Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRI TIBIA/FIBULA W/&W/O CNT RT

Facility

$3,016.40

Service Code	HCPCS 73720RT
Hospital Charge Code	2400526
Hospital Revenue Code	614
Min. Negotiated Rate	$452.46
Max. Negotiated Rate	$452.46
Rate for Payer: Qualcare PPO/HMO/WC	$452.46

MRI TIBIA/FIBULA W/&W/O CNT RT

Facility

$3,016.40

Service Code	HCPCS 73720RT
Hospital Charge Code	2400526
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 TM JOINTS

Facility

$13,500.00

Service Code	HCPCS 70336
Hospital Charge Code	94061019
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 TM JOINTS

Facility

$13,500.00

Service Code	HCPCS 70336
Hospital Charge Code	94061019
Hospital Revenue Code	614
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
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	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
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	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRI UE JNT W/&W/O CNTRST BLTRL

Facility

$11,820.00

Service Code	HCPCS 7322350
Hospital Charge Code	2400533
Hospital Revenue Code	614
Min. Negotiated Rate	$284.86
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$4,491.60
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	$3,546.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,773.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$284.86
Rate for Payer: Wellpoint Medicaid Managed Care	$313.23

MRI UE JNT W/&W/O CNTRST BLTRL

Facility

$11,820.00

Service Code	HCPCS 7322350
Hospital Charge Code	2400533
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 UE JOINT W/CONTRAST BILTRL

Facility

$11,820.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400534
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 UE JOINT W/CONTRAST BILTRL

Facility

$11,820.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400534
Hospital Revenue Code	614
Min. Negotiated Rate	$284.86
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$4,491.60
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	$3,546.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,773.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$284.86
Rate for Payer: Wellpoint Medicaid Managed Care	$313.23

MRI UE JOINT W/O CNTRST BLTRL

Facility

$13,500.00

Service Code	HCPCS 7322150
Hospital Charge Code	2400535
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 UE JOINT W/O CNTRST BLTRL

Facility

$13,500.00

Service Code	HCPCS 7322150
Hospital Charge Code	2400535
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 UE NON JNT W/CONTRST BLTRL

Facility

$4,421.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400537
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI UE NON JNT W/CONTRST BLTRL

Facility

$4,421.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400537
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 UE NON JNT W/O CNTRST BLTL

Facility

$4,161.20

Service Code	HCPCS 7321850
Hospital Charge Code	2400538
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 UE NON JNT W/O CNTRST BLTL

Facility

$4,161.20

Service Code	HCPCS 7321850
Hospital Charge Code	2400538
Hospital Revenue Code	614
Min. Negotiated Rate	$624.18
Max. Negotiated Rate	$624.18
Rate for Payer: Qualcare PPO/HMO/WC	$624.18

MRI UE NON JNT W/&W/O CNTST BL

Facility

$6,032.80

Service Code	HCPCS 7322050
Hospital Charge Code	2400536
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 UE NON JNT W/&W/O CNTST BL

Facility

$6,032.80

Service Code	HCPCS 7322050
Hospital Charge Code	2400536
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI UNLISTED PROCEDURE

Facility

$1,808.25

Service Code	HCPCS 76498
Hospital Charge Code	2400539
Hospital Revenue Code	610
Min. Negotiated Rate	$271.24
Max. Negotiated Rate	$271.24
Rate for Payer: Qualcare PPO/HMO/WC	$271.24

MRI UNLISTED PROCEDURE

Facility

$1,808.25

Service Code	HCPCS 76498
Hospital Charge Code	2400539
Hospital Revenue Code	610
Min. Negotiated Rate	$43.58
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$103.39
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
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: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$47.92

MRI UPPER EXTREMITY

Facility

$2,049.00

Hospital Charge Code	2409005
Hospital Revenue Code	610
Min. Negotiated Rate	$49.38
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$778.62
Rate for Payer: Aetna Medicare Advantage	$614.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.50
Rate for Payer: Cigna Commercial	$1,024.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$614.70
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.35
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$49.38
Rate for Payer: Wellpoint Medicaid Managed Care	$54.30

MRI UPPER EXTREMITY

Facility

$2,049.00

Hospital Charge Code	2409005
Hospital Revenue Code	610
Min. Negotiated Rate	$307.35
Max. Negotiated Rate	$307.35
Rate for Payer: Qualcare PPO/HMO/WC	$307.35

MRI UPPER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73221
Hospital Charge Code	94061109
Hospital Revenue Code	614
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$638.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
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	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MRI UPPER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73221
Hospital Charge Code	94061109
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 EXTREMITY NON

Facility

$1,513.00

Service Code	HCPCS 73218
Hospital Charge Code	2409001
Hospital Revenue Code	614
Min. Negotiated Rate	$36.46
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$586.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.90
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$226.95
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$36.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$40.09

MRI UPPER EXTREMITY NON

Facility

$1,513.00

Service Code	HCPCS 73218
Hospital Charge Code	2409001
Hospital Revenue Code	614
Min. Negotiated Rate	$226.95
Max. Negotiated Rate	$226.95
Rate for Payer: Qualcare PPO/HMO/WC	$226.95

MRI UPPER EXTREMITY NON

Facility

$13,500.00

Service Code	HCPCS 73218
Hospital Charge Code	94061107
Hospital Revenue Code	614
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,023.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$586.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,023.24
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
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	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

Know your out-of-pocket cost for care.

All Charges