Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BREAST IMPLANT MOD PRO 685CC

Facility

$6,750.00

Service Code	HCPCS C1779
Hospital Charge Code	270676079
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

BREAST IMPLANT MOD PRO 685CC

Facility

$6,750.00

Service Code	HCPCS C1779
Hospital Charge Code	270676079
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

BREASTIMPSIENTRASMTHMIDHT+550

Facility

$9,375.00

Service Code	HCPCS L8600
Hospital Charge Code	270700114
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

BREASTIMPSIENTRASMTHMIDHT+550

Facility

$9,375.00

Service Code	HCPCS L8600
Hospital Charge Code	270700114
Hospital Revenue Code	278
Min. Negotiated Rate	$225.94
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$225.94
Rate for Payer: Wellpoint Medicaid Managed Care	$248.44

BREASTIMPSIENTRASMTHRNDMOD+305

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270700582
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+305

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270700582
Hospital Revenue Code	278
Min. Negotiated Rate	$93.03
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$93.03
Rate for Payer: Wellpoint Medicaid Managed Care	$102.29

BREASTIMPSIENTRASMTHRNDMOD+355

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699945
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+355

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699945
Hospital Revenue Code	278
Min. Negotiated Rate	$93.03
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$93.03
Rate for Payer: Wellpoint Medicaid Managed Care	$102.29

BREASTIMPSIENTRASMTHRNDMOD+385

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699946
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+385

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699946
Hospital Revenue Code	278
Min. Negotiated Rate	$93.03
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$93.03
Rate for Payer: Wellpoint Medicaid Managed Care	$102.29

BREASTIMPSIENTRASMTHRNDMOD+415

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699947
Hospital Revenue Code	278
Min. Negotiated Rate	$93.03
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$93.03
Rate for Payer: Wellpoint Medicaid Managed Care	$102.29

BREASTIMPSIENTRASMTHRNDMOD+415

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699947
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+435

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699948
Hospital Revenue Code	278
Min. Negotiated Rate	$93.03
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$93.03
Rate for Payer: Wellpoint Medicaid Managed Care	$102.29

BREASTIMPSIENTRASMTHRNDMOD+435

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699948
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.20
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREAST LOCALIZATION MR GUIDE

Facility

$5,102.50

Service Code	HCPCS 19287
Hospital Charge Code	2409035
Hospital Revenue Code	361
Min. Negotiated Rate	$122.97
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.75
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.38
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$122.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$135.22

BREAST LOCALIZATION MR GUIDE

Facility

$5,102.50

Service Code	HCPCS 19287
Hospital Charge Code	2409035
Hospital Revenue Code	361
Min. Negotiated Rate	$765.38
Max. Negotiated Rate	$765.38
Rate for Payer: Qualcare PPO/HMO/WC	$765.38

BREAST LOCALIZATION US GUIDE

Facility

$2,748.55

Service Code	HCPCS 19285
Hospital Charge Code	2309085
Hospital Revenue Code	361
Min. Negotiated Rate	$412.28
Max. Negotiated Rate	$412.28
Rate for Payer: Qualcare PPO/HMO/WC	$412.28

BREAST LOCALIZATION US GUIDE

Facility

$2,748.55

Service Code	HCPCS 19285
Hospital Charge Code	2309085
Hospital Revenue Code	361
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$824.57
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.28
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$66.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$72.84

BREAST LOCAL MR GUIDE EA ADD L

Facility

$983.40

Service Code	HCPCS 19288
Hospital Charge Code	2409040
Hospital Revenue Code	361
Min. Negotiated Rate	$147.51
Max. Negotiated Rate	$147.51
Rate for Payer: Qualcare PPO/HMO/WC	$147.51

BREAST LOCAL MR GUIDE EA ADD L

Facility

$983.40

Service Code	HCPCS 19288
Hospital Charge Code	2409040
Hospital Revenue Code	361
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$373.69
Rate for Payer: Aetna Medicare Advantage	$295.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.77
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	$250.77
Rate for Payer: Cigna Commercial	$491.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.02
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.51
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$26.06

BREAST LOCALUS GUIDE EA ADD LE

Facility

$2,321.15

Service Code	HCPCS 19286
Hospital Charge Code	2309090
Hospital Revenue Code	361
Min. Negotiated Rate	$348.17
Max. Negotiated Rate	$348.17
Rate for Payer: Qualcare PPO/HMO/WC	$348.17

BREAST LOCALUS GUIDE EA ADD LE

Facility

$2,321.15

Service Code	HCPCS 19286
Hospital Charge Code	2309090
Hospital Revenue Code	361
Min. Negotiated Rate	$55.94
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$882.04
Rate for Payer: Aetna Medicare Advantage	$696.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.89
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	$591.89
Rate for Payer: Cigna Commercial	$1,160.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$696.35
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$55.94
Rate for Payer: Wellpoint Medicaid Managed Care	$61.51

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$30,302.72

Service Code	APR-DRG 3633
Min. Negotiated Rate	$29,708.55
Max. Negotiated Rate	$30,302.72
Rate for Payer: UnitedHealthcare Community & State	$29,708.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$30,302.72
Rate for Payer: Wellpoint Medicaid Managed Care	$29,708.55

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$44,407.81

Service Code	APR-DRG 3634
Min. Negotiated Rate	$43,537.07
Max. Negotiated Rate	$44,407.81
Rate for Payer: UnitedHealthcare Community & State	$43,537.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$44,407.81
Rate for Payer: Wellpoint Medicaid Managed Care	$43,537.07

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$24,438.74

Service Code	APR-DRG 3632
Min. Negotiated Rate	$23,959.55
Max. Negotiated Rate	$24,438.74
Rate for Payer: UnitedHealthcare Community & State	$23,959.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,438.74
Rate for Payer: Wellpoint Medicaid Managed Care	$23,959.55

Know your out-of-pocket cost for care.

All Charges