Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI SHOULDER W/CONTRAST RIGHT

Facility

$5,910.00

Service Code	HCPCS 73222RT
Hospital Charge Code	2400519
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 RIGHT

Facility

$5,910.00

Service Code	HCPCS 73222RT
Hospital Charge Code	2400519
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/O CONTRAST LEFT

Facility

$4,287.95

Service Code	HCPCS 73221LT
Hospital Charge Code	2400521
Hospital Revenue Code	614
Min. Negotiated Rate	$643.19
Max. Negotiated Rate	$643.19
Rate for Payer: Qualcare PPO/HMO/WC	$643.19

MRI SHOULDER W/O CONTRAST LEFT

Facility

$4,287.95

Service Code	HCPCS 73221LT
Hospital Charge Code	2400521
Hospital Revenue Code	614
Min. Negotiated Rate	$557.43
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,286.38
Rate for Payer: Aetna Medicare Advantage	$1,286.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.43
Rate for Payer: Cigna Commercial	$2,143.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$557.43
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$643.19
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI SHOULDER W/O CONTRAST RGHT

Facility

$4,287.95

Service Code	HCPCS 73221RT
Hospital Charge Code	2400522
Hospital Revenue Code	614
Min. Negotiated Rate	$557.43
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,286.38
Rate for Payer: Aetna Medicare Advantage	$1,286.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.43
Rate for Payer: Cigna Commercial	$2,143.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$557.43
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$643.19
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI SHOULDER W/O CONTRAST RGHT

Facility

$4,287.95

Service Code	HCPCS 73221RT
Hospital Charge Code	2400522
Hospital Revenue Code	614
Min. Negotiated Rate	$643.19
Max. Negotiated Rate	$643.19
Rate for Payer: Qualcare PPO/HMO/WC	$643.19

MRI SHOULDER W/O CONTRST BLTRL

Facility

$8,575.90

Service Code	HCPCS 7322150
Hospital Charge Code	2400520
Hospital Revenue Code	614
Min. Negotiated Rate	$1,286.38
Max. Negotiated Rate	$1,286.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.38

MRI SHOULDER W/O CONTRST BLTRL

Facility

$8,575.90

Service Code	HCPCS 7322150
Hospital Charge Code	2400520
Hospital Revenue Code	614
Min. Negotiated Rate	$1,114.87
Max. Negotiated Rate	$4,287.95
Rate for Payer: Aetna Commercial	$2,572.77
Rate for Payer: Aetna Medicare Advantage	$2,572.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.85
Rate for Payer: Cigna Commercial	$4,287.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.87
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.38
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI SPINAL CERV W/ CONT

Facility

$13,500.00

Service Code	HCPCS 72142
Hospital Charge Code	2400133
Hospital Revenue Code	612
Min. Negotiated Rate	$660.11
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	$660.11
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 SPINAL CERV W/ CONT

Facility

$13,500.00

Service Code	HCPCS 72142
Hospital Charge Code	2400133
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 SPINAL CERV W/O CON

Facility

$13,500.00

Service Code	HCPCS 72141
Hospital Charge Code	2400125
Hospital Revenue Code	612
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 SPINAL CERV W/O CON

Facility

$13,500.00

Service Code	HCPCS 72141
Hospital Charge Code	2400125
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 SPINAL CERV W + W/O GAD

Facility

$13,500.00

Service Code	HCPCS 72156
Hospital Charge Code	2400182
Hospital Revenue Code	612
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	$896.29
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 SPINAL CERV W + W/O GAD

Facility

$13,500.00

Service Code	HCPCS 72156
Hospital Charge Code	2400182
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 SPINAL LUMBAR W/O CONT

Facility

$13,500.00

Service Code	HCPCS 72148
Hospital Charge Code	2400166
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 SPINAL LUMBAR W/O CONT

Facility

$13,500.00

Service Code	HCPCS 72148
Hospital Charge Code	2400166
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 SPINAL LUMB W/ 7 + GAD

Facility

$13,500.00

Service Code	HCPCS 72158
Hospital Charge Code	2400208
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 SPINAL LUMB W/ 7 + GAD

Facility

$13,500.00

Service Code	HCPCS 72158
Hospital Charge Code	2400208
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 SPINAL THOR W/ CONT

Facility

$13,500.00

Service Code	HCPCS 72147
Hospital Charge Code	2400158
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 SPINAL THOR W/ CONT

Facility

$13,500.00

Service Code	HCPCS 72147
Hospital Charge Code	2400158
Hospital Revenue Code	612
Min. Negotiated Rate	$617.10
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	$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 SPINAL THOR W/O CONTR

Facility

$13,500.00

Service Code	HCPCS 72146
Hospital Charge Code	2400141
Hospital Revenue Code	612
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 SPINAL THOR W/O CONTR

Facility

$13,500.00

Service Code	HCPCS 72146
Hospital Charge Code	2400141
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 SPINAL THOR W/ + W/O GAD

Facility

$13,500.00

Service Code	HCPCS 72157
Hospital Charge Code	2400190
Hospital Revenue Code	612
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	$896.29
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 SPINAL THOR W/ + W/O GAD

Facility

$13,500.00

Service Code	HCPCS 72157
Hospital Charge Code	2400190
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 STERILE RADIAL OSTEOTOME B

Facility

$560.00

Hospital Charge Code	270684663
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

Know your out-of-pocket cost for care.

All Charges