Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MAMMO NDLE/WIRE LOC BRST RT

Facility

$996.00

Service Code	HCPCS 19281
Hospital Charge Code	2008040
Hospital Revenue Code	361
Min. Negotiated Rate	$149.40
Max. Negotiated Rate	$149.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.40

MAMMO ONE BRST-GL

Facility

$502.65

Service Code	HCPCS 77055
Hospital Charge Code	85000125
Hospital Revenue Code	401
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$75.40
Rate for Payer: Qualcare PPO/HMO/WC	$75.40

MAMMO ONE BRST-GL

Facility

$502.65

Service Code	HCPCS 77055
Hospital Charge Code	85000125
Hospital Revenue Code	401
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$191.01
Rate for Payer: Aetna Medicare Advantage	$150.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.18
Rate for Payer: Cigna Commercial	$251.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.79
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.40
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$13.32

MAMMO ONE BRST-PC

Facility

$186.00

Service Code	HCPCS 7705526
Hospital Charge Code	85000135
Hospital Revenue Code	401
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

MAMMO ONE BRST-PC

Facility

$186.00

Service Code	HCPCS 7705526
Hospital Charge Code	85000135
Hospital Revenue Code	401
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

MAMMO ONE BRST-TC

Facility

$316.65

Service Code	HCPCS 77055TC
Hospital Charge Code	85000130
Hospital Revenue Code	401
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$120.33
Rate for Payer: Aetna Medicare Advantage	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.75
Rate for Payer: Cigna Commercial	$158.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.50
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$7.63
Rate for Payer: Wellpoint Medicaid Managed Care	$8.39

MAMMO ONE BRST-TC

Facility

$316.65

Service Code	HCPCS 77055TC
Hospital Charge Code	85000130
Hospital Revenue Code	401
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$47.50

MAMMOPLASTY,REDUCTION

Facility

$42,601.70

Service Code	HCPCS 19318
Hospital Charge Code	16000335
Hospital Revenue Code	360
Min. Negotiated Rate	$6,390.26
Max. Negotiated Rate	$6,390.26
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26

MAMMOPLASTY,REDUCTION

Facility

$42,601.70

Service Code	HCPCS 19318
Hospital Charge Code	16000335
Hospital Revenue Code	360
Min. Negotiated Rate	$1,026.70
Max. Negotiated Rate	$28,475.80
Rate for Payer: Aetna Commercial	$21,457.24
Rate for Payer: Aetna Medicare Advantage	$25,559.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,475.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,888.69
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	$28,475.80
Rate for Payer: Cigna Commercial	$15,812.86
Rate for Payer: Cigna Medicare Advantage	$7,888.69
Rate for Payer: Clover Medicare Advantage	$7,494.26
Rate for Payer: EmblemHealth Commercial	$23,666.07
Rate for Payer: Humana Medicare Advantage	$8,125.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,888.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,780.51
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,026.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,888.69
Rate for Payer: Wellcare Medicare Advantage	$7,888.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,128.95

MAMMO SCREENING-BILAT

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	94061189
Hospital Revenue Code	403
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$91.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.14

MAMMO SCREENING-BILAT

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	94061189
Hospital Revenue Code	403
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$230.89
Rate for Payer: Aetna Medicare Advantage	$182.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.94
Rate for Payer: Cigna Commercial	$303.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.28
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.14
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$14.64
Rate for Payer: Wellpoint Medicaid Managed Care	$16.10

MAMMO SCREENING-GL

Facility

$464.30

Service Code	HCPCS 77057
Hospital Charge Code	85000155
Hospital Revenue Code	403
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$176.43
Rate for Payer: Aetna Medicare Advantage	$139.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.40
Rate for Payer: Cigna Commercial	$232.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.29
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.64
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$11.19
Rate for Payer: Wellpoint Medicaid Managed Care	$12.30

MAMMO SCREENING-GL

Facility

$464.30

Service Code	HCPCS 77057
Hospital Charge Code	85000155
Hospital Revenue Code	403
Min. Negotiated Rate	$69.64
Max. Negotiated Rate	$69.64
Rate for Payer: Qualcare PPO/HMO/WC	$69.64

