Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$1,398.96
Max. Negotiated Rate	$1,398.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,398.96

MRI BRAIN W/ CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70552
Hospital Charge Code	2400083
Hospital Revenue Code	611
Min. Negotiated Rate	$658.24
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Better Health Medicaid	$1,512.95
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	$658.24
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,543.21

MRI BRAIN W/ CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70552
Hospital Charge Code	2400083
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 WO CONT PORT SWOOP

Facility

$13,500.00

Service Code	HCPCS 70551
Hospital Charge Code	404570551
Hospital Revenue Code	611
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 BRAIN WO CONT PORT SWOOP

Facility

$13,500.00

Service Code	HCPCS 70551
Hospital Charge Code	404570551
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 W/O CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70551
Hospital Charge Code	2400075
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 W/O CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70551
Hospital Charge Code	2400075
Hospital Revenue Code	611
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 BRAIN W/O & W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70553
Hospital Charge Code	2400091
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 W/O & W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70553
Hospital Charge Code	2400091
Hospital Revenue Code	611
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	$1,017.45
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 BRAIN W/STEM W/CONT

Facility

$13,500.00

Service Code	HCPCS 70552
Hospital Charge Code	94061033
Hospital Revenue Code	611
Min. Negotiated Rate	$658.24
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Better Health Medicaid	$1,512.95
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	$658.24
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,543.21

MRI BRAIN W/STEM W/CONT

Facility

$13,500.00

Service Code	HCPCS 70552
Hospital Charge Code	94061033
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 W/STEM W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70551
Hospital Charge Code	94061031
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 W/STEM W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70551
Hospital Charge Code	94061031
Hospital Revenue Code	611
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 BRAIN W/STEM WO/W CON

Facility

$13,500.00

Service Code	HCPCS 70553
Hospital Charge Code	94061499
Hospital Revenue Code	611
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	$1,017.45
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 BRAIN W/STEM WO/W CON

Facility

$13,500.00

Service Code	HCPCS 70553
Hospital Charge Code	94061035
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 W/STEM WO/W CON

Facility

$13,500.00

Service Code	HCPCS 70553
Hospital Charge Code	94061035
Hospital Revenue Code	611
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	$1,017.45
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 BRAIN W/STEM WO/W CON

Facility

$13,500.00

Service Code	HCPCS 70553
Hospital Charge Code	94061499
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 BREAST BILATERAL

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	94061463
Hospital Revenue Code	614
Min. Negotiated Rate	$660.08
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,523.25
Rate for Payer: Aetna Medicare Advantage	$1,523.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.76
Rate for Payer: Cigna Commercial	$2,538.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.08
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.62
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BREAST BILATERAL

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	2400380
Hospital Revenue Code	614
Min. Negotiated Rate	$660.08
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,523.25
Rate for Payer: Aetna Medicare Advantage	$1,523.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.76
Rate for Payer: Cigna Commercial	$2,538.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.08
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.62
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BREAST BILATERAL

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	94061463
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MRI BREAST BILATERAL

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	2400380
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MRI BREAST BILAT W CONTRAST

Facility

$5,078.00

Service Code	HCPCS 77059LT
Hospital Charge Code	2408030
Hospital Revenue Code	614
Min. Negotiated Rate	$761.70
Max. Negotiated Rate	$761.70
Rate for Payer: Qualcare PPO/HMO/WC	$761.70

MRI BREAST BILAT W CONTRAST

Facility

$5,078.00

Service Code	HCPCS 77059LT
Hospital Charge Code	2408030
Hospital Revenue Code	614
Min. Negotiated Rate	$660.14
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,523.40
Rate for Payer: Aetna Medicare Advantage	$1,523.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.89
Rate for Payer: Cigna Commercial	$2,539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.14
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.70
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI BREAST NEEDLE BIOPSY

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2400593
Hospital Revenue Code	361
Min. Negotiated Rate	$129.51
Max. Negotiated Rate	$3,933.12
Rate for Payer: Aetna Commercial	$298.88
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
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	$254.04
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.51
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$3,687.00

MRI BREAST NEEDLE BIOPSY

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2400593
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

Know your out-of-pocket cost for care.

All Charges