Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 77048
Hospital Charge Code	404577048
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 UNI

Facility

$13,500.00

Service Code	HCPCS 77048
Hospital Charge Code	404577048
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	$342.94
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 BRIAN NEURO QUART WITH D

Facility

$1,145.00

Service Code	HCPCS 0866T
Hospital Charge Code	40450866T
Hospital Revenue Code	614
Min. Negotiated Rate	$27.59
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) 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	$343.50
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.75
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$27.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

MRI BRIAN NEURO QUART WITH D

Facility

$1,145.00

Service Code	HCPCS 0866T
Hospital Charge Code	40450866T
Hospital Revenue Code	614
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

MRI CARBON ROD, 200MM

Facility

$1,183.00

Hospital Charge Code	270656539
Hospital Revenue Code	271
Min. Negotiated Rate	$177.45
Max. Negotiated Rate	$177.45
Rate for Payer: Qualcare PPO/HMO/WC	$177.45

MRI CARBON ROD, 200MM

Facility

$1,183.00

Hospital Charge Code	270656539
Hospital Revenue Code	271
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$591.50
Rate for Payer: Aetna Commercial	$449.54
Rate for Payer: Aetna Medicare Advantage	$354.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.67
Rate for Payer: Cigna Commercial	$591.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.90
Rate for Payer: Oxford Commercial	$236.60
Rate for Payer: Qualcare PPO/HMO/WC	$177.45
Rate for Payer: UnitedHealthcare Commercial	$236.60
Rate for Payer: UnitedHealthcare Community & State	$28.51
Rate for Payer: Wellpoint Medicaid Managed Care	$31.35

MRI CARD CARD MORPH WO/WITH FL

Facility

$1,762.00

Service Code	HCPCS 75565
Hospital Charge Code	2408025
Hospital Revenue Code	614
Min. Negotiated Rate	$264.30
Max. Negotiated Rate	$264.30
Rate for Payer: Qualcare PPO/HMO/WC	$264.30

MRI CARD CARD MORPH WO/WITH FL

Facility

$1,762.00

Service Code	HCPCS 75565
Hospital Charge Code	2408025
Hospital Revenue Code	614
Min. Negotiated Rate	$42.46
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$669.56
Rate for Payer: Aetna Medicare Advantage	$528.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$449.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$449.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$449.31
Rate for Payer: Cigna Commercial	$881.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.60
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.30
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$42.46
Rate for Payer: Wellpoint Medicaid Managed Care	$46.69

MRI-CARDC MORPH WO-FOLLWD WITH

Facility

$3,173.52

Service Code	HCPCS 75561
Hospital Charge Code	2408020
Hospital Revenue Code	614
Min. Negotiated Rate	$76.48
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	$580.80
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	$952.06
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$476.03
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$76.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$84.10

MRI-CARDC MORPH WO-FOLLWD WITH

Facility

$3,173.52

Service Code	HCPCS 75561
Hospital Charge Code	2408020
Hospital Revenue Code	614
Min. Negotiated Rate	$476.03
Max. Negotiated Rate	$476.03
Rate for Payer: Qualcare PPO/HMO/WC	$476.03

MRI CARDC W/OR W/O MORPH COMPL

Facility

$1,656.85

Service Code	HCPCS 75554
Hospital Charge Code	2400349
Hospital Revenue Code	610
Min. Negotiated Rate	$39.93
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$629.60
Rate for Payer: Aetna Medicare Advantage	$497.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.50
Rate for Payer: Cigna Commercial	$828.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.06
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.53
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$39.93
Rate for Payer: Wellpoint Medicaid Managed Care	$43.91

MRI CARDC W/OR W/O MORPH COMPL

Facility

$1,656.85

Service Code	HCPCS 75554
Hospital Charge Code	2400349
Hospital Revenue Code	610
Min. Negotiated Rate	$248.53
Max. Negotiated Rate	$248.53
Rate for Payer: Qualcare PPO/HMO/WC	$248.53

