Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT LOOP RECORDE

Facility

$22,680.00

Service Code	HCPCS 33282
Hospital Charge Code	7411033
Hospital Revenue Code	361
Min. Negotiated Rate	$3,402.00
Max. Negotiated Rate	$3,402.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,402.00

IMPLANT LOOP RECORDE

Facility

$22,680.00

Service Code	HCPCS 33282
Hospital Charge Code	7411033
Hospital Revenue Code	361
Min. Negotiated Rate	$546.59
Max. Negotiated Rate	$11,340.00
Rate for Payer: Aetna Commercial	$8,618.40
Rate for Payer: Aetna Medicare Advantage	$6,804.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,783.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,783.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,783.40
Rate for Payer: Cigna Commercial	$11,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,804.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,402.00
Rate for Payer: UnitedHealthcare Community & State	$546.59
Rate for Payer: Wellpoint Medicaid Managed Care	$601.02

IMPLANT MAMMARY SALINE 575cc

Facility

$2,728.00

Hospital Charge Code	270630701
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 MAMMARY SALINE 575cc

Facility

$2,728.00

Hospital Charge Code	270630701
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 MAM SALN 425cc 3501670

Facility

$2,728.00

Hospital Charge Code	270630698
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 MAM SALN 425cc 3501670

Facility

$2,728.00

Hospital Charge Code	270630698
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 MAM SALN 475cc 3501680

Facility

$2,728.00

Hospital Charge Code	270630699
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 MAM SALN 475cc 3501680

Facility

$2,728.00

Hospital Charge Code	270630699
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 MAM SALN 525cc 3501685

Facility

$2,728.00

Hospital Charge Code	270630700
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 MAM SALN 525cc 3501685

Facility

$2,728.00

Hospital Charge Code	270630700
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 MCP JT SILICONE SZ 10

Facility

$9,250.00

Service Code	HCPCS L8630
Hospital Charge Code	270697845
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

IMPLANT MCP JT SILICONE SZ 10

Facility

$9,250.00

Service Code	HCPCS L8630
Hospital Charge Code	270697845
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

IMPLANT MCP JT SILICONE SZ 20

Facility

$9,250.00

Service Code	HCPCS L8630
Hospital Charge Code	270697847
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

IMPLANT MCP JT SILICONE SZ 20

Facility

$9,250.00

Service Code	HCPCS L8630
Hospital Charge Code	270697847
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

IMPLANT MCP JT SILICONE SZ 5

Facility

$9,250.00

Service Code	HCPCS L8630
Hospital Charge Code	270697846
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

IMPLANT MCP JT SILICONE SZ 5

Facility

$9,250.00

Service Code	HCPCS L8630
Hospital Charge Code	270697846
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

IMPLANT MED ROI-A 12MM 27x30MM

Facility

$27,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270685197
Hospital Revenue Code	278
Min. Negotiated Rate	$4,125.00
Max. Negotiated Rate	$6,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,655.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,125.00

IMPLANT MED ROI-A 12MM 27x30MM

Facility

$27,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270685197
Hospital Revenue Code	278
Min. Negotiated Rate	$662.75
Max. Negotiated Rate	$13,750.00
Rate for Payer: Aetna Commercial	$10,450.00
Rate for Payer: Aetna Medicare Advantage	$8,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,012.50
Rate for Payer: Cigna Commercial	$13,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,655.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,125.00
Rate for Payer: UnitedHealthcare Community & State	$662.75
Rate for Payer: Wellpoint Medicaid Managed Care	$728.75

IMPLANT MED ROJ-A 12mm 23x25mm

Facility

$27,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270683449
Hospital Revenue Code	278
Min. Negotiated Rate	$4,125.00
Max. Negotiated Rate	$6,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,655.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,125.00

IMPLANT MED ROJ-A 12mm 23x25mm

Facility

$27,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270683449
Hospital Revenue Code	278
Min. Negotiated Rate	$662.75
Max. Negotiated Rate	$13,750.00
Rate for Payer: Aetna Commercial	$10,450.00
Rate for Payer: Aetna Medicare Advantage	$8,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,012.50
Rate for Payer: Cigna Commercial	$13,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,655.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,125.00
Rate for Payer: UnitedHealthcare Community & State	$662.75
Rate for Payer: Wellpoint Medicaid Managed Care	$728.75

IMPLANT MOD-PLUS PROFILE 397CC

Facility

$3,750.00

Hospital Charge Code	270669958
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT MOD-PLUS PROFILE 397CC

Facility

$3,750.00

Hospital Charge Code	270669958
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

IMPLANT MOD PLUS PROFILE 421CC

Facility

$3,750.00

Hospital Charge Code	270669959
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

IMPLANT MOD PLUS PROFILE 421CC

Facility

$3,750.00

Hospital Charge Code	270669959
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

IMPLANT MOD PLUS PROFILE 457CC

Facility

$3,750.00

Hospital Charge Code	270669960
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Know your out-of-pocket cost for care.

All Charges