Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRI FOREARM W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400467
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FOREARM W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400467
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 FOREARM W/O CONTRAST BLTRL

Facility

$4,161.20

Service Code	HCPCS 7321850
Hospital Charge Code	2400468
Hospital Revenue Code	614
Min. Negotiated Rate	$624.18
Max. Negotiated Rate	$624.18
Rate for Payer: Qualcare PPO/HMO/WC	$624.18

MRI FOREARM W/O CONTRAST BLTRL

Facility

$4,161.20

Service Code	HCPCS 7321850
Hospital Charge Code	2400468
Hospital Revenue Code	614
Min. Negotiated Rate	$100.28
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,581.26
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	$1,248.36
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$624.18
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$100.28
Rate for Payer: Wellpoint Medicaid Managed Care	$110.27

MRI FOREARM W/O CONTRAST LEFT

Facility

$2,080.60

Service Code	HCPCS 73218LT
Hospital Charge Code	2400469
Hospital Revenue Code	614
Min. Negotiated Rate	$50.14
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$790.63
Rate for Payer: Aetna Medicare Advantage	$624.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$530.55
Rate for Payer: Cigna Commercial	$1,040.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.18
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.09
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$50.14
Rate for Payer: Wellpoint Medicaid Managed Care	$55.14

MRI FOREARM W/O CONTRAST LEFT

Facility

$2,080.60

Service Code	HCPCS 73218LT
Hospital Charge Code	2400469
Hospital Revenue Code	614
Min. Negotiated Rate	$312.09
Max. Negotiated Rate	$312.09
Rate for Payer: Qualcare PPO/HMO/WC	$312.09

MRI FOREARM W/O CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400470
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 FOREARM W/O CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400470
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FOREARM W/&W/O CNTRST BLTL

Facility

$6,032.80

Service Code	HCPCS 7322050
Hospital Charge Code	2400462
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI FOREARM W/&W/O CNTRST BLTL

Facility

$6,032.80

Service Code	HCPCS 7322050
Hospital Charge Code	2400462
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 FOREARM W/&W/O CNTRST LEFT

Facility

$3,016.40

Service Code	HCPCS 73220LT
Hospital Charge Code	2400463
Hospital Revenue Code	614
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$452.46
Rate for Payer: Qualcare PPO/HMO/WC	$452.46

MRI FOREARM W/&W/O CNTRST LEFT

Facility

$3,016.40

Service Code	HCPCS 73220LT
Hospital Charge Code	2400463
Hospital Revenue Code	614
Min. Negotiated Rate	$72.70
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,146.23
Rate for Payer: Aetna Medicare Advantage	$904.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$769.18
Rate for Payer: Cigna Commercial	$1,508.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$904.92
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.46
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$72.70
Rate for Payer: Wellpoint Medicaid Managed Care	$79.93

MRI FOREARM W/&W/O CNTRST RGHT

Facility

$3,016.40

Service Code	HCPCS 73220RT
Hospital Charge Code	2400464
Hospital Revenue Code	614
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$452.46
Rate for Payer: Qualcare PPO/HMO/WC	$452.46

MRI FOREARM W/&W/O CNTRST RGHT

Facility

$3,016.40

Service Code	HCPCS 73220RT
Hospital Charge Code	2400464
Hospital Revenue Code	614
Min. Negotiated Rate	$72.70
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,146.23
Rate for Payer: Aetna Medicare Advantage	$904.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$769.18
Rate for Payer: Cigna Commercial	$1,508.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$904.92
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.46
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$72.70
Rate for Payer: Wellpoint Medicaid Managed Care	$79.93

MRI FOR TISSUE ABLATION

Facility

$932.00

Service Code	HCPCS 77022
Hospital Charge Code	7411759
Hospital Revenue Code	610
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$354.16
Rate for Payer: Aetna Medicare Advantage	$279.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.66
Rate for Payer: Cigna Commercial	$466.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.60
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.80
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$22.46
Rate for Payer: Wellpoint Medicaid Managed Care	$24.70

MRI FOR TISSUE ABLATION

Facility

$932.00

Service Code	HCPCS 77022
Hospital Charge Code	7411759
Hospital Revenue Code	610
Min. Negotiated Rate	$139.80
Max. Negotiated Rate	$139.80
Rate for Payer: Qualcare PPO/HMO/WC	$139.80

MRI FOR TISSUE ABLATION

Facility

$932.00

Service Code	HCPCS 77022
Hospital Charge Code	2690285
Hospital Revenue Code	610
Min. Negotiated Rate	$139.80
Max. Negotiated Rate	$139.80
Rate for Payer: Qualcare PPO/HMO/WC	$139.80

MRI FOR TISSUE ABLATION

Facility

$932.00

Service Code	HCPCS 77022
Hospital Charge Code	2690285
Hospital Revenue Code	610
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$354.16
Rate for Payer: Aetna Medicare Advantage	$279.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.66
Rate for Payer: Cigna Commercial	$466.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.60
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.80
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$22.46
Rate for Payer: Wellpoint Medicaid Managed Care	$24.70

MRI FOR TISSUE ABLATION-PC

Facility

$1,127.75

Service Code	HCPCS 7702226
Hospital Charge Code	85000030
Hospital Revenue Code	610
Min. Negotiated Rate	$169.16
Max. Negotiated Rate	$169.16
Rate for Payer: Qualcare PPO/HMO/WC	$169.16

MRI FOR TISSUE ABLATION-PC

Facility

$1,127.75

Service Code	HCPCS 7702226
Hospital Charge Code	85000030
Hospital Revenue Code	610
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$428.55
Rate for Payer: Aetna Medicare Advantage	$338.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.58
Rate for Payer: Cigna Commercial	$563.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.32
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$169.16
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$27.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.89

MRI GUIDANCE FOR INJECTION

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400471
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 GUIDANCE FOR INJECTION

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400471
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI GUIDANCE FOR NEEDLE PLCMNT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400268
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI GUIDANCE FOR NEEDLE PLCMNT

Facility

$1,808.25

Service Code	HCPCS 77021
Hospital Charge Code	2400268
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 GUIDE BRST BIOPSY 1ST LES

Facility

$13,500.00

Service Code	HCPCS 19085LT
Hospital Charge Code	94064025L
Hospital Revenue Code	610
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

Know your out-of-pocket cost for care.

All Charges