Heights University Hospital

All Charges

Charge

Type

Setting

Price

MR GUID FOR TISSUE ABLATION

Facility

$3,038.75

Service Code	HCPCS 77022
Hospital Charge Code	2400030
Hospital Revenue Code	610
Min. Negotiated Rate	$455.81
Max. Negotiated Rate	$455.81
Rate for Payer: Qualcare PPO/HMO/WC	$455.81

MR GUID FOR TISSUE ABLATION

Facility

$3,038.75

Service Code	HCPCS 77022
Hospital Charge Code	2400030
Hospital Revenue Code	610
Min. Negotiated Rate	$208.56
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$911.62
Rate for Payer: Aetna Medicare Advantage	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$774.88
Rate for Payer: Cigna Commercial	$1,519.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$395.04
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$455.81
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI 3D RECON W/O IND WKSTATION

Facility

$650.00

Service Code	HCPCS 76376
Hospital Charge Code	2400606
Hospital Revenue Code	610
Min. Negotiated Rate	$28.74
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$28.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI 3D RECON W/O IND WKSTATION

Facility

$650.00

Service Code	HCPCS 76376
Hospital Charge Code	2400606
Hospital Revenue Code	610
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

MRI ABDOMEM W/ C

Facility

$13,500.00

Service Code	HCPCS 74182
Hospital Charge Code	2400308
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

MRI ABDOMEM W/ C

Facility

$13,500.00

Service Code	HCPCS 74182
Hospital Charge Code	2400308
Hospital Revenue Code	614
Min. Negotiated Rate	$579.70
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) NJ Health	$579.70
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

MRI-ABDOMEN

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	94061129
Hospital Revenue Code	614
Min. Negotiated Rate	$568.20
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) NJ Health	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$568.20
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

MRI-ABDOMEN

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	94061129
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

MRI ABDOMEN W/O CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	2400307
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

MRI ABDOMEN W/O CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	2400307
Hospital Revenue Code	614
Min. Negotiated Rate	$568.20
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) NJ Health	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$568.20
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

MRI ABDOMEN WO/W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74183
Hospital Charge Code	94061131
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) NJ Health	$916.82
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

MRI ABDOMEN WO/W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74183
Hospital Charge Code	94061131
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

MRI ABDOMEN W/WO C

Facility

$13,500.00

Service Code	HCPCS 74183
Hospital Charge Code	2400309
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) NJ Health	$916.82
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

MRI ABDOMEN W/WO C

Facility

$13,500.00

Service Code	HCPCS 74183
Hospital Charge Code	2400309
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

MRI ANKLE W/CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400423
Hospital Revenue Code	614
Min. Negotiated Rate	$574.73
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,326.30
Rate for Payer: Aetna Medicare Advantage	$1,326.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,127.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,127.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,127.36
Rate for Payer: Cigna Commercial	$2,210.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.73
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$663.15
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ANKLE W/CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400423
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI ANKLE W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73722LT
Hospital Charge Code	2400424
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI ANKLE W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73722LT
Hospital Charge Code	2400424
Hospital Revenue Code	614
Min. Negotiated Rate	$287.37
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$663.15
Rate for Payer: Aetna Medicare Advantage	$663.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.68
Rate for Payer: Cigna Commercial	$1,105.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.37
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$331.57
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ANKLE W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73722RT
Hospital Charge Code	2400425
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI ANKLE W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73722RT
Hospital Charge Code	2400425
Hospital Revenue Code	614
Min. Negotiated Rate	$287.37
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$663.15
Rate for Payer: Aetna Medicare Advantage	$663.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.68
Rate for Payer: Cigna Commercial	$1,105.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.37
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$331.57
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ANKLE W/O CONTRAST BILTERL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400426
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

MRI ANKLE W/O CONTRAST BILTERL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400426
Hospital Revenue Code	614
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

MRI ANKLE W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400427
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

MRI ANKLE W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400427
Hospital Revenue Code	614
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

MRI ANKLE W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400428
Hospital Revenue Code	614
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

Know your out-of-pocket cost for care.

All Charges