Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRI FACE NECK ORBIT W/CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70542
Hospital Charge Code	2400443
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 FACE NECK ORBIT W/CONTRAST

Facility

$13,500.00

Service Code	HCPCS 70542
Hospital Charge Code	2400443
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	$660.18
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: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$678.00
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 FACE NECK ORBIT W/&W/O CNT

Facility

$5,866.80

Service Code	HCPCS 70543
Hospital Charge Code	2400442
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI FACE NECK ORBIT W/&W/O CNT

Facility

$5,866.80

Service Code	HCPCS 70543
Hospital Charge Code	2400442
Hospital Revenue Code	614
Min. Negotiated Rate	$141.39
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	$947.50
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	$1,760.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$917.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$880.02
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$141.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$155.47

MRI FACE WITH CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70542
Hospital Charge Code	2400598
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI FACE WITH CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70542
Hospital Charge Code	2400598
Hospital Revenue Code	614
Min. Negotiated Rate	$141.39
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	$660.18
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	$1,760.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$678.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$880.02
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$141.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$155.47

MRI FACE W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70540
Hospital Charge Code	2400599
Hospital Revenue Code	614
Min. Negotiated Rate	$141.39
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	$1,760.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$618.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$880.02
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$141.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$155.47

MRI FACE W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70540
Hospital Charge Code	2400599
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI FACE W & W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70543
Hospital Charge Code	2400597
Hospital Revenue Code	614
Min. Negotiated Rate	$141.39
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	$947.50
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	$1,760.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$917.00
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$880.02
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$141.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$155.47

MRI FACE W & W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70543
Hospital Charge Code	2400597
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI FEMUR W/CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7371950
Hospital Charge Code	2400447
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 FEMUR W/CONTRAST BILATERAL

Facility

$4,421.00

Service Code	HCPCS 7371950
Hospital Charge Code	2400447
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI FEMUR W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73719LT
Hospital Charge Code	2400448
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FEMUR W/CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73719LT
Hospital Charge Code	2400448
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 FEMUR W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73719RT
Hospital Charge Code	2400449
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 FEMUR W/CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73719RT
Hospital Charge Code	2400449
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FEMUR W/O CONTRAST BILTRAL

Facility

$4,421.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400450
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 FEMUR W/O CONTRAST BILTRAL

Facility

$4,421.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400450
Hospital Revenue Code	614
Min. Negotiated Rate	$663.15
Max. Negotiated Rate	$663.15
Rate for Payer: Qualcare PPO/HMO/WC	$663.15

MRI FEMUR W/O CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73718LT
Hospital Charge Code	2400451
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FEMUR W/O CONTRAST LEFT

Facility

$2,210.50

Service Code	HCPCS 73718LT
Hospital Charge Code	2400451
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 FEMUR W/O CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73718RT
Hospital Charge Code	2400452
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 FEMUR W/O CONTRAST RIGHT

Facility

$2,210.50

Service Code	HCPCS 73718RT
Hospital Charge Code	2400452
Hospital Revenue Code	614
Min. Negotiated Rate	$331.57
Max. Negotiated Rate	$331.57
Rate for Payer: Qualcare PPO/HMO/WC	$331.57

MRI FEMUR W/&W/O CONTRAST BLTL

Facility

$6,032.80

Service Code	HCPCS 7372050
Hospital Charge Code	2400444
Hospital Revenue Code	614
Min. Negotiated Rate	$145.39
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$2,292.46
Rate for Payer: Aetna Medicare Advantage	$1,809.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,538.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,538.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,538.36
Rate for Payer: Cigna Commercial	$3,016.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,809.84
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$904.92
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$145.39
Rate for Payer: Wellpoint Medicaid Managed Care	$159.87

MRI FEMUR W/&W/O CONTRAST BLTL

Facility

$6,032.80

Service Code	HCPCS 7372050
Hospital Charge Code	2400444
Hospital Revenue Code	614
Min. Negotiated Rate	$904.92
Max. Negotiated Rate	$904.92
Rate for Payer: Qualcare PPO/HMO/WC	$904.92

MRI FEMUR W/&W/O CONTRAST LEFT

Facility

$3,016.40

Service Code	HCPCS 73720LT
Hospital Charge Code	2400445
Hospital Revenue Code	614
Min. Negotiated Rate	$72.70
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,146.23
Rate for Payer: Aetna Medicare Advantage	$904.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$769.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$769.18
Rate for Payer: Cigna Commercial	$1,508.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$904.92
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.46
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$72.70
Rate for Payer: Wellpoint Medicaid Managed Care	$79.93

Know your out-of-pocket cost for care.

All Charges