Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

EXPANDERS TISSUE 360-430CC

Facility

$9,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270696265
Hospital Revenue Code	278
Min. Negotiated Rate	$225.94
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$225.94
Rate for Payer: Wellpoint Medicaid Managed Care	$248.44

EXPANDER TIS 800 CONTR 3546216

Facility

$6,572.00

Hospital Charge Code	270633937
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TIS 800 CONTR 3546216

Facility

$6,572.00

Hospital Charge Code	270633937
Hospital Revenue Code	278
Min. Negotiated Rate	$158.39
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$2,497.36
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80
Rate for Payer: UnitedHealthcare Community & State	$158.39
Rate for Payer: Wellpoint Medicaid Managed Care	$174.16

EXPANDER TISS 350 SALN 3546212

Facility

$6,875.00

Hospital Charge Code	270639512
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

EXPANDER TISS 350 SALN 3546212

Facility

$6,875.00

Hospital Charge Code	270639512
Hospital Revenue Code	278
Min. Negotiated Rate	$165.69
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$165.69
Rate for Payer: Wellpoint Medicaid Managed Care	$182.19

EXPANDER TISS BREAST 480-575CC

Facility

$9,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270697126
Hospital Revenue Code	278
Min. Negotiated Rate	$225.94
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$225.94
Rate for Payer: Wellpoint Medicaid Managed Care	$248.44

EXPANDER TISS BREAST 480-575CC

Facility

$9,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270697126
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

EXPANDER TISS CONTOUR 354-2213

Facility

$6,572.00

Hospital Charge Code	270618760
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISS CONTOUR 354-2213

Facility

$6,572.00

Hospital Charge Code	270618760
Hospital Revenue Code	278
Min. Negotiated Rate	$158.39
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$2,497.36
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80
Rate for Payer: UnitedHealthcare Community & State	$158.39
Rate for Payer: Wellpoint Medicaid Managed Care	$174.16

EXPANDER TISS CONTOUR 354-2214

Facility

$4,636.85

Hospital Charge Code	270617555
Hospital Revenue Code	278
Min. Negotiated Rate	$695.53
Max. Negotiated Rate	$1,122.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,020.11
Rate for Payer: Qualcare PPO/HMO/WC	$695.53

EXPANDER TISS CONTOUR 354-2214

Facility

$4,636.85

Hospital Charge Code	270617555
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$2,318.43
Rate for Payer: Aetna Commercial	$1,762.00
Rate for Payer: Aetna Medicare Advantage	$1,391.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,182.40
Rate for Payer: Cigna Commercial	$2,318.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,020.11
Rate for Payer: Qualcare PPO/HMO/WC	$695.53
Rate for Payer: UnitedHealthcare Community & State	$111.75
Rate for Payer: Wellpoint Medicaid Managed Care	$122.88

EXPANDER TISS CONTOUR 354-2215

Facility

$4,636.85

Hospital Charge Code	270617111
Hospital Revenue Code	278
Min. Negotiated Rate	$695.53
Max. Negotiated Rate	$1,122.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,020.11
Rate for Payer: Qualcare PPO/HMO/WC	$695.53

EXPANDER TISS CONTOUR 354-2215

Facility

$4,636.85

Hospital Charge Code	270617111
Hospital Revenue Code	278
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$2,318.43
Rate for Payer: Aetna Commercial	$1,762.00
Rate for Payer: Aetna Medicare Advantage	$1,391.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$927.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,182.40
Rate for Payer: Cigna Commercial	$2,318.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,122.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,020.11
Rate for Payer: Qualcare PPO/HMO/WC	$695.53
Rate for Payer: UnitedHealthcare Community & State	$111.75
Rate for Payer: Wellpoint Medicaid Managed Care	$122.88

EXPANDER TISSUE 3542214

Facility

$6,572.00

Hospital Charge Code	270617565
Hospital Revenue Code	278
Min. Negotiated Rate	$158.39
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$2,497.36
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80
Rate for Payer: UnitedHealthcare Community & State	$158.39
Rate for Payer: Wellpoint Medicaid Managed Care	$174.16

EXPANDER TISSUE 3542214

Facility

$6,572.00

Hospital Charge Code	270617565
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 550cc LOW PRO-

Facility

$6,572.00

Hospital Charge Code	270632103
Hospital Revenue Code	278
Min. Negotiated Rate	$158.39
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$2,497.36
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80
Rate for Payer: UnitedHealthcare Community & State	$158.39
Rate for Payer: Wellpoint Medicaid Managed Care	$174.16

EXPANDER TISSUE 550cc LOW PRO-

Facility

$6,423.25

Hospital Charge Code	270632104
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$1,554.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,413.12
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

EXPANDER TISSUE 550cc LOW PRO-

Facility

$6,572.00

Hospital Charge Code	270632103
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 550cc LOW PRO-

Facility

$6,423.25

Hospital Charge Code	270632104
Hospital Revenue Code	278
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$3,211.62
Rate for Payer: Aetna Commercial	$2,440.84
Rate for Payer: Aetna Medicare Advantage	$1,926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,637.93
Rate for Payer: Cigna Commercial	$3,211.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,413.12
Rate for Payer: Qualcare PPO/HMO/WC	$963.49
Rate for Payer: UnitedHealthcare Community & State	$154.80
Rate for Payer: Wellpoint Medicaid Managed Care	$170.22

EXPANDER TISSUE 650cc 3546215

Facility

$6,572.00

Hospital Charge Code	270633213
Hospital Revenue Code	278
Min. Negotiated Rate	$985.80
Max. Negotiated Rate	$1,590.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80

EXPANDER TISSUE 650cc 3546215

Facility

$6,572.00

Hospital Charge Code	270633213
Hospital Revenue Code	278
Min. Negotiated Rate	$158.39
Max. Negotiated Rate	$3,286.00
Rate for Payer: Aetna Commercial	$2,497.36
Rate for Payer: Aetna Medicare Advantage	$1,971.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,314.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,675.86
Rate for Payer: Cigna Commercial	$3,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,590.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,445.84
Rate for Payer: Qualcare PPO/HMO/WC	$985.80
Rate for Payer: UnitedHealthcare Community & State	$158.39
Rate for Payer: Wellpoint Medicaid Managed Care	$174.16

EXPANDER TISSUE 650cc MED 9200

Facility

$8,475.00

Service Code	HCPCS C1789
Hospital Charge Code	270679520
Hospital Revenue Code	278
Min. Negotiated Rate	$204.25
Max. Negotiated Rate	$4,237.50
Rate for Payer: Aetna Commercial	$3,220.50
Rate for Payer: Aetna Medicare Advantage	$2,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,161.12
Rate for Payer: Cigna Commercial	$4,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25
Rate for Payer: UnitedHealthcare Community & State	$204.25
Rate for Payer: Wellpoint Medicaid Managed Care	$224.59

EXPANDER TISSUE 650cc MED 9200

Facility

$8,475.00

Service Code	HCPCS C1789
Hospital Charge Code	270679520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$2,050.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

EXPANDERTISSUEALLOX2 225-280CC

Facility

$9,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270698080
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

EXPANDERTISSUEALLOX2 225-280CC

Facility

$9,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270698080
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

Know your out-of-pocket cost for care.

All Charges