Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

MRI UPPER EXTREM W/WO CO

Facility

$13,500.00

Service Code	HCPCS 73223
Hospital Charge Code	94061111
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 W/WO CO

Facility

$2,354.00

Service Code	HCPCS 73220
Hospital Charge Code	2409010
Hospital Revenue Code	614
Min. Negotiated Rate	$306.02
Max. Negotiated Rate	$3,989.00
Rate for Payer: Aetna Commercial	$706.20
Rate for Payer: Aetna Medicare Advantage	$706.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.27
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	$600.27
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.02
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$353.10
Rate for Payer: UnitedHealthcare Commercial	$3,989.00

MRI UPP EXT OTH THN JT W/WO LT

Facility

$13,500.00

Service Code	HCPCS 73220LT
Hospital Charge Code	2400240
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 UPP EXT OTH THN JT W/WO LT

Facility

$13,500.00

Service Code	HCPCS 73220LT
Hospital Charge Code	2400240
Hospital Revenue Code	614
Min. Negotiated Rate	$1,755.00
Max. Negotiated Rate	$6,750.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
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: UnitedHealthcare Commercial	$3,989.00

MRI UPP EXT OTH THN JT W/WO RT

Facility

$13,500.00

Service Code	HCPCS 73220RT
Hospital Charge Code	2400241
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 UPP EXT OTH THN JT W/WO RT

Facility

$13,500.00

Service Code	HCPCS 73220RT
Hospital Charge Code	2400241
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 UPP EXTR ANY JOINT UPPR LT

Facility

$13,500.00

Service Code	HCPCS 73221LT
Hospital Charge Code	2400257
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 UPP EXTR ANY JOINT UPPR LT

Facility

$13,500.00

Service Code	HCPCS 73221LT
Hospital Charge Code	2400257
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 UPP EXTR ANY JT UPPR RT

Facility

$13,500.00

Service Code	HCPCS 73221RT
Hospital Charge Code	2400258
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 UPP EXTR ANY JT UPPR RT

Facility

$13,500.00

Service Code	HCPCS 73221RT
Hospital Charge Code	2400258
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 WRIST W/CONTRAST BILATERAL

Facility

$11,820.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400543
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 WRIST W/CONTRAST BILATERAL

Facility

$11,820.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400543
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 WRIST W/CONTRAST LEFT

Facility

$5,910.00

Service Code	HCPCS 73222LT
Hospital Charge Code	2400544
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 WRIST W/CONTRAST LEFT

Facility

$5,910.00

Service Code	HCPCS 73222LT
Hospital Charge Code	2400544
Hospital Revenue Code	614
Min. Negotiated Rate	$886.50
Max. Negotiated Rate	$886.50
Rate for Payer: Qualcare PPO/HMO/WC	$886.50

MRI WRIST W/CONTRAST RIGHT

Facility

$5,910.00

Service Code	HCPCS 73222RT
Hospital Charge Code	2400545
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 WRIST W/CONTRAST RIGHT

Facility

$5,910.00

Service Code	HCPCS 73222RT
Hospital Charge Code	2400545
Hospital Revenue Code	614
Min. Negotiated Rate	$886.50
Max. Negotiated Rate	$886.50
Rate for Payer: Qualcare PPO/HMO/WC	$886.50

MRI WRIST W/O CNTRST BILATERAL

Facility

$8,575.90

Service Code	HCPCS 7322150
Hospital Charge Code	2400546
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 WRIST W/O CNTRST BILATERAL

Facility

$8,575.90

Service Code	HCPCS 7322150
Hospital Charge Code	2400546
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 WRIST W/O CONTRAST LEFT

Facility

$4,287.95

Service Code	HCPCS 73221LT
Hospital Charge Code	2400547
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 WRIST W/O CONTRAST LEFT

Facility

$4,287.95

Service Code	HCPCS 73221LT
Hospital Charge Code	2400547
Hospital Revenue Code	614
Min. Negotiated Rate	$643.19
Max. Negotiated Rate	$643.19
Rate for Payer: Qualcare PPO/HMO/WC	$643.19

MRI WRIST W/O CONTRAST RIGHT

Facility

$4,287.95

Service Code	HCPCS 73221RT
Hospital Charge Code	2400548
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 WRIST W/O CONTRAST RIGHT

Facility

$4,287.95

Service Code	HCPCS 73221RT
Hospital Charge Code	2400548
Hospital Revenue Code	614
Min. Negotiated Rate	$643.19
Max. Negotiated Rate	$643.19
Rate for Payer: Qualcare PPO/HMO/WC	$643.19

MRI WRIST W/&W/0 CONTRAST RGHT

Facility

$5,910.00

Service Code	HCPCS 73223RT
Hospital Charge Code	2400542
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 WRIST W/&W/0 CONTRAST RGHT

Facility

$5,910.00

Service Code	HCPCS 73223RT
Hospital Charge Code	2400542
Hospital Revenue Code	614
Min. Negotiated Rate	$886.50
Max. Negotiated Rate	$886.50
Rate for Payer: Qualcare PPO/HMO/WC	$886.50

Know your out-of-pocket cost for care.

All Charges