Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI KNEE W/& W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400500
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 LEFT

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400500
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/& W/O CONTRAST RGHT

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400501
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/& W/O CONTRAST RGHT

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400501
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 LE JOINT W/CONTRAST BILTRL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400509
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI LE JOINT W/CONTRAST BILTRL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400509
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 LE JOINT W/O CONTRST BLTRL

Facility

$14,381.96

Service Code	HCPCS 7372150
Hospital Charge Code	2400510
Hospital Revenue Code	614
Min. Negotiated Rate	$1,869.65
Max. Negotiated Rate	$7,190.98
Rate for Payer: Aetna Commercial	$4,314.59
Rate for Payer: Aetna Medicare Advantage	$4,314.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,667.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,667.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,667.40
Rate for Payer: Cigna Commercial	$7,190.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.65
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,157.29
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI LE JOINT W/O CONTRST BLTRL

Facility

$14,381.96

Service Code	HCPCS 7372150
Hospital Charge Code	2400510
Hospital Revenue Code	614
Min. Negotiated Rate	$2,157.29
Max. Negotiated Rate	$2,157.29
Rate for Payer: Qualcare PPO/HMO/WC	$2,157.29

MRI LE JOINT W/&W/O CNTRST BLT

Facility

$6,032.80

Service Code	HCPCS 7372350
Hospital Charge Code	2400508
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI LE JOINT W/&W/O CNTRST BLT

Facility

$6,032.80

Service Code	HCPCS 7372350
Hospital Charge Code	2400508
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 LE NON JNT W/CONTRST BILTL

Facility

$4,421.00

Service Code	HCPCS 7371950
Hospital Charge Code	2400512
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI LE NON JNT W/CONTRST BILTL

Facility

$4,421.00

Service Code	HCPCS 7371950
Hospital Charge Code	2400512
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 LE NON JNT W/O CNTRST BLTL

Facility

$4,421.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400513
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI LE NON JNT W/O CNTRST BLTL

Facility

$4,421.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400513
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 LE NON JNT W/&W/O CTRST BL

Facility

$6,032.80

Service Code	HCPCS 7372050
Hospital Charge Code	2400511
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI LE NON JNT W/&W/O CTRST BL

Facility

$6,032.80

Service Code	HCPCS 7372050
Hospital Charge Code	2400511
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 LE NONJOINT W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 73719
Hospital Charge Code	406173719
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 LE NONJOINT W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 73719
Hospital Charge Code	406173719
Hospital Revenue Code	614
Min. Negotiated Rate	$637.67
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	$637.67
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 LOWER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73720
Hospital Charge Code	94061117
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 LOWER EXTREMITY

Facility

$2,952.00

Hospital Charge Code	2409020
Hospital Revenue Code	610
Min. Negotiated Rate	$442.80
Max. Negotiated Rate	$442.80
Rate for Payer: Qualcare PPO/HMO/WC	$442.80

MRI LOWER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73720
Hospital Charge Code	94061117
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	$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 LOWER EXTREMITY

Facility

$2,952.00

Hospital Charge Code	2409020
Hospital Revenue Code	610
Min. Negotiated Rate	$383.76
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$885.60
Rate for Payer: Aetna Medicare Advantage	$885.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.76
Rate for Payer: Cigna Commercial	$1,476.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.76
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.80
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI LOWER EXTREMITY NONJ

Facility

$1,513.00

Hospital Charge Code	2409015
Hospital Revenue Code	614
Min. Negotiated Rate	$196.69
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$453.90
Rate for Payer: Aetna Medicare Advantage	$453.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$385.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$385.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$385.81
Rate for Payer: Cigna Commercial	$756.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.69
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$226.95
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI LOWER EXTREMITY NONJ

Facility

$13,500.00

Service Code	HCPCS 73718
Hospital Charge Code	94061115
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 LOWER EXTREMITY NONJ

Facility

$1,513.00

Hospital Charge Code	2409015
Hospital Revenue Code	614
Min. Negotiated Rate	$226.95
Max. Negotiated Rate	$226.95
Rate for Payer: Qualcare PPO/HMO/WC	$226.95

Know your out-of-pocket cost for care.

All Charges