Heights University Hospital

All Charges

Charge

Type

Setting

Price

MRI UE JOINT W/CONTRAST BILTRL

Facility

$11,820.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400534
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 UE JOINT W/CONTRAST BILTRL

Facility

$11,820.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400534
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 UE JOINT W/O CNTRST BLTRL

Facility

$13,500.00

Service Code	HCPCS 7322150
Hospital Charge Code	2400535
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 UE JOINT W/O CNTRST BLTRL

Facility

$13,500.00

Service Code	HCPCS 7322150
Hospital Charge Code	2400535
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 UE NON JNT W/CONTRST BLTRL

Facility

$4,421.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400537
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 UE NON JNT W/CONTRST BLTRL

Facility

$4,421.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400537
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI UE NON JNT W/O CNTRST BLTL

Facility

$4,161.20

Service Code	HCPCS 7321850
Hospital Charge Code	2400538
Hospital Revenue Code	614
Min. Negotiated Rate	$624.18
Max. Negotiated Rate	$624.18
Rate for Payer: Qualcare PPO/HMO/WC	$624.18

MRI UE NON JNT W/O CNTRST BLTL

Facility

$4,161.20

Service Code	HCPCS 7321850
Hospital Charge Code	2400538
Hospital Revenue Code	614
Min. Negotiated Rate	$540.96
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$1,248.36
Rate for Payer: Aetna Medicare Advantage	$1,248.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,061.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,061.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,061.11
Rate for Payer: Cigna Commercial	$2,080.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.96
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$624.18
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI UE NON JNT W/&W/O CNTST BL

Facility

$6,032.80

Service Code	HCPCS 7322050
Hospital Charge Code	2400536
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 UE NON JNT W/&W/O CNTST BL

Facility

$6,032.80

Service Code	HCPCS 7322050
Hospital Charge Code	2400536
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI UNLISTED PROCEDURE

Facility

$1,808.25

Service Code	HCPCS 76498
Hospital Charge Code	2400539
Hospital Revenue Code	610
Min. Negotiated Rate	$207.24
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$542.48
Rate for Payer: Aetna Medicare Advantage	$542.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.07
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI UNLISTED PROCEDURE

Facility

$1,808.25

Service Code	HCPCS 76498
Hospital Charge Code	2400539
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI UPPER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73221
Hospital Charge Code	94061109
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 UPPER EXTREMITY

Facility

$2,049.00

Hospital Charge Code	2409005
Hospital Revenue Code	610
Min. Negotiated Rate	$266.37
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$614.70
Rate for Payer: Aetna Medicare Advantage	$614.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.50
Rate for Payer: Cigna Commercial	$1,024.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.37
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.35
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI UPPER EXTREMITY

Facility

$2,049.00

Hospital Charge Code	2409005
Hospital Revenue Code	610
Min. Negotiated Rate	$307.35
Max. Negotiated Rate	$307.35
Rate for Payer: Qualcare PPO/HMO/WC	$307.35

MRI UPPER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73221
Hospital Charge Code	94061109
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 UPPER EXTREMITY NON

Facility

$13,500.00

Service Code	HCPCS 73218
Hospital Charge Code	94061107
Hospital Revenue Code	614
Min. Negotiated Rate	$566.61
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	$566.61
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 UPPER EXTREMITY NON

Facility

$1,513.00

Service Code	HCPCS 73218
Hospital Charge Code	2409001
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) NJ Health	$566.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$385.81
Rate for Payer: Cigna Commercial	$568.20
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 UPPER EXTREMITY NON

Facility

$13,500.00

Service Code	HCPCS 73218
Hospital Charge Code	94061107
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 UPPER EXTREMITY NON

Facility

$1,513.00

Service Code	HCPCS 73218
Hospital Charge Code	2409001
Hospital Revenue Code	614
Min. Negotiated Rate	$226.95
Max. Negotiated Rate	$226.95
Rate for Payer: Qualcare PPO/HMO/WC	$226.95

MRI UPPER EXTREM-LT

Facility

$13,500.00

Service Code	HCPCS 73221LT
Hospital Charge Code	94061349
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 UPPER EXTREM-LT

Facility

$13,500.00

Service Code	HCPCS 73221LT
Hospital Charge Code	94061349
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 UPPER EXTREM-RT

Facility

$13,500.00

Service Code	HCPCS 73221RT
Hospital Charge Code	94061351
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 UPPER EXTREM-RT

Facility

$13,500.00

Service Code	HCPCS 73221RT
Hospital Charge Code	94061351
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 UPPER EXTREM W/WO CO

Facility

$2,354.00

Service Code	HCPCS 73220
Hospital Charge Code	2409010
Hospital Revenue Code	614
Min. Negotiated Rate	$353.10
Max. Negotiated Rate	$353.10
Rate for Payer: Qualcare PPO/HMO/WC	$353.10

Know your out-of-pocket cost for care.

All Charges