Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

US BREAST COMPLETE LT

Facility

$6,700.00

Service Code	HCPCS 76641LT
Hospital Charge Code	2309095
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US BREAST COMPLETE LT

Facility

$6,700.00

Service Code	HCPCS 76641LT
Hospital Charge Code	94061468
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US BREAST COMPLETE LT

Facility

$6,700.00

Service Code	HCPCS 76641LT
Hospital Charge Code	94061468
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US BREAST COMPLETE RT

Facility

$6,700.00

Service Code	HCPCS 76641RT
Hospital Charge Code	94061464
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US BREAST COMPLETE RT

Facility

$6,700.00

Service Code	HCPCS 76641RT
Hospital Charge Code	94061464
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US-BREAST LIMITED-BI

Facility

$2,100.00

Hospital Charge Code	2309055
Hospital Revenue Code	402
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

US-BREAST LIMITED-BI

Facility

$2,100.00

Hospital Charge Code	2309055
Hospital Revenue Code	402
Min. Negotiated Rate	$50.61
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$798.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$50.61
Rate for Payer: Wellpoint Medicaid Managed Care	$55.65

US BREAST LIMITED BILAT

Facility

$6,700.00

Service Code	HCPCS 7664250
Hospital Charge Code	94061467
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US BREAST LIMITED BILAT

Facility

$6,700.00

Service Code	HCPCS 7664250
Hospital Charge Code	94061467
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US BREAST LIMITED BILAT

Facility

$6,700.00

Service Code	HCPCS 7664250
Hospital Charge Code	2309097
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US BREAST LIMITED BILAT

Facility

$6,700.00

Service Code	HCPCS 7664250
Hospital Charge Code	2309097
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US BREAST LIMITED LT

Facility

$6,700.00

Service Code	HCPCS 76642LT
Hospital Charge Code	2309096
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US BREAST LIMITED LT

Facility

$6,700.00

Service Code	HCPCS 76642LT
Hospital Charge Code	2309096
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US BREAST LIMITED LT

Facility

$6,700.00

Service Code	HCPCS 76642LT
Hospital Charge Code	94061469
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US BREAST LIMITED LT

Facility

$6,700.00

Service Code	HCPCS 76642LT
Hospital Charge Code	94061469
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US BREAST LIMITED RT

Facility

$6,700.00

Service Code	HCPCS 76642RT
Hospital Charge Code	2309092
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US BREAST LIMITED RT

Facility

$6,700.00

Service Code	HCPCS 76642RT
Hospital Charge Code	2309092
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US BREAST LIMITED RT

Facility

$6,700.00

Service Code	HCPCS 76642RT
Hospital Charge Code	94061465
Hospital Revenue Code	402
Min. Negotiated Rate	$161.47
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

US BREAST LIMITED RT

Facility

$6,700.00

Service Code	HCPCS 76642RT
Hospital Charge Code	94061465
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US BREAST PERC VAC ASSIST

Facility

$6,419.95

Hospital Charge Code	21000920
Hospital Revenue Code	361
Min. Negotiated Rate	$962.99
Max. Negotiated Rate	$962.99
Rate for Payer: Qualcare PPO/HMO/WC	$962.99

US BREAST PERC VAC ASSIST

Facility

$6,419.95

Hospital Charge Code	21000920
Hospital Revenue Code	361
Min. Negotiated Rate	$154.72
Max. Negotiated Rate	$3,209.97
Rate for Payer: Aetna Commercial	$2,439.58
Rate for Payer: Aetna Medicare Advantage	$1,925.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.09
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	$1,637.09
Rate for Payer: Cigna Commercial	$3,209.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,925.98
Rate for Payer: Qualcare PPO/HMO/WC	$962.99
Rate for Payer: UnitedHealthcare Community & State	$154.72
Rate for Payer: Wellpoint Medicaid Managed Care	$170.13

US BREAST RIGHT

Facility

$352.05

Service Code	HCPCS 76645
Hospital Charge Code	2301063
Hospital Revenue Code	402
Min. Negotiated Rate	$52.81
Max. Negotiated Rate	$52.81
Rate for Payer: Qualcare PPO/HMO/WC	$52.81

US BREAST RIGHT

Facility

$352.05

Service Code	HCPCS 76645
Hospital Charge Code	2301063
Hospital Revenue Code	402
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$133.78
Rate for Payer: Aetna Medicare Advantage	$105.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.77
Rate for Payer: Cigna Commercial	$176.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.61
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.81
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$8.48
Rate for Payer: Wellpoint Medicaid Managed Care	$9.33

US-BREAST-RT

Facility

$2,100.00

Hospital Charge Code	2309065
Hospital Revenue Code	402
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

US-BREAST-RT

Facility

$2,100.00

Hospital Charge Code	2309065
Hospital Revenue Code	402
Min. Negotiated Rate	$50.61
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$798.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$50.61
Rate for Payer: Wellpoint Medicaid Managed Care	$55.65

Know your out-of-pocket cost for care.

All Charges