Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI CHEST LYMPHADEN H/M W/O CO

Facility

$13,500.00

Service Code	HCPCS 71550
Hospital Charge Code	2400109
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 CHEST LYMPHADEN H/M W/O CO

Facility

$13,500.00

Service Code	HCPCS 71550
Hospital Charge Code	2400109
Hospital Revenue Code	614
Min. Negotiated Rate	$561.00
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	$561.00
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 CHEST LYMPHADEN H/M W/ W/O

Facility

$3,016.40

Service Code	HCPCS 71552
Hospital Charge Code	2400596
Hospital Revenue Code	614
Min. Negotiated Rate	$392.13
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$904.92
Rate for Payer: Aetna Medicare Advantage	$904.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$905.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$769.18
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.13
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.46
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI CHEST LYMPHADEN H/M W/ W/O

Facility

$3,016.40

Service Code	HCPCS 71552
Hospital Charge Code	2400596
Hospital Revenue Code	614
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$452.46
Rate for Payer: Qualcare PPO/HMO/WC	$452.46

MRI CHEST W/ CONTRAST

Facility

$13,500.00

Service Code	HCPCS 71551
Hospital Charge Code	2400432
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 CHEST W/ CONTRAST

Facility

$13,500.00

Service Code	HCPCS 71551
Hospital Charge Code	2400432
Hospital Revenue Code	614
Min. Negotiated Rate	$557.26
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	$557.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$1,866.82
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 CHEST W/O CONTRAST

Facility

$2,620.85

Service Code	HCPCS 71550
Hospital Charge Code	2400550
Hospital Revenue Code	614
Min. Negotiated Rate	$393.13
Max. Negotiated Rate	$393.13
Rate for Payer: Qualcare PPO/HMO/WC	$393.13

MRI CHEST W/O CONTRAST

Facility

$2,620.85

Service Code	HCPCS 71550
Hospital Charge Code	2400550
Hospital Revenue Code	614
Min. Negotiated Rate	$340.71
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$786.25
Rate for Payer: Aetna Medicare Advantage	$786.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$668.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$668.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$668.32
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.71
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.13
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI CHEST W/ OR W/O CONT

Facility

$2,620.85

Service Code	HCPCS 71550
Hospital Charge Code	2400117
Hospital Revenue Code	614
Min. Negotiated Rate	$393.13
Max. Negotiated Rate	$393.13
Rate for Payer: Qualcare PPO/HMO/WC	$393.13

MRI CHEST W/ OR W/O CONT

Facility

$2,620.85

Service Code	HCPCS 71550
Hospital Charge Code	2400117
Hospital Revenue Code	614
Min. Negotiated Rate	$340.71
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$786.25
Rate for Payer: Aetna Medicare Advantage	$786.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$668.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$668.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$668.32
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.71
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.13
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI CHEST W/ & W/O CONTRAST

Facility

$3,016.40

Service Code	HCPCS 71552
Hospital Charge Code	2400549
Hospital Revenue Code	614
Min. Negotiated Rate	$392.13
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$904.92
Rate for Payer: Aetna Medicare Advantage	$904.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$905.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$769.18
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.13
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.46
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI CHEST W/ & W/O CONTRAST

Facility

$3,016.40

Service Code	HCPCS 71552
Hospital Charge Code	2400549
Hospital Revenue Code	614
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$452.46
Rate for Payer: Qualcare PPO/HMO/WC	$452.46

MRI CHEST W/WO CONTRAST

Facility

$13,500.00

Service Code	HCPCS 71552
Hospital Charge Code	94061049
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	$905.77
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 CHEST W/WO CONTRAST

Facility

$13,500.00

Service Code	HCPCS 71552
Hospital Charge Code	94061049
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 DORSAL SPINE

Facility

$13,500.00

Service Code	HCPCS 72146
Hospital Charge Code	94061075
Hospital Revenue Code	612
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRI DORSAL SPINE

Facility

$13,500.00

Service Code	HCPCS 72146
Hospital Charge Code	94061075
Hospital Revenue Code	612
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 DORSAL SPINE W/WO CON

Facility

$13,500.00

Service Code	HCPCS 72157
Hospital Charge Code	94061085
Hospital Revenue Code	612
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	$896.29
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 DORSAL SPINE W/WO CON

Facility

$13,500.00

Service Code	HCPCS 72157
Hospital Charge Code	94061085
Hospital Revenue Code	612
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRI DORSAL SP W/GAD INJ

Facility

$13,500.00

Service Code	HCPCS 72147
Hospital Charge Code	94061077
Hospital Revenue Code	612
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRI DORSAL SP W/GAD INJ

Facility

$13,500.00

Service Code	HCPCS 72147
Hospital Charge Code	94061077
Hospital Revenue Code	612
Min. Negotiated Rate	$617.10
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	$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 DRAINAGE OF PERITONEAL ABC

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400552
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI DRAINAGE OF PERITONEAL ABC

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400552
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 DRAINAGE RETRPERITNEAL ABS

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400553
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 DRAINAGE RETRPERITNEAL ABS

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400553
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI DRAIN SBDIAPHRGM/SBPHRENIC

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400551
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

Know your out-of-pocket cost for care.

All Charges