Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT BIOINDUCTIVE ARTH DEL

Facility

$14,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270690425
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

IMPLANTBLE PULSE GENERATOR KIT

Facility

$102,500.00

Service Code	HCPCS C1778
Hospital Charge Code	270703486
Hospital Revenue Code	278
Min. Negotiated Rate	$15,375.00
Max. Negotiated Rate	$24,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,805.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22,550.00
Rate for Payer: Qualcare PPO/HMO/WC	$15,375.00

IMPLANTBLE PULSE GENERATOR KIT

Facility

$102,500.00

Service Code	HCPCS C1778
Hospital Charge Code	270703486
Hospital Revenue Code	278
Min. Negotiated Rate	$2,470.25
Max. Negotiated Rate	$51,250.00
Rate for Payer: Aetna Commercial	$38,950.00
Rate for Payer: Aetna Medicare Advantage	$30,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,137.50
Rate for Payer: Cigna Commercial	$51,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,805.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22,550.00
Rate for Payer: Qualcare PPO/HMO/WC	$15,375.00
Rate for Payer: UnitedHealthcare Community & State	$2,470.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2,716.25

IMPLANT BREAST 750CC

Facility

$4,775.00

Hospital Charge Code	270665514
Hospital Revenue Code	278
Min. Negotiated Rate	$115.08
Max. Negotiated Rate	$2,387.50
Rate for Payer: Aetna Commercial	$1,814.50
Rate for Payer: Aetna Medicare Advantage	$1,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,217.62
Rate for Payer: Cigna Commercial	$2,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$716.25
Rate for Payer: UnitedHealthcare Community & State	$115.08
Rate for Payer: Wellpoint Medicaid Managed Care	$126.54

IMPLANT BREAST 750CC

Facility

$4,775.00

Hospital Charge Code	270665514
Hospital Revenue Code	278
Min. Negotiated Rate	$716.25
Max. Negotiated Rate	$1,155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$716.25

IMPLANT BREAST 800CC

Facility

$4,775.00

Hospital Charge Code	270665517
Hospital Revenue Code	278
Min. Negotiated Rate	$716.25
Max. Negotiated Rate	$1,155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$716.25

IMPLANT BREAST 800CC

Facility

$4,775.00

Hospital Charge Code	270665517
Hospital Revenue Code	278
Min. Negotiated Rate	$115.08
Max. Negotiated Rate	$2,387.50
Rate for Payer: Aetna Commercial	$1,814.50
Rate for Payer: Aetna Medicare Advantage	$1,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,217.62
Rate for Payer: Cigna Commercial	$2,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$716.25
Rate for Payer: UnitedHealthcare Community & State	$115.08
Rate for Payer: Wellpoint Medicaid Managed Care	$126.54

IMPLANT BREAST RD275cc354-2640

Facility

$3,224.00

Hospital Charge Code	270632176
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$780.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$709.28
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

IMPLANT BREAST RD275cc354-2640

Facility

$3,224.00

Hospital Charge Code	270632176
Hospital Revenue Code	278
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$1,612.00
Rate for Payer: Aetna Commercial	$1,225.12
Rate for Payer: Aetna Medicare Advantage	$967.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$822.12
Rate for Payer: Cigna Commercial	$1,612.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$709.28
Rate for Payer: Qualcare PPO/HMO/WC	$483.60
Rate for Payer: UnitedHealthcare Community & State	$77.70
Rate for Payer: Wellpoint Medicaid Managed Care	$85.44

IMPLANT BREAST ROUND 225CC

Facility

$3,224.00

Hospital Charge Code	270621090
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$780.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$709.28
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

IMPLANT BREAST ROUND 225CC

Facility

$3,224.00

Hospital Charge Code	270621090
Hospital Revenue Code	278
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$1,612.00
Rate for Payer: Aetna Commercial	$1,225.12
Rate for Payer: Aetna Medicare Advantage	$967.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$822.12
Rate for Payer: Cigna Commercial	$1,612.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$709.28
Rate for Payer: Qualcare PPO/HMO/WC	$483.60
Rate for Payer: UnitedHealthcare Community & State	$77.70
Rate for Payer: Wellpoint Medicaid Managed Care	$85.44

