Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

MRI LOWER EXTREM W/WOCON

Facility

$13,500.00

Service Code	HCPCS 73723
Hospital Charge Code	94061121
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	$915.20
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 EXTREM W/WOCON

Facility

$13,500.00

Service Code	HCPCS 73723
Hospital Charge Code	94061121
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 LOW EXT OTH THN JT W/WO LT

Facility

$13,500.00

Service Code	HCPCS 73720LT
Hospital Charge Code	2400273
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 LOW EXT OTH THN JT W/WO LT

Facility

$13,500.00

Service Code	HCPCS 73720LT
Hospital Charge Code	2400273
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 LOW EXT OTH THN JT W/WO RT

Facility

$13,500.00

Service Code	HCPCS 73720RT
Hospital Charge Code	2400274
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 LOW EXT OTH THN JT W/WO RT

Facility

$13,500.00

Service Code	HCPCS 73720RT
Hospital Charge Code	2400274
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 LOWR EXTR ANY JT LOWER LT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400281
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 LOWR EXTR ANY JT LOWER LT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400281
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 LOWR EXTR ANY JT LOW RT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400282
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 LOWR EXTR ANY JT LOW RT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400282
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 LUMBAR SPINE

Facility

$13,500.00

Service Code	HCPCS 72148
Hospital Charge Code	94061079
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 LUMBAR SPINE

Facility

$13,500.00

Service Code	HCPCS 72148
Hospital Charge Code	94061079
Hospital Revenue Code	612
Min. Negotiated Rate	$568.20
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Better Health Medicaid	$801.35
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$817.38

MRI LUMBAR SPINE W/WO CON

Facility

$13,500.00

Service Code	HCPCS 72158
Hospital Charge Code	94061087
Hospital Revenue Code	612
Min. Negotiated Rate	$830.80
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Better Health Medicaid	$1,512.95
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	$1,017.45
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
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,543.21

MRI LUMBAR SPINE W/WO CON

Facility

$13,500.00

Service Code	HCPCS 72158
Hospital Charge Code	94061087
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 LUMBAR SP W/GAD INJ

Facility

$13,500.00

Service Code	HCPCS 72149
Hospital Charge Code	94061081
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 LUMBAR SP W/GAD INJ

Facility

$13,500.00

Service Code	HCPCS 72149
Hospital Charge Code	94061081
Hospital Revenue Code	612
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 LUMBAR W CONT

Facility

$13,500.00

Service Code	HCPCS 72149
Hospital Charge Code	2400174
Hospital Revenue Code	612
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 LUMBAR W CONT

Facility

$13,500.00

Service Code	HCPCS 72149
Hospital Charge Code	2400174
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 MRCP

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	2400608
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 MRCP

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	2400608
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 NECK W/ CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70542
Hospital Charge Code	2400601
Hospital Revenue Code	614
Min. Negotiated Rate	$637.67
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,760.04
Rate for Payer: Aetna Medicare Advantage	$1,760.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.03
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	$1,496.03
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.68
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$880.02
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI NECK W/ CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70542
Hospital Charge Code	2400601
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI NECK W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70540
Hospital Charge Code	2400602
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI NECK W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70540
Hospital Charge Code	2400602
Hospital Revenue Code	614
Min. Negotiated Rate	$561.00
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,760.04
Rate for Payer: Aetna Medicare Advantage	$1,760.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.03
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	$1,496.03
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.68
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$880.02
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

Know your out-of-pocket cost for care.

All Charges