Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MA MAMMO DIAG DIGI LEFT

Facility

$437.50

Hospital Charge Code	2700022
Hospital Revenue Code	401
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

MA MAMMO DIAG DIGI LEFT

Facility

$437.50

Hospital Charge Code	2700022
Hospital Revenue Code	401
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$166.25
Rate for Payer: Aetna Medicare Advantage	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.56
Rate for Payer: Cigna Commercial	$218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.62
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$10.54
Rate for Payer: Wellpoint Medicaid Managed Care	$11.59

MA MAMMO DIAG DIGI RIGHT

Facility

$437.50

Hospital Charge Code	2700023
Hospital Revenue Code	401
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$65.62
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

MA MAMMO DIAG DIGI RIGHT

Facility

$437.50

Hospital Charge Code	2700023
Hospital Revenue Code	401
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$166.25
Rate for Payer: Aetna Medicare Advantage	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.56
Rate for Payer: Cigna Commercial	$218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.25
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.62
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$10.54
Rate for Payer: Wellpoint Medicaid Managed Care	$11.59

MA MAMMO DIAGNOSTIC DIGI BILAT

Facility

$783.75

Hospital Charge Code	2700021
Hospital Revenue Code	401
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$297.82
Rate for Payer: Aetna Medicare Advantage	$235.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.86
Rate for Payer: Cigna Commercial	$391.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.12
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.56
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$18.89
Rate for Payer: Wellpoint Medicaid Managed Care	$20.77

MA MAMMO DIAGNOSTIC DIGI BILAT

Facility

$783.75

Hospital Charge Code	2700021
Hospital Revenue Code	401
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$117.56
Rate for Payer: Qualcare PPO/HMO/WC	$117.56

MAMMAPL,W PROSTHETIC LT

Facility

$89,485.25

Service Code	HCPCS 19325
Hospital Charge Code	16000496
Hospital Revenue Code	360
Min. Negotiated Rate	$13,422.79
Max. Negotiated Rate	$13,422.79
Rate for Payer: Qualcare PPO/HMO/WC	$13,422.79

MAMMAPL,W PROSTHETIC LT

Facility

$89,485.25

Service Code	HCPCS 19325
Hospital Charge Code	16000496
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$35,050.91
Rate for Payer: Aetna Commercial	$26,411.74
Rate for Payer: Aetna Medicare Advantage	$31,461.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,050.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,050.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,710.20
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	$35,050.91
Rate for Payer: Cigna Commercial	$19,464.07
Rate for Payer: Cigna Medicare Advantage	$9,710.20
Rate for Payer: Clover Medicare Advantage	$9,224.69
Rate for Payer: EmblemHealth Commercial	$29,130.60
Rate for Payer: Humana Medicare Advantage	$10,001.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,710.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,845.58
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,422.79
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$2,156.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,710.20
Rate for Payer: Wellcare Medicare Advantage	$9,710.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2,371.36

MAMMO BOTH/ADD VIEW-KOMEN

Facility

$50.00

Service Code	HCPCS 77055
Hospital Charge Code	94061185
Hospital Revenue Code	401
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

MAMMO BOTH/ADD VIEW-KOMEN

Facility

$50.00

Service Code	HCPCS 77055
Hospital Charge Code	94061185
Hospital Revenue Code	401
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

MAMMO BOTH BRSTS-GL

Facility

$643.60

Service Code	HCPCS 77056
Hospital Charge Code	85000140
Hospital Revenue Code	401
Min. Negotiated Rate	$96.54
Max. Negotiated Rate	$96.54
Rate for Payer: Qualcare PPO/HMO/WC	$96.54

MAMMO BOTH BRSTS-GL

Facility

$643.60

Service Code	HCPCS 77056
Hospital Charge Code	85000140
Hospital Revenue Code	401
Min. Negotiated Rate	$15.51
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$244.57
Rate for Payer: Aetna Medicare Advantage	$193.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.12
Rate for Payer: Cigna Commercial	$321.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.08
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.54
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$15.51
Rate for Payer: Wellpoint Medicaid Managed Care	$17.06

MAMMO BOTH BRSTS-PC

Facility

$230.10

Service Code	HCPCS 7705626
Hospital Charge Code	85000150
Hospital Revenue Code	401
Min. Negotiated Rate	$34.52
Max. Negotiated Rate	$34.52
Rate for Payer: Qualcare PPO/HMO/WC	$34.52

MAMMO BOTH BRSTS-PC

Facility

$230.10

Service Code	HCPCS 7705626
Hospital Charge Code	85000150
Hospital Revenue Code	401
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$87.44
Rate for Payer: Aetna Medicare Advantage	$69.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.68
Rate for Payer: Cigna Commercial	$115.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.03
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.52
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$5.55
Rate for Payer: Wellpoint Medicaid Managed Care	$6.10

MAMMO BOTH BRSTS-TC

Facility

$413.55

Service Code	HCPCS 77056TC
Hospital Charge Code	85000145
Hospital Revenue Code	401
Min. Negotiated Rate	$62.03
Max. Negotiated Rate	$62.03
Rate for Payer: Qualcare PPO/HMO/WC	$62.03

MAMMO BOTH BRSTS-TC

Facility

$413.55

Service Code	HCPCS 77056TC
Hospital Charge Code	85000145
Hospital Revenue Code	401
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$157.15
Rate for Payer: Aetna Medicare Advantage	$124.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.46
Rate for Payer: Cigna Commercial	$206.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.06
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.03
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$9.97
Rate for Payer: Wellpoint Medicaid Managed Care	$10.96

MAMMOGRAPHY-BILAT

Facility

$396.00

Service Code	HCPCS 77056
Hospital Charge Code	94061187
Hospital Revenue Code	401
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$59.40
Rate for Payer: Qualcare PPO/HMO/WC	$59.40

MAMMOGRAPHY-BILAT

Facility

$396.00

Service Code	HCPCS 77056
Hospital Charge Code	94061187
Hospital Revenue Code	401
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$150.48
Rate for Payer: Aetna Medicare Advantage	$118.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.98
Rate for Payer: Cigna Commercial	$198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.80
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.40
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$9.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10.49

MAMMOGRAPHY-LT

Facility

$208.00

Service Code	HCPCS 77055LT
Hospital Charge Code	94061437
Hospital Revenue Code	401
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

MAMMOGRAPHY-LT

Facility

$208.00

Service Code	HCPCS 77055LT
Hospital Charge Code	94061437
Hospital Revenue Code	401
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

MAMMOGRAPHY-RT

Facility

$208.00

Service Code	HCPCS 77055RT
Hospital Charge Code	94061439
Hospital Revenue Code	401
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

MAMMOGRAPHY-RT

Facility

$208.00

Service Code	HCPCS 77055RT
Hospital Charge Code	94061439
Hospital Revenue Code	401
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

MAMMOL OINTMENT/15GM

Facility

$43.00

Hospital Charge Code	60634300
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

MAMMOL OINTMENT/15GM

Facility

$43.00

Hospital Charge Code	60634300
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

MAMMO NDLE/WIRE LOC BRST RT

Facility

$996.00

Service Code	HCPCS 19281
Hospital Charge Code	2008040
Hospital Revenue Code	361
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$7,082.74
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,082.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,082.74
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.80
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.40
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$24.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.39

Know your out-of-pocket cost for care.

All Charges