500.00

Service Code	HCPCS C8906
Hospital Charge Code	2400381
Hospital Revenue Code	614
Min. Negotiated Rate	$830.80
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Commercial	$4,050.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,755.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MR BREAST BI W/O C

Facility

$1,706.45

Service Code	HCPCS C8907
Hospital Charge Code	2400382
Hospital Revenue Code	614
Min. Negotiated Rate	$255.97
Max. Negotiated Rate	$255.97
Rate for Payer: Qualcare PPO/HMO/WC	$255.97

Know your out-of-pocket cost for care.

All Charges