Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 GUIDE BRST BIOPSY 1ST LES

Facility

$13,500.00

Service Code	HCPCS 1908550
Hospital Charge Code	94064025
Hospital Revenue Code	610
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 GUIDE BRST BIOPSY 1ST LES

Facility

$13,500.00

Service Code	HCPCS 19085RT
Hospital Charge Code	94064025R
Hospital Revenue Code	610
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 GUIDE BRST BIOPSY 1ST LES

Facility

$13,500.00

Service Code	HCPCS 19085RT
Hospital Charge Code	94064025R
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

MRI GUIDE BRST BIOPSY 1ST LES

Facility

$13,500.00

Service Code	HCPCS 1908550
Hospital Charge Code	94064025
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

MRI GUIDE BRST BIOPSY ADD LES

Facility

$13,500.00

Service Code	HCPCS 19086
Hospital Charge Code	94064027R
Hospital Revenue Code	610
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 GUIDE BRST BIOPSY ADD LES

Facility

$13,500.00

Service Code	HCPCS 19086
Hospital Charge Code	94064027R
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

MRI GUIDE BRST BIOPSY ADD LES

Facility

$13,500.00

Service Code	HCPCS 19086
Hospital Charge Code	94064027L
Hospital Revenue Code	610
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 GUIDE BRST BIOPSY ADD LES

Facility

$13,500.00

Service Code	HCPCS 19086
Hospital Charge Code	94064027L
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

MRI GUIDE BRST BIOPSY ADD LES

Facility

$13,500.00

Service Code	HCPCS 19086
Hospital Charge Code	94064027
Hospital Revenue Code	610
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 GUIDE BRST BIOPSY ADD LES

Facility

$13,500.00

Service Code	HCPCS 19086
Hospital Charge Code	94064027
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

MRI HAND W/CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400475
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI HAND W/CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400475
Hospital Revenue Code	614
Min. Negotiated Rate	$106.55
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,679.98
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	$1,326.30
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$663.15
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$106.55
Rate for Payer: Wellpoint Medicaid Managed Care	$117.16

MRI HAND W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73219LT
Hospital Charge Code	2400476
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 HAND W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73219LT
Hospital Charge Code	2400476
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI HAND W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400477
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 HAND W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73219RT
Hospital Charge Code	2400477
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI HAND W/O CONTRAST BILATERL

Facility

$2,080.60

Service Code	HCPCS 7321850
Hospital Charge Code	2400478
Hospital Revenue Code	614
Min. Negotiated Rate	$312.09
Max. Negotiated Rate	$312.09
Rate for Payer: Qualcare PPO/HMO/WC	$312.09

MRI HAND W/O CONTRAST BILATERL

Facility

$2,080.60

Service Code	HCPCS 7321850
Hospital Charge Code	2400478
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 HAND W/O CONTRAST LEFT

Facility

$2,080.60

Service Code	HCPCS 73218LT
Hospital Charge Code	2400479
Hospital Revenue Code	614
Min. Negotiated Rate	$312.09
Max. Negotiated Rate	$312.09
Rate for Payer: Qualcare PPO/HMO/WC	$312.09

MRI HAND W/O CONTRAST LEFT

Facility

$2,080.60

Service Code	HCPCS 73218LT
Hospital Charge Code	2400479
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 HAND W/O CONTRAST RIGHT

Facility

$2,080.60

Service Code	HCPCS 73218RT
Hospital Charge Code	2400480
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 HAND W/O CONTRAST RIGHT

Facility

$2,080.60

Service Code	HCPCS 73218RT
Hospital Charge Code	2400480
Hospital Revenue Code	614
Min. Negotiated Rate	$312.09
Max. Negotiated Rate	$312.09
Rate for Payer: Qualcare PPO/HMO/WC	$312.09

MRI HAND W/&W/O CONTRAST BLTRL

Facility

$6,032.80

Service Code	HCPCS 7322050
Hospital Charge Code	2400472
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 HAND W/&W/O CONTRAST BLTRL

Facility

$6,032.80

Service Code	HCPCS 7322050
Hospital Charge Code	2400472
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

Know your out-of-pocket cost for care.

All Charges