Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BREAKPOINT CLUSTER REGION

Facility

$204.00

Hospital Charge Code	3009859
Hospital Revenue Code	301
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

BREAST 310CC HIGH PROFILE

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270701714
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BREAST 310CC HIGH PROFILE

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270701714
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

BREAST 350 CC SMOOTH

Facility

$5,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270701440
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

BREAST 350 CC SMOOTH

Facility

$5,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270701440
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$71,325.04

Service Code	MSDRG 584
Min. Negotiated Rate	$21,717.56
Max. Negotiated Rate	$71,325.04
Rate for Payer: Cigna Commercial	$40,061.06
Rate for Payer: Cigna Medicare Advantage	$22,860.59
Rate for Payer: Clover Medicare Advantage	$21,717.56
Rate for Payer: EmblemHealth Commercial	$68,581.77
Rate for Payer: Humana Medicare Advantage	$23,546.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,860.59
Rate for Payer: Oxford Commercial	$28,792.42
Rate for Payer: UnitedHealthcare Commercial	$50,488.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,860.59
Rate for Payer: Wellcare Medicare Advantage	$22,860.59
Rate for Payer: Aetna Commercial	$49,265.77
Rate for Payer: Aetna Medicare Advantage	$71,325.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,591.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,591.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,860.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45,591.56

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$64,485.78

Service Code	MSDRG 585
Min. Negotiated Rate	$19,635.09
Max. Negotiated Rate	$64,485.78
Rate for Payer: Aetna Commercial	$44,566.43
Rate for Payer: Aetna Medicare Advantage	$64,485.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39,078.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39,078.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,668.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39,078.48
Rate for Payer: Cigna Commercial	$36,101.18
Rate for Payer: Cigna Medicare Advantage	$20,668.52
Rate for Payer: Clover Medicare Advantage	$19,635.09
Rate for Payer: EmblemHealth Commercial	$62,005.56
Rate for Payer: Humana Medicare Advantage	$21,288.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,668.52
Rate for Payer: Oxford Commercial	$25,946.40
Rate for Payer: UnitedHealthcare Commercial	$45,497.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,668.52
Rate for Payer: Wellcare Medicare Advantage	$20,668.52

BREAST CREAM

Facility

$34.60

Hospital Charge Code	60628428
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

BREAST CREAM

Facility

$34.60

Hospital Charge Code	60628428
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

BREAST EXPANDER 300CC

Facility

$5,650.00

Hospital Charge Code	270667482
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

BREAST EXPANDER 300CC

Facility

$5,650.00

Hospital Charge Code	270667482
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

BREAST EXPANDER 400CC

Facility

$5,650.00

Hospital Charge Code	270667483
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

BREAST EXPANDER 400CC

Facility

$5,650.00

Hospital Charge Code	270667483
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

BREAST EXPANDER 500cc

Facility

$5,650.00

Hospital Charge Code	270665562
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

BREAST EXPANDER 500cc

Facility

$5,650.00

Hospital Charge Code	270665562
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

BREAST EXPANDER 550 CC

Facility

$9,875.00

Service Code	HCPCS C1789
Hospital Charge Code	270701281
Hospital Revenue Code	278
Min. Negotiated Rate	$237.99
Max. Negotiated Rate	$4,937.50
Rate for Payer: Aetna Commercial	$3,752.50
Rate for Payer: Aetna Medicare Advantage	$2,962.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,518.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,518.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,518.12
Rate for Payer: Cigna Commercial	$4,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,172.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,481.25
Rate for Payer: UnitedHealthcare Community & State	$237.99
Rate for Payer: Wellpoint Medicaid Managed Care	$261.69

BREAST EXPANDER 550 CC

Facility

$9,875.00

Service Code	HCPCS C1789
Hospital Charge Code	270701281
Hospital Revenue Code	278
Min. Negotiated Rate	$1,481.25
Max. Negotiated Rate	$2,389.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,172.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,481.25

BREAST EXPANDER 600cc

Facility

$5,650.00

Service Code	HCPCS C1789
Hospital Charge Code	270665563
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

BREAST EXPANDER 600cc

Facility

$5,650.00

Service Code	HCPCS C1789
Hospital Charge Code	270665563
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

BREAST EXPANDER 700cc

Facility

$5,650.00

Hospital Charge Code	270665564
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

BREAST EXPANDER 700cc

Facility

$5,650.00

Hospital Charge Code	270665564
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

BREAST EXPANDER 850cc

Facility

$5,650.00

Hospital Charge Code	270666304
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

BREAST EXPANDER 850cc

Facility

$5,650.00

Hospital Charge Code	270666304
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

BREAST EXPANDERS W/TABS 400CC

Facility

$6,750.00

Hospital Charge Code	270669278
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

BREAST EXPANDERS W/TABS 400CC

Facility

$6,750.00

Hospital Charge Code	270669278
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

Know your out-of-pocket cost for care.

All Charges