Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRA LOW EXTR W/ OR W/O CONT RT

Facility

$13,500.00

Service Code	HCPCS 73725RT
Hospital Charge Code	2400300
Hospital Revenue Code	616
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRA LOW EXTR W/ OR W/O CONT RT

Facility

$13,500.00

Service Code	HCPCS 73725RT
Hospital Charge Code	2400300
Hospital Revenue Code	616
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

MRA LOWR EXTR W/ CON BIL

Facility

$1,944.85

Service Code	HCPCS 7372550
Hospital Charge Code	24000295
Hospital Revenue Code	610
Min. Negotiated Rate	$46.87
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$739.04
Rate for Payer: Aetna Medicare Advantage	$583.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.94
Rate for Payer: Cigna Commercial	$972.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$583.46
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$291.73
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$46.87
Rate for Payer: Wellpoint Medicaid Managed Care	$51.54

MRA LOWR EXTR W/ CON BIL

Facility

$1,944.85

Service Code	HCPCS 7372550
Hospital Charge Code	2400295
Hospital Revenue Code	610
Min. Negotiated Rate	$46.87
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$739.04
Rate for Payer: Aetna Medicare Advantage	$583.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.94
Rate for Payer: Cigna Commercial	$972.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$583.46
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$291.73
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$46.87
Rate for Payer: Wellpoint Medicaid Managed Care	$51.54

MRA LOWR EXTR W/ CON BIL

Facility

$3,889.70

Service Code	HCPCS 7372550
Hospital Charge Code	2400095
Hospital Revenue Code	616
Min. Negotiated Rate	$93.74
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,478.09
Rate for Payer: Aetna Medicare Advantage	$1,166.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$991.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$991.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$991.87
Rate for Payer: Cigna Commercial	$1,944.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,166.91
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$583.46
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$93.74
Rate for Payer: Wellpoint Medicaid Managed Care	$103.08

MRA LOWR EXTR W/ CON BIL

Facility

$3,889.70

Service Code	HCPCS 7372550
Hospital Charge Code	2400095
Hospital Revenue Code	616
Min. Negotiated Rate	$583.46
Max. Negotiated Rate	$583.46
Rate for Payer: Qualcare PPO/HMO/WC	$583.46

MRA LOWR EXTR W/ CON BIL

Facility

$1,944.85

Service Code	HCPCS 7372550
Hospital Charge Code	24000295
Hospital Revenue Code	610
Min. Negotiated Rate	$291.73
Max. Negotiated Rate	$291.73
Rate for Payer: Qualcare PPO/HMO/WC	$291.73

MRA LOWR EXTR W/ CON BIL

Facility

$1,944.85

Service Code	HCPCS 7372550
Hospital Charge Code	2400295
Hospital Revenue Code	610
Min. Negotiated Rate	$291.73
Max. Negotiated Rate	$291.73
Rate for Payer: Qualcare PPO/HMO/WC	$291.73

MRA LOWR EXTR W/OR W/O CO LT

Facility

$1,944.85

Service Code	HCPCS 73725LT
Hospital Charge Code	2400299
Hospital Revenue Code	616
Min. Negotiated Rate	$46.87
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$739.04
Rate for Payer: Aetna Medicare Advantage	$583.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.94
Rate for Payer: Cigna Commercial	$972.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$583.46
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$291.73
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$46.87
Rate for Payer: Wellpoint Medicaid Managed Care	$51.54

MRA LOWR EXTR W/OR W/O CO LT

Facility

$1,944.85

Service Code	HCPCS 73725LT
Hospital Charge Code	2400299
Hospital Revenue Code	616
Min. Negotiated Rate	$291.73
Max. Negotiated Rate	$291.73
Rate for Payer: Qualcare PPO/HMO/WC	$291.73

MRA LOWR EXTR W & W/O CON BIL

Facility

$13,500.00

Service Code	HCPCS 7372550
Hospital Charge Code	2400097
Hospital Revenue Code	616
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

MRA LOWR EXTR W & W/O CON BIL

Facility

$13,500.00

Service Code	HCPCS 7372550
Hospital Charge Code	2400097
Hospital Revenue Code	616
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRA LWR EX LT W/ C

Facility

$1,937.65

Service Code	HCPCS 73725LT
Hospital Charge Code	2400298
Hospital Revenue Code	616
Min. Negotiated Rate	$290.65
Max. Negotiated Rate	$290.65
Rate for Payer: Qualcare PPO/HMO/WC	$290.65

