Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI HIP W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73722LT
Hospital Charge Code	2400485
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI HIP W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73722LT
Hospital Charge Code	2400485
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 HIP W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73722RT
Hospital Charge Code	2400486
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 HIP W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73722RT
Hospital Charge Code	2400486
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI HIP W/O CONTRAST BILATERAL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400487
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 HIP W/O CONTRAST BILATERAL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400487
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 HIP W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400488
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 HIP W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400488
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 HIP W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400489
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 HIP W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400489
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 HIP W/&W/O CONTRAST BILTRL

Facility

$13,500.00

Service Code	HCPCS 7372350
Hospital Charge Code	2400481
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 HIP W/&W/O CONTRAST BILTRL

Facility

$13,500.00

Service Code	HCPCS 7372350
Hospital Charge Code	2400481
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 HIP W/& W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400482
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 HIP W/& W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400482
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 HIP W/& W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400483
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 HIP W/& W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400483
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 HUMERUS W/CONTRAST BILATRL

Facility

$2,210.50

Service Code	HCPCS 7321950
Hospital Charge Code	2400493
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI HUMERUS W/CONTRAST BILATRL

Facility

$2,210.50

Service Code	HCPCS 7321950
Hospital Charge Code	2400493
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 HUMERUS W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73219LT
Hospital Charge Code	2400494
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 HUMERUS W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73219LT
Hospital Charge Code	2400494
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI HUMERUS W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400495
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 HUMERUS W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400495
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI HUMERUS W/O CNTRAST BILTRL

Facility

$2,080.60

Service Code	HCPCS 7321850
Hospital Charge Code	2400496
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 HUMERUS W/O CNTRAST BILTRL

Facility

$2,080.60

Service Code	HCPCS 7321850
Hospital Charge Code	2400496
Hospital Revenue Code	614
Min. Negotiated Rate	$312.09
Max. Negotiated Rate	$312.09
Rate for Payer: Qualcare PPO/HMO/WC	$312.09

MRI HUMERUS W/O CONTRAST LEFT

Facility

$2,080.60

Service Code	HCPCS 73218LT
Hospital Charge Code	2400497
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