Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRI KNEE W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400507
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 KNEE W/O CONTRAST RIGHT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400507
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 KNEE W/O CONTRST BILATERAL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400505
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 KNEE W/O CONTRST BILATERAL

Facility

$13,500.00

Service Code	HCPCS 7372150
Hospital Charge Code	2400505
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 KNEE W/&W/O CONTRAST BILTL

Facility

$2,072.35

Service Code	HCPCS 7372350
Hospital Charge Code	2400499
Hospital Revenue Code	614
Min. Negotiated Rate	$310.85
Max. Negotiated Rate	$310.85
Rate for Payer: Qualcare PPO/HMO/WC	$310.85

MRI KNEE W/&W/O CONTRAST BILTL

Facility

$2,072.35

Service Code	HCPCS 7372350
Hospital Charge Code	2400499
Hospital Revenue Code	614
Min. Negotiated Rate	$49.94
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$787.49
Rate for Payer: Aetna Medicare Advantage	$621.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$528.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$528.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$528.45
Rate for Payer: Cigna Commercial	$1,036.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.71
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.85
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$49.94
Rate for Payer: Wellpoint Medicaid Managed Care	$54.92

MRI KNEE W/& W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400500
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 KNEE W/& W/O CONTRAST LEFT

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400500
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 KNEE W/& W/O CONTRAST RGHT

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400501
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 KNEE W/& W/O CONTRAST RGHT

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400501
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 LE JOINT W/CONTRAST BILTRL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400509
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 LE JOINT W/CONTRAST BILTRL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400509
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI LE JOINT W/O CONTRST BLTRL

Facility

$14,381.96

Service Code	HCPCS 7372150
Hospital Charge Code	2400510
Hospital Revenue Code	614
Min. Negotiated Rate	$2,157.29
Max. Negotiated Rate	$2,157.29
Rate for Payer: Qualcare PPO/HMO/WC	$2,157.29

MRI LE JOINT W/O CONTRST BLTRL

Facility

$14,381.96

Service Code	HCPCS 7372150
Hospital Charge Code	2400510
Hospital Revenue Code	614
Min. Negotiated Rate	$346.61
Max. Negotiated Rate	$7,190.98
Rate for Payer: Aetna Commercial	$5,465.14
Rate for Payer: Aetna Medicare Advantage	$4,314.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,667.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,667.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,667.40
Rate for Payer: Cigna Commercial	$7,190.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,314.59
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,157.29
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$346.61
Rate for Payer: Wellpoint Medicaid Managed Care	$381.12

MRI LE JOINT W/&W/O CNTRST BLT

Facility

$6,032.80

Service Code	HCPCS 7372350
Hospital Charge Code	2400508
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 LE JOINT W/&W/O CNTRST BLT

Facility

$6,032.80

Service Code	HCPCS 7372350
Hospital Charge Code	2400508
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI LE NON JNT W/CONTRST BILTL

Facility

$4,421.00

Service Code	HCPCS 7371950
Hospital Charge Code	2400512
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI LE NON JNT W/CONTRST BILTL

Facility

$4,421.00

Service Code	HCPCS 7371950
Hospital Charge Code	2400512
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 LE NON JNT W/O CNTRST BLTL

Facility

$4,421.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400513
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI LE NON JNT W/O CNTRST BLTL

Facility

$4,421.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400513
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 LE NON JNT W/&W/O CTRST BL

Facility

$6,032.80

Service Code	HCPCS 7372050
Hospital Charge Code	2400511
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI LE NON JNT W/&W/O CTRST BL

Facility

$6,032.80

Service Code	HCPCS 7372050
Hospital Charge Code	2400511
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 LE NONJOINT W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 73719
Hospital Charge Code	406173719
Hospital Revenue Code	614
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$414.47
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
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: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRI LE NONJOINT W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 73719
Hospital Charge Code	406173719
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 LOWER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73720
Hospital Charge Code	94061117
Hospital Revenue Code	614
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,496.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,496.11
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$414.47
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
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: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

Know your out-of-pocket cost for care.

All Charges