MRA LWR EX LT W/ C

Facility

$1,937.65

Service Code	HCPCS 73725LT
Hospital Charge Code	2400298
Hospital Revenue Code	616
Min. Negotiated Rate	$46.70
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$736.31
Rate for Payer: Aetna Medicare Advantage	$581.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.10
Rate for Payer: Cigna Commercial	$968.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$581.29
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$290.65
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$46.70
Rate for Payer: Wellpoint Medicaid Managed Care	$51.35

MRA LWR EX LT W/O C

Facility

$1,706.45

Service Code	HCPCS 73725LT
Hospital Charge Code	2400297
Hospital Revenue Code	616
Min. Negotiated Rate	$255.97
Max. Negotiated Rate	$255.97
Rate for Payer: Qualcare PPO/HMO/WC	$255.97

MRA LWR EX LT W/O C

Facility

$1,706.45

Service Code	HCPCS 73725LT
Hospital Charge Code	2400297
Hospital Revenue Code	616
Min. Negotiated Rate	$41.13
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$648.45
Rate for Payer: Aetna Medicare Advantage	$511.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.14
Rate for Payer: Cigna Commercial	$853.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.94
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.97
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$41.13
Rate for Payer: Wellpoint Medicaid Managed Care	$45.22

MRA LWR EX LT W/O FOL W/ C

Facility

$2,320.85

Service Code	HCPCS 73725LT
Hospital Charge Code	2400296
Hospital Revenue Code	616
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$881.92
Rate for Payer: Aetna Medicare Advantage	$696.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.82
Rate for Payer: Cigna Commercial	$1,160.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$696.25
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.13
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$55.93
Rate for Payer: Wellpoint Medicaid Managed Care	$61.50

MRA LWR EX LT W/O FOL W/ C

Facility

$2,320.85

Service Code	HCPCS 73725LT
Hospital Charge Code	2400296
Hospital Revenue Code	616
Min. Negotiated Rate	$348.13
Max. Negotiated Rate	$348.13
Rate for Payer: Qualcare PPO/HMO/WC	$348.13

MRA LWR EX RT W/ C

Facility

$1,937.65

Service Code	HCPCS 73725RT
Hospital Charge Code	2400301
Hospital Revenue Code	616
Min. Negotiated Rate	$46.70
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$736.31
Rate for Payer: Aetna Medicare Advantage	$581.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.10
Rate for Payer: Cigna Commercial	$968.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$581.29
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$290.65
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$46.70
Rate for Payer: Wellpoint Medicaid Managed Care	$51.35

MRA LWR EX RT W/ C

Facility

$1,937.65

Service Code	HCPCS 73725RT
Hospital Charge Code	2400301
Hospital Revenue Code	616
Min. Negotiated Rate	$290.65
Max. Negotiated Rate	$290.65
Rate for Payer: Qualcare PPO/HMO/WC	$290.65

MRA LWR EX RT W/O C

Facility

$1,706.45

Service Code	HCPCS 73725RT
Hospital Charge Code	2400302
Hospital Revenue Code	616
Min. Negotiated Rate	$41.13
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$648.45
Rate for Payer: Aetna Medicare Advantage	$511.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.14
Rate for Payer: Cigna Commercial	$853.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.94
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.97
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$41.13
Rate for Payer: Wellpoint Medicaid Managed Care	$45.22

MRA LWR EX RT W/O C

Facility

$1,706.45

Service Code	HCPCS 73725RT
Hospital Charge Code	2400302
Hospital Revenue Code	616
Min. Negotiated Rate	$255.97
Max. Negotiated Rate	$255.97
Rate for Payer: Qualcare PPO/HMO/WC	$255.97

MRA LWR EX RT W/O FOL W/ C

Facility

$2,320.85

Service Code	HCPCS 73725RT
Hospital Charge Code	2400303
Hospital Revenue Code	616
Min. Negotiated Rate	$348.13
Max. Negotiated Rate	$348.13
Rate for Payer: Qualcare PPO/HMO/WC	$348.13

MRA LWR EX RT W/O FOL W/ C

Facility

$2,320.85

Service Code	HCPCS 73725RT
Hospital Charge Code	2400303
Hospital Revenue Code	616
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$881.92
Rate for Payer: Aetna Medicare Advantage	$696.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.82
Rate for Payer: Cigna Commercial	$1,160.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$696.25
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.13
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$55.93
Rate for Payer: Wellpoint Medicaid Managed Care	$61.50

MRA/MRV ABDOMEN W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74185
Hospital Charge Code	2400316
Hospital Revenue Code	618
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