Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BREAST IMPLANT GEL ROUND 370CC

Facility

$4,975.00

Hospital Charge Code	270667908
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

BREAST IMPLANT GEL ROUND 425CC

Facility

$4,975.00

Hospital Charge Code	270667906
Hospital Revenue Code	278
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Community & State	$119.90
Rate for Payer: Wellpoint Medicaid Managed Care	$131.84

BREAST IMPLANT GEL ROUND 425CC

Facility

$4,975.00

Hospital Charge Code	270667906
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

BREAST IMPLANT GEL ROUND 485CC

Facility

$4,975.00

Hospital Charge Code	270667907
Hospital Revenue Code	278
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Community & State	$119.90
Rate for Payer: Wellpoint Medicaid Managed Care	$131.84

BREAST IMPLANT GEL ROUND 485CC

Facility

$4,975.00

Hospital Charge Code	270667907
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

BREAST IMPLANT HIGH PRO 400CC

Facility

$4,900.00

Hospital Charge Code	270672828
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT HIGH PRO 400CC

Facility

$4,900.00

Hospital Charge Code	270672828
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 450CC

Facility

$4,900.00

Hospital Charge Code	270672829
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 450CC

Facility

$4,900.00

Hospital Charge Code	270672829
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT HIGH PRO 500CC

Facility

$4,900.00

Hospital Charge Code	270672830
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT HIGH PRO 500CC

Facility

$4,900.00

Hospital Charge Code	270672830
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 550CC

Facility

$4,900.00

Hospital Charge Code	270672831
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 550CC

Facility

$4,900.00

Hospital Charge Code	270672831
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT HIGH PRO 600CC

Facility

$4,900.00

Hospital Charge Code	270670849
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT HIGH PRO 600CC

Facility

$4,900.00

Hospital Charge Code	270670849
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 650CC

Facility

$4,900.00

Hospital Charge Code	270670848
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT HIGH PRO 650CC

Facility

$4,900.00

Hospital Charge Code	270670848
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 700CC

Facility

$4,900.00

Hospital Charge Code	270674069
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT HIGH PRO 700CC

Facility

$4,900.00

Hospital Charge Code	270674069
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 750CC

Facility

$4,900.00

Hospital Charge Code	270665515
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT HIGH PRO 750CC

Facility

$4,900.00

Hospital Charge Code	270665515
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 800CC

Facility

$4,900.00

Hospital Charge Code	270665518
Hospital Revenue Code	278
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$1,185.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00

BREAST IMPLANT HIGH PRO 800CC

Facility

$4,900.00

Hospital Charge Code	270665518
Hospital Revenue Code	278
Min. Negotiated Rate	$118.09
Max. Negotiated Rate	$2,450.00
Rate for Payer: Aetna Commercial	$1,862.00
Rate for Payer: Aetna Medicare Advantage	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.50
Rate for Payer: Cigna Commercial	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$735.00
Rate for Payer: UnitedHealthcare Community & State	$118.09
Rate for Payer: Wellpoint Medicaid Managed Care	$129.85

BREAST IMPLANT MOD PRO 650CC

Facility

$6,750.00

Hospital Charge Code	270676080
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 IMPLANT MOD PRO 650CC

Facility

$6,750.00

Hospital Charge Code	270676080
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