Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRI BREAST BILATERAL

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	94061463
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MRI BREAST BILATERAL

Facility

$5,077.50

Service Code	HCPCS 77059
Hospital Charge Code	94061463
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

MRI BREAST BILAT W CONTRAST

Facility

$5,078.00

Service Code	HCPCS 77059LT
Hospital Charge Code	2408030
Hospital Revenue Code	614
Min. Negotiated Rate	$122.38
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,929.64
Rate for Payer: Aetna Medicare Advantage	$1,523.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.89
Rate for Payer: Cigna Commercial	$2,539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,523.40
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.70
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$122.38
Rate for Payer: Wellpoint Medicaid Managed Care	$134.57

MRI BREAST BILAT W CONTRAST

Facility

$5,078.00

Service Code	HCPCS 77059LT
Hospital Charge Code	2408030
Hospital Revenue Code	614
Min. Negotiated Rate	$761.70
Max. Negotiated Rate	$761.70
Rate for Payer: Qualcare PPO/HMO/WC	$761.70

MRI BREAST NEEDLE BIOPSY

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2400593
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MRI BREAST NEEDLE BIOPSY

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2400593
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

MRI BREAST NEEDLE LOCALIZATION

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2400594
Hospital Revenue Code	361
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.88
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.44
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

MRI BREAST NEEDLE LOCALIZATION

Facility

$996.25

Service Code	HCPCS 19281
Hospital Charge Code	2400594
Hospital Revenue Code	361
Min. Negotiated Rate	$149.44
Max. Negotiated Rate	$149.44
Rate for Payer: Qualcare PPO/HMO/WC	$149.44

MRI BREAST UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	94061461
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MRI BREAST UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	94061461
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

MRI BREAST UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400372
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

MRI BREAST UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400372
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MRI BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	404577047
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 BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	404577047
Hospital Revenue Code	614
Min. Negotiated Rate	$221.03
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	$221.03
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 BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	406177047
Hospital Revenue Code	614
Min. Negotiated Rate	$221.03
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	$221.03
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 BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	406177047
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 BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	406177046
Hospital Revenue Code	614
Min. Negotiated Rate	$215.55
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	$215.55
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 BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	404577046
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 BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	406177046
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 BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	404577046
Hospital Revenue Code	614
Min. Negotiated Rate	$215.55
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	$215.55
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 BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406144049
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) NJ Health	$349.85
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 BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406144049
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 BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	404577049
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 BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	404577049
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) NJ Health	$349.85
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 BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406177048
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

Know your out-of-pocket cost for care.

All Charges