MRI CARDIAC/MORPHLGY W/CONTRAS

Facility

$2,000.85

Service Code	HCPCS 75553
Hospital Charge Code	2400331
Hospital Revenue Code	610
Min. Negotiated Rate	$48.22
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$760.32
Rate for Payer: Aetna Medicare Advantage	$600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.22
Rate for Payer: Cigna Commercial	$1,000.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.25
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.13
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$48.22
Rate for Payer: Wellpoint Medicaid Managed Care	$53.02

MRI CARDIAC/MORPHLGY W/CONTRAS

Facility

$2,000.85

Service Code	HCPCS 75553
Hospital Charge Code	2400331
Hospital Revenue Code	610
Min. Negotiated Rate	$300.13
Max. Negotiated Rate	$300.13
Rate for Payer: Qualcare PPO/HMO/WC	$300.13

MRI CARDIAC/MORPHLGY W/O CONTR

Facility

$2,000.85

Service Code	HCPCS 75552
Hospital Charge Code	2400323
Hospital Revenue Code	610
Min. Negotiated Rate	$48.22
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$760.32
Rate for Payer: Aetna Medicare Advantage	$600.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.22
Rate for Payer: Cigna Commercial	$1,000.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.25
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.13
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$48.22
Rate for Payer: Wellpoint Medicaid Managed Care	$53.02

MRI CARDIAC/MORPHLGY W/O CONTR

Facility

$2,000.85

Service Code	HCPCS 75552
Hospital Charge Code	2400323
Hospital Revenue Code	610
Min. Negotiated Rate	$300.13
Max. Negotiated Rate	$300.13
Rate for Payer: Qualcare PPO/HMO/WC	$300.13

MRI-CARDIAC MORPH W/O CONTRAST

Facility

$2,036.00

Service Code	HCPCS 75557
Hospital Charge Code	2408015
Hospital Revenue Code	614
Min. Negotiated Rate	$305.40
Max. Negotiated Rate	$305.40
Rate for Payer: Qualcare PPO/HMO/WC	$305.40

MRI-CARDIAC MORPH W/O CONTRAST

Facility

$2,036.00

Service Code	HCPCS 75557
Hospital Charge Code	2408015
Hospital Revenue Code	614
Min. Negotiated Rate	$49.07
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	$580.80
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	$610.80
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$305.40
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$49.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$53.95

MRI CARDIAC W/OR W/O MORPH LTD

Facility

$1,656.85

Service Code	HCPCS 75555
Hospital Charge Code	2400356
Hospital Revenue Code	610
Min. Negotiated Rate	$248.53
Max. Negotiated Rate	$248.53
Rate for Payer: Qualcare PPO/HMO/WC	$248.53

MRI CARDIAC W/OR W/O MORPH LTD

Facility

$1,656.85

Service Code	HCPCS 75555
Hospital Charge Code	2400356
Hospital Revenue Code	610
Min. Negotiated Rate	$39.93
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$629.60
Rate for Payer: Aetna Medicare Advantage	$497.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.50
Rate for Payer: Cigna Commercial	$828.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.06
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.53
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$39.93
Rate for Payer: Wellpoint Medicaid Managed Care	$43.91

MRI CERVICAL SPINE

Facility

$13,500.00

Service Code	HCPCS 72141
Hospital Charge Code	94061071
Hospital Revenue Code	612
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$534.00
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 CERVICAL SPINE

Facility

$13,500.00

Service Code	HCPCS 72141
Hospital Charge Code	94061071
Hospital Revenue Code	612
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRI CERVICAL SP W/GAD INJ

Facility

$13,500.00

Service Code	HCPCS 72142
Hospital Charge Code	94061073
Hospital Revenue Code	612
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	$683.41
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.00
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 CERVICAL SP W/GAD INJ

Facility

$13,500.00

Service Code	HCPCS 72142
Hospital Charge Code	94061073
Hospital Revenue Code	612
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