Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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/ & W/O CONT RT

Facility

$13,500.00

Service Code	HCPCS 73225RT
Hospital Charge Code	2400266
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 UPP EXTR W/ & W/O CONT RT

Facility

$13,500.00

Service Code	HCPCS 73225RT
Hospital Charge Code	2400266
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

MR BREAST BI W/ C

Facility

$13,500.00

Service Code	HCPCS C8906
Hospital Charge Code	2400381
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

MR BREAST BI W/ C

Facility

$13,500.00

Service Code	HCPCS C8906
Hospital Charge Code	2400381
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) 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

MR BREAST BI W/O C

Facility

$1,706.45

Service Code	HCPCS C8907
Hospital Charge Code	2400382
Hospital Revenue Code	614
Min. Negotiated Rate	$255.97
Max. Negotiated Rate	$255.97
Rate for Payer: Qualcare PPO/HMO/WC	$255.97

MR BREAST BI W/O C

Facility

$1,706.45

Service Code	HCPCS C8907
Hospital Charge Code	2400382
Hospital Revenue Code	614
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

MR BREAST BI W/O FOL W/ C

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	2400383
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MR BREAST BI W/O FOL W/ C

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	2400383
Hospital Revenue Code	614
Min. Negotiated Rate	$122.37
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,929.45
Rate for Payer: Aetna Medicare Advantage	$1,523.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.76
Rate for Payer: Cigna Commercial	$2,538.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,523.25
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.62
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$122.37
Rate for Payer: Wellpoint Medicaid Managed Care	$134.55

MR BREAST UNI W/ C

Facility

$13,500.00

Service Code	HCPCS C8903
Hospital Charge Code	2400373
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

MR BREAST UNI W/ C

Facility

$13,500.00

Service Code	HCPCS C8903
Hospital Charge Code	2400373
Hospital Revenue Code	614
Min. Negotiated Rate	$197.96
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.19
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$208.38
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MR BREAST UNI W/O C

Facility

$1,706.45

Service Code	HCPCS C8904
Hospital Charge Code	2400374
Hospital Revenue Code	614
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

MR BREAST UNI W/O C

Facility

$1,706.45

Service Code	HCPCS C8904
Hospital Charge Code	2400374
Hospital Revenue Code	614
Min. Negotiated Rate	$255.97
Max. Negotiated Rate	$255.97
Rate for Payer: Qualcare PPO/HMO/WC	$255.97

MR BREAST UNI W/WO C

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400375
Hospital Revenue Code	614
Min. Negotiated Rate	$122.37
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,929.45
Rate for Payer: Aetna Medicare Advantage	$1,523.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.76
Rate for Payer: Cigna Commercial	$2,538.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,523.25
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.62
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$122.37
Rate for Payer: Wellpoint Medicaid Managed Care	$134.55

MR BREAST UNI W/WO C

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400375
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MR BRST WIRE LOC PREOP PLCMT

Facility

$996.25

Hospital Charge Code	2400416
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$378.57
Rate for Payer: Aetna Medicare Advantage	$298.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.04
Rate for Payer: Cigna Commercial	$498.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

MR BRST WIRE LOC PREOP PLCMT

Facility

$996.25

Hospital Charge Code	2400416
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MR CHEST LYMPHADEN H/M W/ C

Facility

$2,210.50

Service Code	HCPCS 71551
Hospital Charge Code	2400110
Hospital Revenue Code	614
Min. Negotiated Rate	$53.27
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$2,533.19
Rate for Payer: Aetna Medicare Advantage	$3,017.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$931.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$576.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,361.79
Rate for Payer: Cigna Commercial	$1,866.82
Rate for Payer: Cigna Medicare Advantage	$931.32
Rate for Payer: Clover Medicare Advantage	$884.75
Rate for Payer: EmblemHealth Commercial	$2,793.96
Rate for Payer: Humana Medicare Advantage	$959.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$931.32
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: UnitedHealthcare Medicare Advantage	$931.32
Rate for Payer: Wellcare Medicare Advantage	$931.32
Rate for Payer: Wellpoint Medicaid Managed Care	$58.58

MR CHEST LYMPHADEN H/M W/ C

Facility

$2,210.50

Service Code	HCPCS 71551
Hospital Charge Code	2400110
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MR CHEST LYMPHADEN H/M W/WO C

Facility

$13,500.00

Service Code	HCPCS 71552
Hospital Charge Code	2400111
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

MR CHEST LYMPHADEN H/M W/WO C

Facility

$13,500.00

Service Code	HCPCS 71552
Hospital Charge Code	2400111
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	$937.74
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

MR DIAG IV INJECT GADOLINIUM

Facility

$261.65

Service Code	HCPCS A9579
Hospital Charge Code	2400398
Hospital Revenue Code	255
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$130.82
Rate for Payer: Aetna Commercial	$99.43
Rate for Payer: Aetna Medicare Advantage	$78.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.72
Rate for Payer: Cigna Commercial	$130.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.50
Rate for Payer: Oxford Commercial	$52.33
Rate for Payer: Qualcare PPO/HMO/WC	$39.25
Rate for Payer: UnitedHealthcare Commercial	$52.33
Rate for Payer: UnitedHealthcare Community & State	$6.31
Rate for Payer: Wellpoint Medicaid Managed Care	$6.93

MR DIAG IV INJECT GADOLINIUM

Facility

$261.65

Service Code	HCPCS A9579
Hospital Charge Code	2400398
Hospital Revenue Code	255
Min. Negotiated Rate	$39.25
Max. Negotiated Rate	$39.25
Rate for Payer: Qualcare PPO/HMO/WC	$39.25

MR GUIDANCE FOR NDL PLACE-GL

Facility

$2,433.20

Service Code	HCPCS 77021
Hospital Charge Code	85000015
Hospital Revenue Code	610
Min. Negotiated Rate	$364.98
Max. Negotiated Rate	$364.98
Rate for Payer: Qualcare PPO/HMO/WC	$364.98

MR GUIDANCE FOR NDL PLACE-GL

Facility

$2,433.20

Service Code	HCPCS 77021
Hospital Charge Code	85000015
Hospital Revenue Code	610
Min. Negotiated Rate	$58.64
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$924.62
Rate for Payer: Aetna Medicare Advantage	$729.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$620.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$620.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$620.47
Rate for Payer: Cigna Commercial	$1,216.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.96
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$364.98
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$58.64
Rate for Payer: Wellpoint Medicaid Managed Care	$64.48

Know your out-of-pocket cost for care.

All Charges