Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI NECK W & WITHOUT CON

Facility

$13,500.00

Service Code	HCPCS 70543
Hospital Charge Code	94061025
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 & WITHOUT CON

Facility

$13,500.00

Service Code	HCPCS 70543
Hospital Charge Code	94061025
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 NECK W/ & W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70543
Hospital Charge Code	2400600
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/ & W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70543
Hospital Charge Code	2400600
Hospital Revenue Code	614
Min. Negotiated Rate	$762.68
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	$915.20
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 NON STERILE TREPHINE 21.5

Facility

$2,350.00

Hospital Charge Code	270690415
Hospital Revenue Code	272
Min. Negotiated Rate	$305.50
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$705.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.50
Rate for Payer: Oxford Commercial	$1,175.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Commercial	$1,175.00

MRI NON STERILE TREPHINE 21.5

Facility

$2,350.00

Hospital Charge Code	270690415
Hospital Revenue Code	272
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

MRI ONE BRST-GL

Facility

$3,597.20

Service Code	HCPCS 77058
Hospital Charge Code	85000170
Hospital Revenue Code	614
Min. Negotiated Rate	$539.58
Max. Negotiated Rate	$539.58
Rate for Payer: Qualcare PPO/HMO/WC	$539.58

MRI ONE BRST-GL

Facility

$3,597.20

Service Code	HCPCS 77058
Hospital Charge Code	85000170
Hospital Revenue Code	614
Min. Negotiated Rate	$467.64
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,079.16
Rate for Payer: Aetna Medicare Advantage	$1,079.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$917.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$917.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$917.29
Rate for Payer: Cigna Commercial	$1,798.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.64
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$539.58
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ONE BRST-PC

Facility

$430.50

Service Code	HCPCS 7705826
Hospital Charge Code	85000180
Hospital Revenue Code	610
Min. Negotiated Rate	$55.97
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$129.15
Rate for Payer: Aetna Medicare Advantage	$129.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.78
Rate for Payer: Cigna Commercial	$215.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.97
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.58
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ONE BRST-PC

Facility

$430.50

Service Code	HCPCS 7705826
Hospital Charge Code	85000180
Hospital Revenue Code	610
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$64.58

MRI ONE BRSTS-GL

Facility

$3,595.20

Service Code	HCPCS 77059
Hospital Charge Code	85000185
Hospital Revenue Code	614
Min. Negotiated Rate	$467.38
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,078.56
Rate for Payer: Aetna Medicare Advantage	$1,078.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.78
Rate for Payer: Cigna Commercial	$1,797.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.38
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$539.28
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ONE BRSTS-GL

Facility

$3,595.20

Service Code	HCPCS 77059
Hospital Charge Code	85000185
Hospital Revenue Code	614
Min. Negotiated Rate	$539.28
Max. Negotiated Rate	$539.28
Rate for Payer: Qualcare PPO/HMO/WC	$539.28

MRI ONE BRSTS-PC

Facility

$428.50

Service Code	HCPCS 7705926
Hospital Charge Code	85000195
Hospital Revenue Code	610
Min. Negotiated Rate	$64.28
Max. Negotiated Rate	$64.28
Rate for Payer: Qualcare PPO/HMO/WC	$64.28

MRI ONE BRSTS-PC

Facility

$428.50

Service Code	HCPCS 7705926
Hospital Charge Code	85000195
Hospital Revenue Code	610
Min. Negotiated Rate	$55.70
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$128.55
Rate for Payer: Aetna Medicare Advantage	$128.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.27
Rate for Payer: Cigna Commercial	$214.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.70
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.28
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ONE BRSTS-TC

Facility

$3,166.70

Service Code	HCPCS 77059TC
Hospital Charge Code	85000190
Hospital Revenue Code	610
Min. Negotiated Rate	$411.67
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$950.01
Rate for Payer: Aetna Medicare Advantage	$950.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$807.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$807.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$807.51
Rate for Payer: Cigna Commercial	$1,583.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.67
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ONE BRSTS-TC

Facility

$3,166.70

Service Code	HCPCS 77059TC
Hospital Charge Code	85000190
Hospital Revenue Code	610
Min. Negotiated Rate	$475.00
Max. Negotiated Rate	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.00

MRI ONE BRST-TC

Facility

$3,166.70

Service Code	HCPCS 77058TC
Hospital Charge Code	85000175
Hospital Revenue Code	610
Min. Negotiated Rate	$411.67
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$950.01
Rate for Payer: Aetna Medicare Advantage	$950.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$807.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$807.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$807.51
Rate for Payer: Cigna Commercial	$1,583.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.67
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI ONE BRST-TC

Facility

$3,166.70

Service Code	HCPCS 77058TC
Hospital Charge Code	85000175
Hospital Revenue Code	610
Min. Negotiated Rate	$475.00
Max. Negotiated Rate	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.00

MRI - OPEN SENT OUTSIDE

Facility

$9,109.53

Service Code	HCPCS 70551
Hospital Charge Code	2400415
Hospital Revenue Code	611
Min. Negotiated Rate	$568.20
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$2,732.86
Rate for Payer: Aetna Medicare Advantage	$2,732.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,322.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,322.93
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	$2,322.93
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,184.24
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,366.43
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI - OPEN SENT OUTSIDE

Facility

$9,109.53

Service Code	HCPCS 70551
Hospital Charge Code	2400415
Hospital Revenue Code	611
Min. Negotiated Rate	$1,366.43
Max. Negotiated Rate	$1,366.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,366.43

MRI ORBIT

Facility

$13,500.00

Service Code	HCPCS 70540
Hospital Charge Code	94061023
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 ORBIT

Facility

$13,500.00

Service Code	HCPCS 70540
Hospital Charge Code	94061023
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	$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 ORBIT FACE AND NECK W/O

Facility

$13,500.00

Service Code	HCPCS 70540
Hospital Charge Code	2400059
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 ORBIT FACE AND NECK W/O

Facility

$13,500.00

Service Code	HCPCS 70540
Hospital Charge Code	2400059
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	$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 ORBIT W/ CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70542
Hospital Charge Code	2400604
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

Know your out-of-pocket cost for care.

All Charges