Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROSTHESIS BRST CONTR 354-2914

Facility

$3,145.65

Hospital Charge Code	270614096
Hospital Revenue Code	278
Min. Negotiated Rate	$471.85
Max. Negotiated Rate	$761.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$629.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$761.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$692.04
Rate for Payer: Qualcare PPO/HMO/WC	$471.85

PROSTHESIS BRST CONTR 354-2914

Facility

$4,980.00

Hospital Charge Code	270614100
Hospital Revenue Code	278
Min. Negotiated Rate	$747.00
Max. Negotiated Rate	$1,205.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$996.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,205.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,095.60
Rate for Payer: Qualcare PPO/HMO/WC	$747.00

PROSTHESIS BRST CONTR 354-2914

Facility

$4,980.00

Hospital Charge Code	270614100
Hospital Revenue Code	278
Min. Negotiated Rate	$120.02
Max. Negotiated Rate	$2,490.00
Rate for Payer: Aetna Commercial	$1,892.40
Rate for Payer: Aetna Medicare Advantage	$1,494.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$996.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,269.90
Rate for Payer: Cigna Commercial	$2,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,205.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,095.60
Rate for Payer: Qualcare PPO/HMO/WC	$747.00
Rate for Payer: UnitedHealthcare Community & State	$120.02
Rate for Payer: Wellpoint Medicaid Managed Care	$131.97

PROSTHESIS BRST CONTR 354-2914

Facility

$3,145.65

Hospital Charge Code	270614096
Hospital Revenue Code	278
Min. Negotiated Rate	$75.81
Max. Negotiated Rate	$1,572.83
Rate for Payer: Aetna Commercial	$1,195.35
Rate for Payer: Aetna Medicare Advantage	$943.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$802.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$802.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$629.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$802.14
Rate for Payer: Cigna Commercial	$1,572.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$761.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$692.04
Rate for Payer: Qualcare PPO/HMO/WC	$471.85
Rate for Payer: UnitedHealthcare Community & State	$75.81
Rate for Payer: Wellpoint Medicaid Managed Care	$83.36

PROSTHESIS BRST SALIN 354-2635

Facility

$4,596.85

Hospital Charge Code	270621091
Hospital Revenue Code	278
Min. Negotiated Rate	$110.78
Max. Negotiated Rate	$2,298.43
Rate for Payer: Aetna Commercial	$1,746.80
Rate for Payer: Aetna Medicare Advantage	$1,379.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$919.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,172.20
Rate for Payer: Cigna Commercial	$2,298.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,112.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,011.31
Rate for Payer: Qualcare PPO/HMO/WC	$689.53
Rate for Payer: UnitedHealthcare Community & State	$110.78
Rate for Payer: Wellpoint Medicaid Managed Care	$121.82

PROSTHESIS BRST SALIN 354-2635

Facility

$4,596.85

Hospital Charge Code	270621091
Hospital Revenue Code	278
Min. Negotiated Rate	$689.53
Max. Negotiated Rate	$1,112.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$919.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,112.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,011.31
Rate for Payer: Qualcare PPO/HMO/WC	$689.53

PROSTHESIS BRST SALIN 354-2650

Facility

$3,145.65

Hospital Charge Code	270621641
Hospital Revenue Code	278
Min. Negotiated Rate	$471.85
Max. Negotiated Rate	$761.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$629.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$761.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$692.04
Rate for Payer: Qualcare PPO/HMO/WC	$471.85

PROSTHESIS BRST SALIN 354-2650

Facility

$3,145.65

Hospital Charge Code	270621641
Hospital Revenue Code	278
Min. Negotiated Rate	$75.81
Max. Negotiated Rate	$1,572.83
Rate for Payer: Aetna Commercial	$1,195.35
Rate for Payer: Aetna Medicare Advantage	$943.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$802.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$802.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$629.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$802.14
Rate for Payer: Cigna Commercial	$1,572.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$761.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$692.04
Rate for Payer: Qualcare PPO/HMO/WC	$471.85
Rate for Payer: UnitedHealthcare Community & State	$75.81
Rate for Payer: Wellpoint Medicaid Managed Care	$83.36

PROSTHESIS CUP BI-POLAR 49MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270615751
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

PROSTHESIS CUP BI-POLAR 49MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270615751
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

PROSTHESIS INCUS EAR 140940

Facility

$408.00

Hospital Charge Code	270620719
Hospital Revenue Code	278
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$204.00
Rate for Payer: Aetna Commercial	$155.04
Rate for Payer: Aetna Medicare Advantage	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.04
Rate for Payer: Cigna Commercial	$204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.76
Rate for Payer: Qualcare PPO/HMO/WC	$61.20
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$10.81

PROSTHESIS INCUS EAR 140940

Facility

$408.00

Hospital Charge Code	270620719
Hospital Revenue Code	278
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$98.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.76
Rate for Payer: Qualcare PPO/HMO/WC	$61.20

PROSTHESIS JOINT SM APP 140956

Facility

$1,820.40

Hospital Charge Code	270632699
Hospital Revenue Code	278
Min. Negotiated Rate	$273.06
Max. Negotiated Rate	$440.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$440.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$400.49
Rate for Payer: Qualcare PPO/HMO/WC	$273.06

PROSTHESIS JOINT SM APP 140956

Facility

$1,820.40

Hospital Charge Code	270632699
Hospital Revenue Code	278
Min. Negotiated Rate	$43.87
Max. Negotiated Rate	$910.20
Rate for Payer: Aetna Commercial	$691.75
Rate for Payer: Aetna Medicare Advantage	$546.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$464.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$464.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$464.20
Rate for Payer: Cigna Commercial	$910.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$440.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$400.49
Rate for Payer: Qualcare PPO/HMO/WC	$273.06
Rate for Payer: UnitedHealthcare Community & State	$43.87
Rate for Payer: Wellpoint Medicaid Managed Care	$48.24

