Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI FOOT W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73719LT
Hospital Charge Code	2400457
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 FOOT W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73719RT
Hospital Charge Code	2400458
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FOOT W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73719RT
Hospital Charge Code	2400458
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 FOOT W/O CONTRAST BILATERL

Facility

$13,500.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400459
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 FOOT W/O CONTRAST BILATERL

Facility

$13,500.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400459
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 FOOT W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73718LT
Hospital Charge Code	2400460
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 FOOT W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73718LT
Hospital Charge Code	2400460
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 FOOT W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73718RT
Hospital Charge Code	2400461
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 FOOT W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73718RT
Hospital Charge Code	2400461
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 FOOT W/&W/O CONTRAST BLTRL

Facility

$6,032.80

Service Code	HCPCS 7372050
Hospital Charge Code	2400453
Hospital Revenue Code	614
Min. Negotiated Rate	$784.26
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,809.84
Rate for Payer: Aetna Medicare Advantage	$1,809.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,538.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,538.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,538.36
Rate for Payer: Cigna Commercial	$3,016.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.26
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$904.92
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI FOOT W/&W/O CONTRAST BLTRL

Facility

$6,032.80

Service Code	HCPCS 7372050
Hospital Charge Code	2400453
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI FOOT W/&W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73720LT
Hospital Charge Code	2400454
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 FOOT W/&W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73720LT
Hospital Charge Code	2400454
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 FOOT W/&W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73720RT
Hospital Charge Code	2400455
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 FOOT W/&W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73720RT
Hospital Charge Code	2400455
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 FOREARM W/CONTRAST BILATRL

Facility

$4,421.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400465
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI FOREARM W/CONTRAST BILATRL

Facility

$4,421.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400465
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 FOREARM W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73219LT
Hospital Charge Code	2400466
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FOREARM W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73219LT
Hospital Charge Code	2400466
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 FOREARM W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400467
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FOREARM W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400467
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 FOREARM W/O CONTRAST BLTRL

Facility

$4,161.20

Service Code	HCPCS 7321850
Hospital Charge Code	2400468
Hospital Revenue Code	614
Min. Negotiated Rate	$540.96
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,248.36
Rate for Payer: Aetna Medicare Advantage	$1,248.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,061.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,061.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,061.11
Rate for Payer: Cigna Commercial	$2,080.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.96
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$624.18
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI FOREARM W/O CONTRAST BLTRL

Facility

$4,161.20

Service Code	HCPCS 7321850
Hospital Charge Code	2400468
Hospital Revenue Code	614
Min. Negotiated Rate	$624.18
Max. Negotiated Rate	$624.18
Rate for Payer: Qualcare PPO/HMO/WC	$624.18

MRI FOREARM W/O CONTRAST LEFT

Facility

$2,080.60

Service Code	HCPCS 73218LT
Hospital Charge Code	2400469
Hospital Revenue Code	614
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) PPO	$530.55
Rate for Payer: Cigna Commercial	$1,040.30
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 FOREARM W/O CONTRAST LEFT

Facility

$2,080.60

Service Code	HCPCS 73218LT
Hospital Charge Code	2400469
Hospital Revenue Code	614
Min. Negotiated Rate	$312.09
Max. Negotiated Rate	$312.09
Rate for Payer: Qualcare PPO/HMO/WC	$312.09

Know your out-of-pocket cost for care.

All Charges