Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SIZER HIGH PROFILE 800CC

Facility

$1,000.00

Hospital Charge Code	270671036
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MAMMARY ROUND 475cc

Facility

$223.25

Hospital Charge Code	270630703
Hospital Revenue Code	272
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Qualcare PPO/HMO/WC	$33.49

SIZER MAMMARY ROUND 475cc

Facility

$223.25

Hospital Charge Code	270630703
Hospital Revenue Code	272
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$111.62
Rate for Payer: Aetna Commercial	$84.83
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.93
Rate for Payer: Cigna Commercial	$111.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.97
Rate for Payer: Oxford Commercial	$44.65
Rate for Payer: Qualcare PPO/HMO/WC	$33.49
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: UnitedHealthcare Community & State	$5.38
Rate for Payer: Wellpoint Medicaid Managed Care	$5.92

SIZER MAMMARY SALINE MOD+475cc

Facility

$225.00

Hospital Charge Code	270638758
Hospital Revenue Code	272
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

SIZER MAMMARY SALINE MOD+475cc

Facility

$225.00

Hospital Charge Code	270638758
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

SIZER MAM RD VOL 225cc 351225S

Facility

$223.25

Hospital Charge Code	270632177
Hospital Revenue Code	272
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Qualcare PPO/HMO/WC	$33.49

SIZER MAM RD VOL 225cc 351225S

Facility

$223.25

Hospital Charge Code	270632177
Hospital Revenue Code	272
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$111.62
Rate for Payer: Aetna Commercial	$84.83
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.93
Rate for Payer: Cigna Commercial	$111.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.97
Rate for Payer: Oxford Commercial	$44.65
Rate for Payer: Qualcare PPO/HMO/WC	$33.49
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: UnitedHealthcare Community & State	$5.38
Rate for Payer: Wellpoint Medicaid Managed Care	$5.92

SIZER MOD-PLUS PROFILE 397CC

Facility

$1,000.00

Hospital Charge Code	270669940
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

SIZER MOD-PLUS PROFILE 397CC

Facility

$1,000.00

Hospital Charge Code	270669940
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 421CC

Facility

$1,000.00

Hospital Charge Code	270669941
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

SIZER MOD PLUS PROFILE 421CC

Facility

$1,000.00

Hospital Charge Code	270669941
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 457CC

Facility

$1,000.00

Hospital Charge Code	270669942
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 457CC

Facility

$1,000.00

Hospital Charge Code	270669942
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

SIZER MOD PLUS PROFILE 575CC

Facility

$1,000.00

Hospital Charge Code	270671031
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 575CC

Facility

$1,000.00

Hospital Charge Code	270671031
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

SIZER MOD PLUS PROFILE 616CC

Facility

$1,000.00

Hospital Charge Code	270671032
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 616CC

Facility

$1,000.00

Hospital Charge Code	270671032
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

SIZER MOD PLUS PROFILE 659CC

Facility

$1,000.00

Hospital Charge Code	270671033
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

SIZER MOD PLUS PROFILE 659CC

Facility

$1,000.00

Hospital Charge Code	270671033
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER RD VOL 325cc MAM 3513255

Facility

$223.25

Hospital Charge Code	270632429
Hospital Revenue Code	272
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$111.62
Rate for Payer: Aetna Commercial	$84.83
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.93
Rate for Payer: Cigna Commercial	$111.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.97
Rate for Payer: Oxford Commercial	$44.65
Rate for Payer: Qualcare PPO/HMO/WC	$33.49
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: UnitedHealthcare Community & State	$5.38
Rate for Payer: Wellpoint Medicaid Managed Care	$5.92

SIZER RD VOL 325cc MAM 3513255

Facility

$223.25

Hospital Charge Code	270632429
Hospital Revenue Code	272
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Qualcare PPO/HMO/WC	$33.49

SIZER ROUND VOL 375CC 350375S

Facility

$223.25

Hospital Charge Code	270621639
Hospital Revenue Code	272
Min. Negotiated Rate	$33.49
Max. Negotiated Rate	$33.49
Rate for Payer: Qualcare PPO/HMO/WC	$33.49

SIZER ROUND VOL 375CC 350375S

Facility

$223.25

Hospital Charge Code	270621639
Hospital Revenue Code	272
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$111.62
Rate for Payer: Aetna Commercial	$84.83
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.93
Rate for Payer: Cigna Commercial	$111.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.97
Rate for Payer: Oxford Commercial	$44.65
Rate for Payer: Qualcare PPO/HMO/WC	$33.49
Rate for Payer: UnitedHealthcare Commercial	$44.65
Rate for Payer: UnitedHealthcare Community & State	$5.38
Rate for Payer: Wellpoint Medicaid Managed Care	$5.92

SIZERS BREAST

Facility

$1,500.00

Hospital Charge Code	270665521
Hospital Revenue Code	270
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

SIZERS BREAST

Facility

$1,500.00

Hospital Charge Code	270665521
Hospital Revenue Code	270
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges