Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI BIOPSY PANCREAS

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400563
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI BIOPSY PANCREAS

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400563
Hospital Revenue Code	610
Min. Negotiated Rate	$209.22
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$542.48
Rate for Payer: Aetna Medicare Advantage	$542.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$490.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.07
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BIOPSY PLEURA LEFT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400564
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI BIOPSY PLEURA LEFT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400564
Hospital Revenue Code	610
Min. Negotiated Rate	$209.22
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$542.48
Rate for Payer: Aetna Medicare Advantage	$542.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$490.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.07
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BIOPSY PLEURA RIGHT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400565
Hospital Revenue Code	610
Min. Negotiated Rate	$209.22
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$542.48
Rate for Payer: Aetna Medicare Advantage	$542.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$490.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.07
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BIOPSY PLEURA RIGHT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400565
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI BIOPSY RENAL LEFT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400566
Hospital Revenue Code	610
Min. Negotiated Rate	$209.22
Max. Negotiated Rate	$3,989.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: Aetna Commercial	$542.48
Rate for Payer: Aetna Medicare Advantage	$542.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$490.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.07
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BIOPSY RENAL LEFT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400566
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI BIOPSY RENAL RIGHT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400567
Hospital Revenue Code	610
Min. Negotiated Rate	$209.22
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$542.48
Rate for Payer: Aetna Medicare Advantage	$542.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$490.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.07
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BIOPSY RENAL RIGHT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400567
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI BONE MARROW BLOOD SUPPLY

Facility

$2,588.75

Service Code	HCPCS 77084
Hospital Charge Code	2400364
Hospital Revenue Code	614
Min. Negotiated Rate	$388.31
Max. Negotiated Rate	$388.31
Rate for Payer: Qualcare PPO/HMO/WC	$388.31

MRI BONE MARROW BLOOD SUPPLY

Facility

$2,588.75

Service Code	HCPCS 77084
Hospital Charge Code	2400364
Hospital Revenue Code	614
Min. Negotiated Rate	$232.89
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$776.62
Rate for Payer: Aetna Medicare Advantage	$776.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$660.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$660.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$660.13
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.54
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$388.31
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BRAIN IAC WITH CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70558
Hospital Charge Code	2400587
Hospital Revenue Code	611
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRI BRAIN IAC WITH CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70558
Hospital Charge Code	2400587
Hospital Revenue Code	611
Min. Negotiated Rate	$417.70
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	$853.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$417.70
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 BRAIN IAC WITHOUT CONTRAST

Facility

$2,080.60

Service Code	HCPCS 70557
Hospital Charge Code	2400588
Hospital Revenue Code	611
Min. Negotiated Rate	$270.48
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$624.18
Rate for Payer: Aetna Medicare Advantage	$624.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$771.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$530.55
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.48
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.09
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BRAIN IAC WITHOUT CONTRAST

Facility

$2,080.60

Service Code	HCPCS 70557
Hospital Charge Code	2400588
Hospital Revenue Code	611
Min. Negotiated Rate	$312.09
Max. Negotiated Rate	$312.09
Rate for Payer: Qualcare PPO/HMO/WC	$312.09

MRI BRAIN IAC W & W/O CONTRAST

Facility

$3,155.25

Service Code	HCPCS 70559
Hospital Charge Code	2400589
Hospital Revenue Code	611
Min. Negotiated Rate	$473.29
Max. Negotiated Rate	$473.29
Rate for Payer: Qualcare PPO/HMO/WC	$473.29

MRI BRAIN IAC W & W/O CONTRAST

Facility

$3,155.25

Service Code	HCPCS 70559
Hospital Charge Code	2400589
Hospital Revenue Code	611
Min. Negotiated Rate	$410.18
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$946.58
Rate for Payer: Aetna Medicare Advantage	$946.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$804.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$804.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$804.59
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.18
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$473.29
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BRAIN NEUROQUANT

Facility

$1,145.00

Service Code	HCPCS 0865T
Hospital Charge Code	40610865T
Hospital Revenue Code	614
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

MRI BRAIN NEUROQUANT

Facility

$1,145.00

Service Code	HCPCS 0865T
Hospital Charge Code	40610865T
Hospital Revenue Code	614
Min. Negotiated Rate	$148.85
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$343.50
Rate for Payer: Aetna Medicare Advantage	$343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.98
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.85
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.75
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BRAIN PITUITARY W/CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70552
Hospital Charge Code	2400591
Hospital Revenue Code	611
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI BRAIN PITUITARY W/CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70552
Hospital Charge Code	2400591
Hospital Revenue Code	611
Min. Negotiated Rate	$658.24
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Better Health Medicaid	$1,512.95
Rate for Payer: Aetna Commercial	$1,760.04
Rate for Payer: Aetna Medicare Advantage	$1,760.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$658.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.03
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.68
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$880.02
Rate for Payer: UnitedHealthcare Commercial	$3,989.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,543.21

MRI BRAIN PITUITARY W/O CNTRST

Facility

$9,109.53

Service Code	HCPCS 70551
Hospital Charge Code	2400592
Hospital Revenue Code	611
Min. Negotiated Rate	$1,366.43
Max. Negotiated Rate	$1,366.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,366.43

MRI BRAIN PITUITARY W/O CNTRST

Facility

$9,109.53

Service Code	HCPCS 70551
Hospital Charge Code	2400592
Hospital Revenue Code	611
Min. Negotiated Rate	$568.20
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$2,732.86
Rate for Payer: Aetna Medicare Advantage	$2,732.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,322.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,322.93
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	$2,322.93
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,184.24
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,366.43
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BRAIN PIT W & W/O CONTRAST

Facility

$9,326.42

Service Code	HCPCS 70553
Hospital Charge Code	2400590
Hospital Revenue Code	611
Min. Negotiated Rate	$830.80
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$2,797.93
Rate for Payer: Aetna Medicare Advantage	$2,797.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,378.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,378.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,017.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,378.24
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,212.43
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,398.96
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

Know your out-of-pocket cost for care.

All Charges