PROSTHESIS JOINT SM APP 140957

Facility

$1,823.40

Hospital Charge Code	270632700
Hospital Revenue Code	278
Min. Negotiated Rate	$273.51
Max. Negotiated Rate	$441.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.15
Rate for Payer: Qualcare PPO/HMO/WC	$273.51

PROSTHESIS JOINT SM APP 140957

Facility

$1,823.40

Hospital Charge Code	270632700
Hospital Revenue Code	278
Min. Negotiated Rate	$43.94
Max. Negotiated Rate	$911.70
Rate for Payer: Aetna Commercial	$692.89
Rate for Payer: Aetna Medicare Advantage	$547.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$464.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$464.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$464.97
Rate for Payer: Cigna Commercial	$911.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.15
Rate for Payer: Qualcare PPO/HMO/WC	$273.51
Rate for Payer: UnitedHealthcare Community & State	$43.94
Rate for Payer: Wellpoint Medicaid Managed Care	$48.32

PROSTHESIS MAMMARY 125 3501610

Facility

$5,056.85

Hospital Charge Code	270615789
Hospital Revenue Code	278
Min. Negotiated Rate	$121.87
Max. Negotiated Rate	$2,528.43
Rate for Payer: Aetna Commercial	$1,921.60
Rate for Payer: Aetna Medicare Advantage	$1,517.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,011.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,289.50
Rate for Payer: Cigna Commercial	$2,528.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,223.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,112.51
Rate for Payer: Qualcare PPO/HMO/WC	$758.53
Rate for Payer: UnitedHealthcare Community & State	$121.87
Rate for Payer: Wellpoint Medicaid Managed Care	$134.01

PROSTHESIS MAMMARY 125 3501610

Facility

$5,056.85

Hospital Charge Code	270615789
Hospital Revenue Code	278
Min. Negotiated Rate	$758.53
Max. Negotiated Rate	$1,223.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,011.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,223.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,112.51
Rate for Payer: Qualcare PPO/HMO/WC	$758.53

PROSTHESIS MAMMARY 150 3501615

Facility

$4,213.65

Hospital Charge Code	270615790
Hospital Revenue Code	278
Min. Negotiated Rate	$632.05
Max. Negotiated Rate	$1,019.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$842.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,019.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$927.00
Rate for Payer: Qualcare PPO/HMO/WC	$632.05

PROSTHESIS MAMMARY 150 3501615

Facility

$4,213.65

Hospital Charge Code	270615790
Hospital Revenue Code	278
Min. Negotiated Rate	$101.55
Max. Negotiated Rate	$2,106.82
Rate for Payer: Aetna Commercial	$1,601.19
Rate for Payer: Aetna Medicare Advantage	$1,264.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,074.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,074.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$842.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,074.48
Rate for Payer: Cigna Commercial	$2,106.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,019.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$927.00
Rate for Payer: Qualcare PPO/HMO/WC	$632.05
Rate for Payer: UnitedHealthcare Community & State	$101.55
Rate for Payer: Wellpoint Medicaid Managed Care	$111.66

PROSTHESIS MIDDLE EAR 140917

Facility

$1,872.00

Hospital Charge Code	270621099
Hospital Revenue Code	278
Min. Negotiated Rate	$280.80
Max. Negotiated Rate	$453.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$374.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$411.84
Rate for Payer: Qualcare PPO/HMO/WC	$280.80

PROSTHESIS MIDDLE EAR 140917

Facility

$1,872.00

Hospital Charge Code	270621099
Hospital Revenue Code	278
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$936.00
Rate for Payer: Aetna Commercial	$711.36
Rate for Payer: Aetna Medicare Advantage	$561.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$477.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$477.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$374.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$477.36
Rate for Payer: Cigna Commercial	$936.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$411.84
Rate for Payer: Qualcare PPO/HMO/WC	$280.80
Rate for Payer: UnitedHealthcare Community & State	$45.12
Rate for Payer: Wellpoint Medicaid Managed Care	$49.61

PROSTHESIS SPECT 275CC

Facility

$3,830.45

Hospital Charge Code	270603857
Hospital Revenue Code	278
Min. Negotiated Rate	$574.57
Max. Negotiated Rate	$926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57

PROSTHESIS SPECT 275CC

Facility

$3,830.45

Hospital Charge Code	270603857
Hospital Revenue Code	278
Min. Negotiated Rate	$92.31
Max. Negotiated Rate	$1,915.22
Rate for Payer: Aetna Commercial	$1,455.57
Rate for Payer: Aetna Medicare Advantage	$1,149.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$976.76
Rate for Payer: Cigna Commercial	$1,915.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57
Rate for Payer: UnitedHealthcare Community & State	$92.31
Rate for Payer: Wellpoint Medicaid Managed Care	$101.51

PROSTHESIS SPECT 350CC

Facility

$3,830.45

Hospital Charge Code	270603856
Hospital Revenue Code	278
Min. Negotiated Rate	$92.31
Max. Negotiated Rate	$1,915.22
Rate for Payer: Aetna Commercial	$1,455.57
Rate for Payer: Aetna Medicare Advantage	$1,149.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$766.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$976.76
Rate for Payer: Cigna Commercial	$1,915.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$926.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$842.70
Rate for Payer: Qualcare PPO/HMO/WC	$574.57
Rate for Payer: UnitedHealthcare Community & State	$92.31
Rate for Payer: Wellpoint Medicaid Managed Care	$101.51

Know your out-of-pocket cost for care.

All Charges