Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MR GUIDANCE FOR NDL PLACE-PC

Facility

$400.90

Service Code	HCPCS 7702126
Hospital Charge Code	85000025
Hospital Revenue Code	610
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$152.34
Rate for Payer: Aetna Medicare Advantage	$120.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.23
Rate for Payer: Cigna Commercial	$200.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.27
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.13
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$9.66
Rate for Payer: Wellpoint Medicaid Managed Care	$10.62

MR GUIDANCE FOR NDL PLACE-PC

Facility

$400.90

Service Code	HCPCS 7702126
Hospital Charge Code	85000025
Hospital Revenue Code	610
Min. Negotiated Rate	$60.13
Max. Negotiated Rate	$60.13
Rate for Payer: Qualcare PPO/HMO/WC	$60.13

MR GUID FOR NEEDLE PLACE

Facility

$932.00

Service Code	HCPCS 77021
Hospital Charge Code	2690280
Hospital Revenue Code	610
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$354.16
Rate for Payer: Aetna Medicare Advantage	$279.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.66
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	$237.66
Rate for Payer: Cigna Commercial	$466.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.60
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.80
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$22.46
Rate for Payer: Wellpoint Medicaid Managed Care	$24.70

MR GUID FOR NEEDLE PLACE

Facility

$932.00

Service Code	HCPCS 77021
Hospital Charge Code	7411758
Hospital Revenue Code	610
Min. Negotiated Rate	$139.80
Max. Negotiated Rate	$139.80
Rate for Payer: Qualcare PPO/HMO/WC	$139.80

MR GUID FOR NEEDLE PLACE

Facility

$932.00

Service Code	HCPCS 77021
Hospital Charge Code	2690280
Hospital Revenue Code	610
Min. Negotiated Rate	$139.80
Max. Negotiated Rate	$139.80
Rate for Payer: Qualcare PPO/HMO/WC	$139.80

MR GUID FOR NEEDLE PLACE

Facility

$932.00

Service Code	HCPCS 77021
Hospital Charge Code	7411758
Hospital Revenue Code	610
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$354.16
Rate for Payer: Aetna Medicare Advantage	$279.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.66
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	$237.66
Rate for Payer: Cigna Commercial	$466.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.60
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.80
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$22.46
Rate for Payer: Wellpoint Medicaid Managed Care	$24.70

MR GUID FOR TISSUE ABLATION

Facility

$3,038.75

Service Code	HCPCS 77022
Hospital Charge Code	2400030
Hospital Revenue Code	610
Min. Negotiated Rate	$455.81
Max. Negotiated Rate	$455.81
Rate for Payer: Qualcare PPO/HMO/WC	$455.81

MR GUID FOR TISSUE ABLATION

Facility

$3,038.75

Service Code	HCPCS 77022
Hospital Charge Code	2400030
Hospital Revenue Code	610
Min. Negotiated Rate	$73.23
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,154.72
Rate for Payer: Aetna Medicare Advantage	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$774.88
Rate for Payer: Cigna Commercial	$1,519.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$911.62
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$455.81
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$73.23
Rate for Payer: Wellpoint Medicaid Managed Care	$80.53

MRI 3D RECON W/O IND WKSTATION

Facility

$650.00

Service Code	HCPCS 76376
Hospital Charge Code	2400606
Hospital Revenue Code	610
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

MRI 3D RECON W/O IND WKSTATION

Facility

$650.00

Service Code	HCPCS 76376
Hospital Charge Code	2400606
Hospital Revenue Code	610
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

MRI ABDOMEM W/ C

Facility

$13,500.00

Service Code	HCPCS 74182
Hospital Charge Code	2400308
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	$600.16
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 ABDOMEM W/ C

Facility

$13,500.00

Service Code	HCPCS 74182
Hospital Charge Code	2400308
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-ABDOMEN

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	94061129
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-ABDOMEN

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	94061129
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 ABDOMEN W/O CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	2400307
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 ABDOMEN W/O CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	2400307
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 ABDOMEN WO/W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74183
Hospital Charge Code	94061131
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	$949.18
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 ABDOMEN WO/W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 74183
Hospital Charge Code	94061131
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 ABDOMEN W/WO C

Facility

$13,500.00

Service Code	HCPCS 74183
Hospital Charge Code	2400309
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 ABDOMEN W/WO C

Facility

$13,500.00

Service Code	HCPCS 74183
Hospital Charge Code	2400309
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	$949.18
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 ANKLE W/CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400423
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI ANKLE W/CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400423
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 ANKLE W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73722LT
Hospital Charge Code	2400424
Hospital Revenue Code	614
Min. Negotiated Rate	$53.27
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$839.99
Rate for Payer: Aetna Medicare Advantage	$663.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.68
Rate for Payer: Cigna Commercial	$1,105.25
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: Wellpoint Medicaid Managed Care	$58.58

MRI ANKLE W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73722LT
Hospital Charge Code	2400424
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI ANKLE W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73722RT
Hospital Charge Code	2400425
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

Know your out-of-pocket cost for care.

All Charges