Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

MRI ORBIT W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70540
Hospital Charge Code	2400605
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

MRI ORBIT W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70540
Hospital Charge Code	2400605
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI ORBIT W/ & W/O CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70543
Hospital Charge Code	2400603
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 W/ & W/O CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70543
Hospital Charge Code	2400603
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 - PELVIS

Facility

$13,500.00

Service Code	HCPCS 72195
Hospital Charge Code	94061093
Hospital Revenue Code	614
Min. Negotiated Rate	$514.25
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	$514.25
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 - PELVIS

Facility

$13,500.00

Service Code	HCPCS 72195
Hospital Charge Code	94061093
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 PELVIS W/ CONTRAST

Facility

$13,500.00

Service Code	HCPCS 72196
Hospital Charge Code	2400224
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 PELVIS W/ CONTRAST

Facility

$13,500.00

Service Code	HCPCS 72196
Hospital Charge Code	2400224
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 PELVIS W/WO CONTRAST

Facility

$13,500.00

Service Code	HCPCS 72197
Hospital Charge Code	94061095
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 PELVIS W/WO CONTRAST

Facility

$13,500.00

Service Code	HCPCS 72197
Hospital Charge Code	94061095
Hospital Revenue Code	614
Min. Negotiated Rate	$830.80
Max. Negotiated Rate	$4,050.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00
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	$916.82
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: Wellcare New Jersey Medicaid/Family Care	$1,543.21

MRI PULSE OXIMETRY-MULTI DETER

Facility

$312.85

Service Code	HCPCS 94761
Hospital Charge Code	2400414
Hospital Revenue Code	460
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$93.86
Rate for Payer: Aetna Medicare Advantage	$93.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.78
Rate for Payer: Cigna Commercial	$5.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.67
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.93
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

MRI PULSE OXIMETRY-MULTI DETER

Facility

$312.85

Service Code	HCPCS 94761
Hospital Charge Code	2400414
Hospital Revenue Code	460
Min. Negotiated Rate	$46.93
Max. Negotiated Rate	$46.93
Rate for Payer: Qualcare PPO/HMO/WC	$46.93

MRI PULSE OXIMETRY-SING.DETER

Facility

$158.45

Service Code	HCPCS 94760
Hospital Charge Code	2400406
Hospital Revenue Code	460
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$23.77
Rate for Payer: Qualcare PPO/HMO/WC	$23.77

MRI PULSE OXIMETRY-SING.DETER

Facility

$158.45

Service Code	HCPCS 94760
Hospital Charge Code	2400406
Hospital Revenue Code	460
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$1,793.00
Rate for Payer: Aetna Commercial	$47.53
Rate for Payer: Aetna Medicare Advantage	$47.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.40
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.60
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.77
Rate for Payer: UnitedHealthcare Commercial	$1,793.00

MRI SHLDER W/&W/O CNTRST BILTL

Facility

$11,820.00

Service Code	HCPCS 7322350
Hospital Charge Code	2400514
Hospital Revenue Code	614
Min. Negotiated Rate	$1,773.00
Max. Negotiated Rate	$1,773.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,773.00

MRI SHLDER W/&W/O CNTRST BILTL

Facility

$11,820.00

Service Code	HCPCS 7322350
Hospital Charge Code	2400514
Hospital Revenue Code	614
Min. Negotiated Rate	$1,536.60
Max. Negotiated Rate	$5,910.00
Rate for Payer: Aetna Commercial	$3,546.00
Rate for Payer: Aetna Medicare Advantage	$3,546.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,014.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,014.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,014.10
Rate for Payer: Cigna Commercial	$5,910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.60
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,773.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI SHLDER W/&W/O CONTRST LEFT

Facility

$5,910.00

Service Code	HCPCS 73223LT
Hospital Charge Code	2400515
Hospital Revenue Code	614
Min. Negotiated Rate	$768.30
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,773.00
Rate for Payer: Aetna Medicare Advantage	$1,773.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,507.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,507.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,507.05
Rate for Payer: Cigna Commercial	$2,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$768.30
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$886.50
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI SHLDER W/&W/O CONTRST LEFT

Facility

$5,910.00

Service Code	HCPCS 73223LT
Hospital Charge Code	2400515
Hospital Revenue Code	614
Min. Negotiated Rate	$886.50
Max. Negotiated Rate	$886.50
Rate for Payer: Qualcare PPO/HMO/WC	$886.50

MRI SHLDER W/&W/O CONTRST RGHT

Facility

$5,910.00

Service Code	HCPCS 73223RT
Hospital Charge Code	2400516
Hospital Revenue Code	614
Min. Negotiated Rate	$886.50
Max. Negotiated Rate	$886.50
Rate for Payer: Qualcare PPO/HMO/WC	$886.50

MRI SHLDER W/&W/O CONTRST RGHT

Facility

$5,910.00

Service Code	HCPCS 73223RT
Hospital Charge Code	2400516
Hospital Revenue Code	614
Min. Negotiated Rate	$768.30
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,773.00
Rate for Payer: Aetna Medicare Advantage	$1,773.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,507.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,507.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,507.05
Rate for Payer: Cigna Commercial	$2,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$768.30
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$886.50
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI SHOULDER W/CONTRAST BILTRL

Facility

$11,820.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400517
Hospital Revenue Code	614
Min. Negotiated Rate	$1,536.60
Max. Negotiated Rate	$5,910.00
Rate for Payer: Aetna Commercial	$3,546.00
Rate for Payer: Aetna Medicare Advantage	$3,546.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,014.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,014.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,014.10
Rate for Payer: Cigna Commercial	$5,910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.60
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,773.00
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI SHOULDER W/CONTRAST BILTRL

Facility

$11,820.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400517
Hospital Revenue Code	614
Min. Negotiated Rate	$1,773.00
Max. Negotiated Rate	$1,773.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,773.00

MRI SHOULDER W/CONTRAST LEFT

Facility

$5,910.00

Service Code	HCPCS 73222LT
Hospital Charge Code	2400518
Hospital Revenue Code	614
Min. Negotiated Rate	$886.50
Max. Negotiated Rate	$886.50
Rate for Payer: Qualcare PPO/HMO/WC	$886.50

MRI SHOULDER W/CONTRAST LEFT

Facility

$5,910.00

Service Code	HCPCS 73222LT
Hospital Charge Code	2400518
Hospital Revenue Code	614
Min. Negotiated Rate	$768.30
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,773.00
Rate for Payer: Aetna Medicare Advantage	$1,773.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,507.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,507.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,507.05
Rate for Payer: Cigna Commercial	$2,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$768.30
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$886.50
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

Know your out-of-pocket cost for care.

All Charges