Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRA/MRV UPPER EXT W/WO CONT LT

Facility

$13,500.00

Service Code	HCPCS 73225LT
Hospital Charge Code	2400265
Hospital Revenue Code	618
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/MRV UPPER EXT W/WO CONT LT

Facility

$13,500.00

Service Code	HCPCS 73225LT
Hospital Charge Code	2400265
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

MRA NECK W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70547
Hospital Charge Code	94061029
Hospital Revenue Code	615
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

MRA NECK W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70547
Hospital Charge Code	94061029
Hospital Revenue Code	615
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MR ANGIOGRAPHY ABDOMEN

Facility

$2,354.00

Service Code	HCPCS 74185
Hospital Charge Code	94061133
Hospital Revenue Code	618
Min. Negotiated Rate	$56.73
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$894.52
Rate for Payer: Aetna Medicare Advantage	$706.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$600.27
Rate for Payer: Cigna Commercial	$1,177.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.20
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$353.10
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$56.73
Rate for Payer: Wellpoint Medicaid Managed Care	$62.38

MR ANGIOGRAPHY ABDOMEN

Facility

$2,354.00

Service Code	HCPCS 74185
Hospital Charge Code	94061133
Hospital Revenue Code	618
Min. Negotiated Rate	$353.10
Max. Negotiated Rate	$353.10
Rate for Payer: Qualcare PPO/HMO/WC	$353.10

MR ANGIO LOWER EXTREMITY

Facility

$2,354.00

Service Code	HCPCS 73725
Hospital Charge Code	94061123
Hospital Revenue Code	616
Min. Negotiated Rate	$353.10
Max. Negotiated Rate	$353.10
Rate for Payer: Qualcare PPO/HMO/WC	$353.10

MR ANGIO LOWER EXTREMITY

Facility

$2,354.00

Service Code	HCPCS 73725
Hospital Charge Code	94061123
Hospital Revenue Code	616
Min. Negotiated Rate	$56.73
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$894.52
Rate for Payer: Aetna Medicare Advantage	$706.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.27
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	$600.27
Rate for Payer: Cigna Commercial	$1,177.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.20
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$353.10
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$56.73
Rate for Payer: Wellpoint Medicaid Managed Care	$62.38

MR ANGIO PELVIS

Facility

$2,354.00

Service Code	HCPCS 72198
Hospital Charge Code	94061097
Hospital Revenue Code	618
Min. Negotiated Rate	$56.73
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$894.52
Rate for Payer: Aetna Medicare Advantage	$706.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$600.27
Rate for Payer: Cigna Commercial	$1,177.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.20
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$353.10
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$56.73
Rate for Payer: Wellpoint Medicaid Managed Care	$62.38

MR ANGIO PELVIS

Facility

$2,354.00

Service Code	HCPCS 72198
Hospital Charge Code	94061097
Hospital Revenue Code	618
Min. Negotiated Rate	$353.10
Max. Negotiated Rate	$353.10
Rate for Payer: Qualcare PPO/HMO/WC	$353.10

MRA PELVIS W/ CONT

Facility

$1,944.80

Service Code	HCPCS 72198
Hospital Charge Code	2400230
Hospital Revenue Code	618
Min. Negotiated Rate	$46.87
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$739.02
Rate for Payer: Aetna Medicare Advantage	$583.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.92
Rate for Payer: Cigna Commercial	$972.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$583.44
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$291.72
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 PELVIS W/ CONT

Facility

$1,944.80

Service Code	HCPCS 72198
Hospital Charge Code	2400230
Hospital Revenue Code	618
Min. Negotiated Rate	$291.72
Max. Negotiated Rate	$291.72
Rate for Payer: Qualcare PPO/HMO/WC	$291.72

MRA PELVIS W & W/O CONT

Facility

$1,944.80

Service Code	HCPCS 72198
Hospital Charge Code	2400232
Hospital Revenue Code	618
Min. Negotiated Rate	$46.87
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$739.02
Rate for Payer: Aetna Medicare Advantage	$583.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.92
Rate for Payer: Cigna Commercial	$972.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$583.44
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$291.72
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 PELVIS W & W/O CONT

Facility

$1,944.80

Service Code	HCPCS 72198
Hospital Charge Code	2400232
Hospital Revenue Code	618
Min. Negotiated Rate	$291.72
Max. Negotiated Rate	$291.72
Rate for Payer: Qualcare PPO/HMO/WC	$291.72