MAMMO SCREENING-PC

Facility

$186.00

Service Code	HCPCS 7705726
Hospital Charge Code	85000165
Hospital Revenue Code	403
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

MAMMO SCREENING-PC

Facility

$186.00

Service Code	HCPCS 7705726
Hospital Charge Code	85000165
Hospital Revenue Code	403
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

MAMMO SCREENING-TC

Facility

$278.30

Service Code	HCPCS 77057TC
Hospital Charge Code	85000160
Hospital Revenue Code	403
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$1,916.00
Rate for Payer: Aetna Commercial	$105.75
Rate for Payer: Aetna Medicare Advantage	$83.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.97
Rate for Payer: Cigna Commercial	$139.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.49
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.74
Rate for Payer: UnitedHealthcare Commercial	$1,916.00
Rate for Payer: UnitedHealthcare Community & State	$6.71
Rate for Payer: Wellpoint Medicaid Managed Care	$7.37

MAMMO SCREENING-TC

Facility

$278.30

Service Code	HCPCS 77057TC
Hospital Charge Code	85000160
Hospital Revenue Code	403
Min. Negotiated Rate	$41.74
Max. Negotiated Rate	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$41.74

MAMMOTOME BIOPSY SITE IDENTIFI

Facility

$492.00

Hospital Charge Code	26702050
Hospital Revenue Code	272
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna Commercial	$186.96
Rate for Payer: Aetna Medicare Advantage	$147.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.46
Rate for Payer: Cigna Commercial	$246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.60
Rate for Payer: Oxford Commercial	$98.40
Rate for Payer: Qualcare PPO/HMO/WC	$73.80
Rate for Payer: UnitedHealthcare Commercial	$98.40
Rate for Payer: UnitedHealthcare Community & State	$11.86
Rate for Payer: Wellpoint Medicaid Managed Care	$13.04

MAMMOTOME BIOPSY SITE IDENTIFI

Facility

$492.00

Hospital Charge Code	26702050
Hospital Revenue Code	272
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$73.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.80

MAMMOTOME PROBE

Facility

$1,475.00

Hospital Charge Code	26702052
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

MAMMOTOME PROBE

Facility

$1,475.00

Hospital Charge Code	26702052
Hospital Revenue Code	272
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.50
Rate for Payer: Oxford Commercial	$295.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$295.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

MAMMOTOME STANDARD BREAST MARK

Facility

$1,968.00

Hospital Charge Code	270663458
Hospital Revenue Code	272
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$984.00
Rate for Payer: Aetna Commercial	$747.84
Rate for Payer: Aetna Medicare Advantage	$590.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$501.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$501.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$501.84
Rate for Payer: Cigna Commercial	$984.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$590.40
Rate for Payer: Oxford Commercial	$393.60
Rate for Payer: Qualcare PPO/HMO/WC	$295.20
Rate for Payer: UnitedHealthcare Commercial	$393.60
Rate for Payer: UnitedHealthcare Community & State	$47.43
Rate for Payer: Wellpoint Medicaid Managed Care	$52.15

MAMMOTOME STANDARD BREAST MARK

Facility

$1,968.00

Hospital Charge Code	270663458
Hospital Revenue Code	272
Min. Negotiated Rate	$295.20
Max. Negotiated Rate	$295.20
Rate for Payer: Qualcare PPO/HMO/WC	$295.20

MAMMOTOME STAR MARKER

Facility

$492.00

Hospital Charge Code	26702048
Hospital Revenue Code	272
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$73.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.80

MAMMOTOME STAR MARKER

Facility

$492.00

Hospital Charge Code	26702048
Hospital Revenue Code	272
Min. Negotiated Rate	$11.86
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna Commercial	$186.96
Rate for Payer: Aetna Medicare Advantage	$147.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.46
Rate for Payer: Cigna Commercial	$246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.60
Rate for Payer: Oxford Commercial	$98.40
Rate for Payer: Qualcare PPO/HMO/WC	$73.80
Rate for Payer: UnitedHealthcare Commercial	$98.40
Rate for Payer: UnitedHealthcare Community & State	$11.86
Rate for Payer: Wellpoint Medicaid Managed Care	$13.04

Know your out-of-pocket cost for care.

All Charges