Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 CONTRAST RIGHT

Facility

$2,080.60

Service Code	HCPCS 73218RT
Hospital Charge Code	2400498
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 RIGHT

Facility

$2,080.60

Service Code	HCPCS 73218RT
Hospital Charge Code	2400498
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/&W/O CNTRST BLTL

Facility

$3,016.40

Service Code	HCPCS 73220
Hospital Charge Code	2400490
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	$561.00
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 HUMERUS W/&W/O CNTRST BLTL

Facility

$3,016.40

Service Code	HCPCS 73220
Hospital Charge Code	2400490
Hospital Revenue Code	614
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$452.46
Rate for Payer: Qualcare PPO/HMO/WC	$452.46

MRI HUMERUS W/&W/O CNTRST LEFT

Facility

$3,016.40

Service Code	HCPCS 73220LT
Hospital Charge Code	2400491
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) PPO	$769.18
Rate for Payer: Cigna Commercial	$1,508.20
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 HUMERUS W/&W/O CNTRST LEFT

Facility

$3,016.40

Service Code	HCPCS 73220LT
Hospital Charge Code	2400491
Hospital Revenue Code	614
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$452.46
Rate for Payer: Qualcare PPO/HMO/WC	$452.46

MRI HUMERUS W/&W/O CNTRST RGHT

Facility

$3,016.40

Service Code	HCPCS 73220RT
Hospital Charge Code	2400492
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) PPO	$769.18
Rate for Payer: Cigna Commercial	$1,508.20
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 HUMERUS W/&W/O CNTRST RGHT

Facility

$3,016.40

Service Code	HCPCS 73220RT
Hospital Charge Code	2400492
Hospital Revenue Code	614
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$452.46
Rate for Payer: Qualcare PPO/HMO/WC	$452.46

MRI JOINT LOWER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73721
Hospital Charge Code	94061119
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 JOINT LOWER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73721
Hospital Charge Code	94061119
Hospital Revenue Code	614
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 KNEE W/ CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400502
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 KNEE W/ CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400502
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI KNEE W/ CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73722LT
Hospital Charge Code	2400503
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 KNEE W/ CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73722LT
Hospital Charge Code	2400503
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI KNEE W/ CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73722RT
Hospital Charge Code	2400504
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI KNEE W/ CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73722RT
Hospital Charge Code	2400504
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 KNEE W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400506
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 KNEE W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400506
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 KNEE W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400507
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 KNEE W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400507
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 KNEE W/O CONTRST BILATERAL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400505
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 KNEE W/O CONTRST BILATERAL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400505
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 KNEE W/&W/O CONTRAST BILTL

Facility

$2,072.35

Service Code	HCPCS 7372350
Hospital Charge Code	2400499
Hospital Revenue Code	614
Min. Negotiated Rate	$269.41
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$621.71
Rate for Payer: Aetna Medicare Advantage	$621.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$528.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$528.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$528.45
Rate for Payer: Cigna Commercial	$1,036.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.41
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.85
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI KNEE W/&W/O CONTRAST BILTL

Facility

$2,072.35

Service Code	HCPCS 7372350
Hospital Charge Code	2400499
Hospital Revenue Code	614
Min. Negotiated Rate	$310.85
Max. Negotiated Rate	$310.85
Rate for Payer: Qualcare PPO/HMO/WC	$310.85

Know your out-of-pocket cost for care.

All Charges