Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI BREAST NEEDLE LOCALIZATION

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2400594
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 LOCALIZATION

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2400594
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MRI BREAST UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400372
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 UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	94061461
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 UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	94061461
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 UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400372
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 WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	406177047
Hospital Revenue Code	614
Min. Negotiated Rate	$213.50
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	$213.50
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 BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	404577047
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 BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	406177047
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 BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	404577047
Hospital Revenue Code	614
Min. Negotiated Rate	$213.50
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	$213.50
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 BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	404577046
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 BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	404577046
Hospital Revenue Code	614
Min. Negotiated Rate	$208.21
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	$208.21
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 BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	406177046
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 BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	406177046
Hospital Revenue Code	614
Min. Negotiated Rate	$208.21
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	$208.21
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 BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	404577049
Hospital Revenue Code	614
Min. Negotiated Rate	$337.93
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	$337.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$386.29
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 BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406144049
Hospital Revenue Code	614
Min. Negotiated Rate	$337.93
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	$337.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$386.29
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 BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	404577049
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 BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406144049
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 BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77048
Hospital Charge Code	404577048
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 BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406177048
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 BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406177048
Hospital Revenue Code	614
Min. Negotiated Rate	$337.93
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	$337.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$386.29
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 BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77048
Hospital Charge Code	404577048
Hospital Revenue Code	614
Min. Negotiated Rate	$331.25
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	$331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$380.35
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 BRIAN NEURO QUART WITH D

Facility

$1,145.00

Service Code	HCPCS 0866T
Hospital Charge Code	40450866T
Hospital Revenue Code	614
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

MRI BRIAN NEURO QUART WITH D

Facility

$1,145.00

Service Code	HCPCS 0866T
Hospital Charge Code	40450866T
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 CARBON ROD, 200MM

Facility

$1,183.00

Hospital Charge Code	270656539
Hospital Revenue Code	271
Min. Negotiated Rate	$153.79
Max. Negotiated Rate	$591.50
Rate for Payer: Aetna Commercial	$354.90
Rate for Payer: Aetna Medicare Advantage	$354.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.67
Rate for Payer: Cigna Commercial	$591.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.79
Rate for Payer: Oxford Commercial	$591.50
Rate for Payer: Qualcare PPO/HMO/WC	$177.45
Rate for Payer: UnitedHealthcare Commercial	$591.50

Know your out-of-pocket cost for care.

All Charges