Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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 PUMP AMEDA SGL HYGIE

Facility

$96.39

Hospital Charge Code	270657026
Hospital Revenue Code	270
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$14.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.46

BREAST PUMP AMEDA SGL HYGIE

Facility

$96.39

Hospital Charge Code	270657026
Hospital Revenue Code	270
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$48.20
Rate for Payer: Aetna Commercial	$36.63
Rate for Payer: Aetna Medicare Advantage	$28.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.58
Rate for Payer: Cigna Commercial	$48.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.92
Rate for Payer: Oxford Commercial	$19.28
Rate for Payer: Qualcare PPO/HMO/WC	$14.46
Rate for Payer: UnitedHealthcare Commercial	$19.28
Rate for Payer: UnitedHealthcare Community & State	$2.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.55

BREAST PUMP MANUALELECTRIC

Facility

$109.27

Hospital Charge Code	270650206
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$54.63
Rate for Payer: Aetna Commercial	$41.52
Rate for Payer: Aetna Medicare Advantage	$32.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.86
Rate for Payer: Cigna Commercial	$54.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.78
Rate for Payer: Oxford Commercial	$21.85
Rate for Payer: Qualcare PPO/HMO/WC	$16.39
Rate for Payer: UnitedHealthcare Commercial	$21.85
Rate for Payer: UnitedHealthcare Community & State	$2.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

BREAST PUMP MANUALELECTRIC

Facility

$109.27

Hospital Charge Code	270650206
Hospital Revenue Code	270
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$16.39
Rate for Payer: Qualcare PPO/HMO/WC	$16.39

BREAST RECONSTR W FF

Facility

$31,390.90

Service Code	HCPCS 19364
Hospital Charge Code	16000537
Hospital Revenue Code	360
Min. Negotiated Rate	$4,708.64
Max. Negotiated Rate	$4,708.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,708.64

BREAST RECONSTR W FF

Facility

$31,390.90

Service Code	HCPCS 19364
Hospital Charge Code	16000537
Hospital Revenue Code	360
Min. Negotiated Rate	$756.52
Max. Negotiated Rate	$15,695.45
Rate for Payer: Aetna Commercial	$11,928.54
Rate for Payer: Aetna Medicare Advantage	$9,417.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,004.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,004.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,004.68
Rate for Payer: Cigna Commercial	$15,695.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,417.27
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,708.64
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$756.52
Rate for Payer: Wellpoint Medicaid Managed Care	$831.86

BREAST RECONSTR W/ LAT FLAP

Facility

$21,668.55

Service Code	HCPCS 19361
Hospital Charge Code	1600000458
Hospital Revenue Code	360
Min. Negotiated Rate	$522.21
Max. Negotiated Rate	$10,834.27
Rate for Payer: Aetna Commercial	$8,234.05
Rate for Payer: Aetna Medicare Advantage	$6,500.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,525.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,525.48
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	$5,525.48
Rate for Payer: Cigna Commercial	$10,834.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,500.56
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,250.28
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$522.21
Rate for Payer: Wellpoint Medicaid Managed Care	$574.22

BREAST RECONSTR W/ LAT FLAP

Facility

$21,668.55

Service Code	HCPCS 19361
Hospital Charge Code	1600000458
Hospital Revenue Code	360
Min. Negotiated Rate	$3,250.28
Max. Negotiated Rate	$3,250.28
Rate for Payer: Qualcare PPO/HMO/WC	$3,250.28

BREAST RECONST W TISS EXP

Facility

$57,566.30

Service Code	HCPCS 19357
Hospital Charge Code	16000467
Hospital Revenue Code	360
Min. Negotiated Rate	$1,387.35
Max. Negotiated Rate	$59,098.51
Rate for Payer: Aetna Commercial	$44,532.22
Rate for Payer: Aetna Medicare Advantage	$53,045.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59,098.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59,098.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,372.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,742.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59,098.51
Rate for Payer: Cigna Commercial	$32,817.88
Rate for Payer: Cigna Medicare Advantage	$16,372.14
Rate for Payer: Clover Medicare Advantage	$15,553.53
Rate for Payer: EmblemHealth Commercial	$49,116.42
Rate for Payer: Humana Medicare Advantage	$16,863.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,372.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,269.89
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,387.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,372.14
Rate for Payer: Wellcare Medicare Advantage	$16,372.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1,525.51

BREAST RECONST W TISS EXP

Facility

$57,566.30

Service Code	HCPCS 19357
Hospital Charge Code	16000467
Hospital Revenue Code	360
Min. Negotiated Rate	$8,634.94
Max. Negotiated Rate	$8,634.94
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94

BREAST-RT

Facility

$2,100.00

Service Code	HCPCS 76645RT
Hospital Charge Code	94061433
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

BREAST-RT

Facility

$2,100.00

Service Code	HCPCS 76645RT
Hospital Charge Code	94061433
Hospital Revenue Code	402
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$315.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

BREAST SIZER 450CC

Facility

$1,500.00

Hospital Charge Code	270672833
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 450CC

Facility

$1,500.00

Hospital Charge Code	270672833
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

BREAST SIZER 500CC

Facility

$1,500.00

Hospital Charge Code	270672834
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 500CC

Facility

$1,500.00

Hospital Charge Code	270672834
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

BREAST SIZER 550CC

Facility

$1,500.00

Hospital Charge Code	270672835
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 550CC

Facility

$1,500.00

Hospital Charge Code	270672835
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

BREAST SIZER 600CC

Facility

$1,500.00

Hospital Charge Code	270675851
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 600CC

Facility

$1,500.00

Hospital Charge Code	270675851
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

BREAST SIZER 650CC

Facility

$1,500.00

Hospital Charge Code	270675850
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 650CC

Facility

$1,500.00

Hospital Charge Code	270675850
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

BREAST SIZER 700CC

Facility

$1,500.00

Hospital Charge Code	270674070
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 700CC

Facility

$1,500.00

Hospital Charge Code	270674070
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

Know your out-of-pocket cost for care.

All Charges