MRA SPINAL CANAL W/OR W/O CONT

Facility

$1,354.45

Service Code	HCPCS 72159
Hospital Charge Code	2400216
Hospital Revenue Code	618
Min. Negotiated Rate	$203.17
Max. Negotiated Rate	$203.17
Rate for Payer: Qualcare PPO/HMO/WC	$203.17

MRA SPINAL CANAL W/OR W/O CONT

Facility

$1,354.45

Service Code	HCPCS 72159
Hospital Charge Code	2400216
Hospital Revenue Code	618
Min. Negotiated Rate	$32.64
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$514.69
Rate for Payer: Aetna Medicare Advantage	$406.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$532.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.38
Rate for Payer: Cigna Commercial	$677.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.33
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.17
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$32.64
Rate for Payer: Wellpoint Medicaid Managed Care	$35.89

MRA UPPER EXT W CONTRAST

Facility

$2,043.00

Service Code	HCPCS 73225
Hospital Charge Code	2408005
Hospital Revenue Code	618
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

MRA UPPER EXT W CONTRAST

Facility

$2,043.00

Service Code	HCPCS 73225
Hospital Charge Code	2408005
Hospital Revenue Code	618
Min. Negotiated Rate	$49.24
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$776.34
Rate for Payer: Aetna Medicare Advantage	$612.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$486.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.97
Rate for Payer: Cigna Commercial	$1,021.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.90
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.45
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$49.24
Rate for Payer: Wellpoint Medicaid Managed Care	$54.14

MRA UPP EXTR W CONTR LT

Facility

$2,043.25

Service Code	HCPCS 73225LT
Hospital Charge Code	2400263
Hospital Revenue Code	618
Min. Negotiated Rate	$306.49
Max. Negotiated Rate	$306.49
Rate for Payer: Qualcare PPO/HMO/WC	$306.49

MRA UPP EXTR W CONTR LT

Facility

$2,043.25

Service Code	HCPCS 73225LT
Hospital Charge Code	2400263
Hospital Revenue Code	618
Min. Negotiated Rate	$49.24
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$776.43
Rate for Payer: Aetna Medicare Advantage	$612.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.03
Rate for Payer: Cigna Commercial	$1,021.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.98
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.49
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$49.24
Rate for Payer: Wellpoint Medicaid Managed Care	$54.15

MRA UPP EXTR W/ CONTR RT

Facility

$2,043.25

Service Code	HCPCS 73225RT
Hospital Charge Code	2400264
Hospital Revenue Code	618
Min. Negotiated Rate	$306.49
Max. Negotiated Rate	$306.49
Rate for Payer: Qualcare PPO/HMO/WC	$306.49

MRA UPP EXTR W/ CONTR RT

Facility

$2,043.25

Service Code	HCPCS 73225RT
Hospital Charge Code	2400264
Hospital Revenue Code	618
Min. Negotiated Rate	$49.24
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$776.43
Rate for Payer: Aetna Medicare Advantage	$612.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.03
Rate for Payer: Cigna Commercial	$1,021.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.98
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.49
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$49.24
Rate for Payer: Wellpoint Medicaid Managed Care	$54.15

MRA UPP EXTR W/O CONTR LT

Facility

$2,043.25

Service Code	HCPCS 73225LT
Hospital Charge Code	2400261
Hospital Revenue Code	618
Min. Negotiated Rate	$49.24
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$776.43
Rate for Payer: Aetna Medicare Advantage	$612.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.03
Rate for Payer: Cigna Commercial	$1,021.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.98
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.49
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$49.24
Rate for Payer: Wellpoint Medicaid Managed Care	$54.15

MRA UPP EXTR W/O CONTR LT

Facility

$2,043.25

Service Code	HCPCS 73225LT
Hospital Charge Code	2400261
Hospital Revenue Code	618
Min. Negotiated Rate	$306.49
Max. Negotiated Rate	$306.49
Rate for Payer: Qualcare PPO/HMO/WC	$306.49

MRA UPP EXTR W/O CONTR RT

Facility

$2,043.25

Service Code	HCPCS 73225RT
Hospital Charge Code	2400262
Hospital Revenue Code	618
Min. Negotiated Rate	$306.49
Max. Negotiated Rate	$306.49
Rate for Payer: Qualcare PPO/HMO/WC	$306.49

Know your out-of-pocket cost for care.

All Charges