IMPLANT BREAST SM RND 255CC

Facility

$5,475.00

Service Code	HCPCS C1789
Hospital Charge Code	270698115
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

IMPLANT BREAST SM RND 255CC

Facility

$5,475.00

Service Code	HCPCS C1789
Hospital Charge Code	270698115
Hospital Revenue Code	278
Min. Negotiated Rate	$131.95
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$131.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.09

IMPLANT BRST SAL 350cc 3501655

Facility

$2,728.00

Hospital Charge Code	270631845
Hospital Revenue Code	278
Min. Negotiated Rate	$65.74
Max. Negotiated Rate	$1,364.00
Rate for Payer: Aetna Commercial	$1,036.64
Rate for Payer: Aetna Medicare Advantage	$818.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$695.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$695.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$695.64
Rate for Payer: Cigna Commercial	$1,364.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$600.16
Rate for Payer: Qualcare PPO/HMO/WC	$409.20
Rate for Payer: UnitedHealthcare Community & State	$65.74
Rate for Payer: Wellpoint Medicaid Managed Care	$72.29

IMPLANT BRST SAL 350cc 3501655

Facility

$2,728.00

Hospital Charge Code	270631845
Hospital Revenue Code	278
Min. Negotiated Rate	$409.20
Max. Negotiated Rate	$660.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$660.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$600.16
Rate for Payer: Qualcare PPO/HMO/WC	$409.20

IMPLANT BRST SALI 225c 3501630

Facility

$2,852.00

Hospital Charge Code	270634094
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 225c 3501630

Facility

$2,852.00

Hospital Charge Code	270634094
Hospital Revenue Code	278
Min. Negotiated Rate	$68.73
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$1,083.76
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80
Rate for Payer: UnitedHealthcare Community & State	$68.73
Rate for Payer: Wellpoint Medicaid Managed Care	$75.58

IMPLANT BRST SALI 250c 3501635

Facility

$2,852.00

Hospital Charge Code	270631841
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 250c 3501635

Facility

$2,852.00

Hospital Charge Code	270631841
Hospital Revenue Code	278
Min. Negotiated Rate	$68.73
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$1,083.76
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80
Rate for Payer: UnitedHealthcare Community & State	$68.73
Rate for Payer: Wellpoint Medicaid Managed Care	$75.58

IMPLANT BRST SALI 275c 3501640

Facility

$2,852.00

Hospital Charge Code	270631842
Hospital Revenue Code	278
Min. Negotiated Rate	$68.73
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$1,083.76
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80
Rate for Payer: UnitedHealthcare Community & State	$68.73
Rate for Payer: Wellpoint Medicaid Managed Care	$75.58

IMPLANT BRST SALI 275c 3501640

Facility

$2,852.00

Hospital Charge Code	270631842
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 300c 3501645

Facility

$2,852.00

Hospital Charge Code	270631843
Hospital Revenue Code	278
Min. Negotiated Rate	$68.73
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$1,083.76
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80
Rate for Payer: UnitedHealthcare Community & State	$68.73
Rate for Payer: Wellpoint Medicaid Managed Care	$75.58

IMPLANT BRST SALI 300c 3501645

Facility

$2,852.00

Hospital Charge Code	270631843
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

IMPLANT BRST SALI 325c 3501650

Facility

$2,852.00

Hospital Charge Code	270631844
Hospital Revenue Code	278
Min. Negotiated Rate	$68.73
Max. Negotiated Rate	$1,426.00
Rate for Payer: Aetna Commercial	$1,083.76
Rate for Payer: Aetna Medicare Advantage	$855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$727.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$727.26
Rate for Payer: Cigna Commercial	$1,426.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80
Rate for Payer: UnitedHealthcare Community & State	$68.73
Rate for Payer: Wellpoint Medicaid Managed Care	$75.58

IMPLANT BRST SALI 325c 3501650

Facility

$2,852.00

Hospital Charge Code	270631844
Hospital Revenue Code	278
Min. Negotiated Rate	$427.80
Max. Negotiated Rate	$690.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$570.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$627.44
Rate for Payer: Qualcare PPO/HMO/WC	$427.80

Know your out-of-pocket cost for care.

All Charges