Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MRI MRCP

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	2400608
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 MRCP

Facility

$13,500.00

Service Code	HCPCS 74181
Hospital Charge Code	2400608
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 NECK W/ CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70542
Hospital Charge Code	2400601
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 NECK W/ CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70542
Hospital Charge Code	2400601
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI NECK W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70540
Hospital Charge Code	2400602
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 NECK W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70540
Hospital Charge Code	2400602
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI NECK W & WITHOUT CON

Facility

$13,500.00

Service Code	HCPCS 70543
Hospital Charge Code	94061025
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	$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	$4,050.00
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	$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 NECK W & WITHOUT CON

Facility

$13,500.00

Service Code	HCPCS 70543
Hospital Charge Code	94061025
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 NECK W/ & W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70543
Hospital Charge Code	2400600
Hospital Revenue Code	614
Min. Negotiated Rate	$880.02
Max. Negotiated Rate	$880.02
Rate for Payer: Qualcare PPO/HMO/WC	$880.02

MRI NECK W/ & W/O CONTRAST

Facility

$5,866.80

Service Code	HCPCS 70543
Hospital Charge Code	2400600
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 NON STERILE TREPHINE 21.5

Facility

$2,350.00

Hospital Charge Code	270690415
Hospital Revenue Code	272
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

MRI NON STERILE TREPHINE 21.5

Facility

$2,350.00

Hospital Charge Code	270690415
Hospital Revenue Code	272
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$893.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.00
Rate for Payer: Oxford Commercial	$470.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Commercial	$470.00
Rate for Payer: UnitedHealthcare Community & State	$56.63
Rate for Payer: Wellpoint Medicaid Managed Care	$62.27

MRI ONE BRST-GL

Facility

$3,597.20

Service Code	HCPCS 77058
Hospital Charge Code	85000170
Hospital Revenue Code	614
Min. Negotiated Rate	$86.69
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,366.94
Rate for Payer: Aetna Medicare Advantage	$1,079.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$917.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$917.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$917.29
Rate for Payer: Cigna Commercial	$1,798.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.16
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$539.58
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$86.69
Rate for Payer: Wellpoint Medicaid Managed Care	$95.33

MRI ONE BRST-GL

Facility

$3,597.20

Service Code	HCPCS 77058
Hospital Charge Code	85000170
Hospital Revenue Code	614
Min. Negotiated Rate	$539.58
Max. Negotiated Rate	$539.58
Rate for Payer: Qualcare PPO/HMO/WC	$539.58

MRI ONE BRST-PC

Facility

$430.50

Service Code	HCPCS 7705826
Hospital Charge Code	85000180
Hospital Revenue Code	610
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$64.58

MRI ONE BRST-PC

Facility

$430.50

Service Code	HCPCS 7705826
Hospital Charge Code	85000180
Hospital Revenue Code	610
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$129.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.78
Rate for Payer: Cigna Commercial	$215.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.15
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.58
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.41

MRI ONE BRSTS-GL

Facility

$3,595.20

Service Code	HCPCS 77059
Hospital Charge Code	85000185
Hospital Revenue Code	614
Min. Negotiated Rate	$86.64
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,366.18
Rate for Payer: Aetna Medicare Advantage	$1,078.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.78
Rate for Payer: Cigna Commercial	$1,797.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,078.56
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$539.28
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$86.64
Rate for Payer: Wellpoint Medicaid Managed Care	$95.27

MRI ONE BRSTS-GL

Facility

$3,595.20

Service Code	HCPCS 77059
Hospital Charge Code	85000185
Hospital Revenue Code	614
Min. Negotiated Rate	$539.28
Max. Negotiated Rate	$539.28
Rate for Payer: Qualcare PPO/HMO/WC	$539.28

MRI ONE BRSTS-PC

Facility

$428.50

Service Code	HCPCS 7705926
Hospital Charge Code	85000195
Hospital Revenue Code	610
Min. Negotiated Rate	$64.28
Max. Negotiated Rate	$64.28
Rate for Payer: Qualcare PPO/HMO/WC	$64.28

MRI ONE BRSTS-PC

Facility

$428.50

Service Code	HCPCS 7705926
Hospital Charge Code	85000195
Hospital Revenue Code	610
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$162.83
Rate for Payer: Aetna Medicare Advantage	$128.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.27
Rate for Payer: Cigna Commercial	$214.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.55
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.28
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

MRI ONE BRSTS-TC

Facility

$3,166.70

Service Code	HCPCS 77059TC
Hospital Charge Code	85000190
Hospital Revenue Code	610
Min. Negotiated Rate	$475.00
Max. Negotiated Rate	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.00

MRI ONE BRSTS-TC

Facility

$3,166.70

Service Code	HCPCS 77059TC
Hospital Charge Code	85000190
Hospital Revenue Code	610
Min. Negotiated Rate	$76.32
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,203.35
Rate for Payer: Aetna Medicare Advantage	$950.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$807.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$807.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$807.51
Rate for Payer: Cigna Commercial	$1,583.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$950.01
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$76.32
Rate for Payer: Wellpoint Medicaid Managed Care	$83.92

MRI ONE BRST-TC

Facility

$3,166.70

Service Code	HCPCS 77058TC
Hospital Charge Code	85000175
Hospital Revenue Code	610
Min. Negotiated Rate	$475.00
Max. Negotiated Rate	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.00

MRI ONE BRST-TC

Facility

$3,166.70

Service Code	HCPCS 77058TC
Hospital Charge Code	85000175
Hospital Revenue Code	610
Min. Negotiated Rate	$76.32
Max. Negotiated Rate	$6,162.00
Rate for Payer: Aetna Commercial	$1,203.35
Rate for Payer: Aetna Medicare Advantage	$950.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$807.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$807.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$807.51
Rate for Payer: Cigna Commercial	$1,583.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$950.01
Rate for Payer: Oxford Commercial	$3,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.00
Rate for Payer: UnitedHealthcare Commercial	$6,162.00
Rate for Payer: UnitedHealthcare Community & State	$76.32
Rate for Payer: Wellpoint Medicaid Managed Care	$83.92

MRI - OPEN SENT OUTSIDE

Facility

$9,109.53

Service Code	HCPCS 70551
Hospital Charge Code	2400415
Hospital Revenue Code	611
Min. Negotiated Rate	$1,366.43
Max. Negotiated Rate	$1,366.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,366.43

Know your out-of-pocket cost for care.

All Charges