Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRI ANKLE W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73722RT
Hospital Charge Code	2400425
Hospital Revenue Code	614
Min. Negotiated Rate	$53.27
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$839.99
Rate for Payer: Aetna Medicare Advantage	$663.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.68
Rate for Payer: Cigna Commercial	$1,105.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.15
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$331.57
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$53.27
Rate for Payer: Wellpoint Medicaid Managed Care	$58.58

MRI ANKLE W/O CONTRAST BILTERL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400426
Hospital Revenue Code	614
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
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	$4,050.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRI ANKLE W/O CONTRAST BILTERL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400426
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 ANKLE W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400427
Hospital Revenue Code	614
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
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	$4,050.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRI ANKLE W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400427
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 ANKLE W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400428
Hospital Revenue Code	614
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
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	$4,050.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRI ANKLE W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400428
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 ANKLE W/&W/O CONTRAST BLTL

Facility

$6,032.80

Service Code	HCPCS 7372350
Hospital Charge Code	2400420
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI ANKLE W/&W/O CONTRAST BLTL

Facility

$6,032.80

Service Code	HCPCS 7372350
Hospital Charge Code	2400420
Hospital Revenue Code	614
Min. Negotiated Rate	$145.39
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$2,292.46
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	$1,809.84
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$904.92
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$145.39
Rate for Payer: Wellpoint Medicaid Managed Care	$159.87

MRI ANKLE W/&W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400421
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 ANKLE W/&W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400421
Hospital Revenue Code	614
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
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	$4,050.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRI ANKLE W/&W/O CONTRAST RGHT

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400422
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 ANKLE W/&W/O CONTRAST RGHT

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400422
Hospital Revenue Code	614
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
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	$4,050.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRI ASPIRATION

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400554
Hospital Revenue Code	610
Min. Negotiated Rate	$43.58
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$687.13
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) NJ Health	$216.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$904.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.48
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$43.58
Rate for Payer: Wellpoint Medicaid Managed Care	$47.92

MRI ASPIRATION

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400554
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI ASPIRATION RENAL LEFT

Facility

$1,808.25

Service Code	HCPCS 77021LT
Hospital Charge Code	2400555
Hospital Revenue Code	610
Min. Negotiated Rate	$43.58
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$687.13
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	$904.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.48
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$43.58
Rate for Payer: Wellpoint Medicaid Managed Care	$47.92

MRI ASPIRATION RENAL LEFT

Facility

$1,808.25

Service Code	HCPCS 77021LT
Hospital Charge Code	2400555
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI ASPIRATION RENAL RIGHT

Facility

$1,808.25

Service Code	HCPCS 77021RT
Hospital Charge Code	2400556
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI ASPIRATION RENAL RIGHT

Facility

$1,808.25

Service Code	HCPCS 77021RT
Hospital Charge Code	2400556
Hospital Revenue Code	610
Min. Negotiated Rate	$43.58
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$687.13
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	$904.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.48
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$43.58
Rate for Payer: Wellpoint Medicaid Managed Care	$47.92

MRI BIOPSY

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400557
Hospital Revenue Code	610
Min. Negotiated Rate	$43.58
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$687.13
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) NJ Health	$216.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$904.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.48
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$43.58
Rate for Payer: Wellpoint Medicaid Managed Care	$47.92

MRI BIOPSY

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400557
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI BIOPSY ABDOMEN

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400558
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI BIOPSY ABDOMEN

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400558
Hospital Revenue Code	610
Min. Negotiated Rate	$43.58
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$687.13
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) NJ Health	$216.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$904.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.48
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$43.58
Rate for Payer: Wellpoint Medicaid Managed Care	$47.92

MRI BIOPSY BONE

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400559
Hospital Revenue Code	610
Min. Negotiated Rate	$43.58
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$687.13
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) NJ Health	$216.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.10
Rate for Payer: Cigna Commercial	$904.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.48
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.24
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$43.58
Rate for Payer: Wellpoint Medicaid Managed Care	$47.92

MRI BIOPSY BONE

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400559
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

Know your out-of-pocket cost for care.

All Charges