Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BRACKET UNIVRL KEYHOLE 9.25 14

Facility

$270.00

Hospital Charge Code	270665198
Hospital Revenue Code	270
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

BRACKMANN PARTAL HA/C 11-12305

Facility

$920.85

Hospital Charge Code	270624163
Hospital Revenue Code	272
Min. Negotiated Rate	$138.13
Max. Negotiated Rate	$138.13
Rate for Payer: Qualcare PPO/HMO/WC	$138.13

BRACKMANN PARTAL HA/C 11-12305

Facility

$920.85

Hospital Charge Code	270624163
Hospital Revenue Code	272
Min. Negotiated Rate	$22.19
Max. Negotiated Rate	$460.43
Rate for Payer: Aetna Commercial	$349.92
Rate for Payer: Aetna Medicare Advantage	$276.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.82
Rate for Payer: Cigna Commercial	$460.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.25
Rate for Payer: Oxford Commercial	$184.17
Rate for Payer: Qualcare PPO/HMO/WC	$138.13
Rate for Payer: UnitedHealthcare Commercial	$184.17
Rate for Payer: UnitedHealthcare Community & State	$22.19
Rate for Payer: Wellpoint Medicaid Managed Care	$24.40

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$9,908.52

Service Code	APR-DRG 0562
Min. Negotiated Rate	$9,714.24
Max. Negotiated Rate	$9,908.52
Rate for Payer: UnitedHealthcare Community & State	$9,714.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,908.52
Rate for Payer: Wellpoint Medicaid Managed Care	$9,714.24

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$23,972.77

Service Code	APR-DRG 0564
Min. Negotiated Rate	$23,502.72
Max. Negotiated Rate	$23,972.77
Rate for Payer: UnitedHealthcare Community & State	$23,502.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,972.77
Rate for Payer: Wellpoint Medicaid Managed Care	$23,502.72

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$7,417.72

Service Code	APR-DRG 0561
Min. Negotiated Rate	$7,272.27
Max. Negotiated Rate	$7,417.72
Rate for Payer: UnitedHealthcare Community & State	$7,272.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,417.72
Rate for Payer: Wellpoint Medicaid Managed Care	$7,272.27

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$15,000.08

Service Code	APR-DRG 0563
Min. Negotiated Rate	$14,705.96
Max. Negotiated Rate	$15,000.08
Rate for Payer: UnitedHealthcare Community & State	$14,705.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,000.08
Rate for Payer: Wellpoint Medicaid Managed Care	$14,705.96

BRA SURGICAL EXTRA EXTRA LARGE

Facility

$132.50

Hospital Charge Code	270665572
Hospital Revenue Code	272
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$66.25
Rate for Payer: Aetna Commercial	$50.35
Rate for Payer: Aetna Medicare Advantage	$39.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.79
Rate for Payer: Cigna Commercial	$66.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.75
Rate for Payer: Oxford Commercial	$26.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.88
Rate for Payer: UnitedHealthcare Commercial	$26.50
Rate for Payer: UnitedHealthcare Community & State	$3.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.51

BRA SURGICAL EXTRA EXTRA LARGE

Facility

$132.50

Hospital Charge Code	270665572
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$19.88
Rate for Payer: Qualcare PPO/HMO/WC	$19.88

BRA SURGICAL EXTRA LARGE

Facility

$133.35

Hospital Charge Code	270665571
Hospital Revenue Code	272
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$66.67
Rate for Payer: Aetna Commercial	$50.67
Rate for Payer: Aetna Medicare Advantage	$40.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.00
Rate for Payer: Cigna Commercial	$66.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.01
Rate for Payer: Oxford Commercial	$26.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.00
Rate for Payer: UnitedHealthcare Commercial	$26.67
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.53

BRA SURGICAL EXTRA LARGE

Facility

$133.35

Hospital Charge Code	270665571
Hospital Revenue Code	272
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.00

BRA SURGICAL MED

Facility

$133.33

Hospital Charge Code	270665569
Hospital Revenue Code	270
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$66.67
Rate for Payer: Aetna Commercial	$50.67
Rate for Payer: Aetna Medicare Advantage	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.00
Rate for Payer: Cigna Commercial	$66.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.00
Rate for Payer: Oxford Commercial	$26.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.00
Rate for Payer: UnitedHealthcare Commercial	$26.67
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.53

BRA SURGICAL MED

Facility

$133.33

Hospital Charge Code	270665569
Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.00

BRA SURGICAL SUPPORT SURGI 3XL

Facility

$208.70

Hospital Charge Code	270676375
Hospital Revenue Code	272
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.30

BRA SURGICAL SUPPORT SURGI 3XL

Facility

$208.70

Hospital Charge Code	270676375
Hospital Revenue Code	272
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$104.35
Rate for Payer: Aetna Commercial	$79.31
Rate for Payer: Aetna Medicare Advantage	$62.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.22
Rate for Payer: Cigna Commercial	$104.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.61
Rate for Payer: Oxford Commercial	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$31.30
Rate for Payer: UnitedHealthcare Commercial	$41.74
Rate for Payer: UnitedHealthcare Community & State	$5.03
Rate for Payer: Wellpoint Medicaid Managed Care	$5.53

BRA SURGICAL SUPPORT SURGI 4XL

Facility

$208.70

Hospital Charge Code	270676376
Hospital Revenue Code	272
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$104.35
Rate for Payer: Aetna Commercial	$79.31
Rate for Payer: Aetna Medicare Advantage	$62.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.22
Rate for Payer: Cigna Commercial	$104.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.61
Rate for Payer: Oxford Commercial	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$31.30
Rate for Payer: UnitedHealthcare Commercial	$41.74
Rate for Payer: UnitedHealthcare Community & State	$5.03
Rate for Payer: Wellpoint Medicaid Managed Care	$5.53

BRA SURGICAL SUPPORT SURGI 4XL

Facility

$208.70

Hospital Charge Code	270676376
Hospital Revenue Code	272
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.30

BRA SURGICAL SUPPORT SURGI L38

Facility

$162.25

Hospital Charge Code	270655462
Hospital Revenue Code	270
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$81.12
Rate for Payer: Aetna Commercial	$61.66
Rate for Payer: Aetna Medicare Advantage	$48.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.37
Rate for Payer: Cigna Commercial	$81.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.67
Rate for Payer: Oxford Commercial	$32.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.34
Rate for Payer: UnitedHealthcare Commercial	$32.45
Rate for Payer: UnitedHealthcare Community & State	$3.91
Rate for Payer: Wellpoint Medicaid Managed Care	$4.30

BRA SURGICAL SUPPORT SURGI L38

Facility

$162.25

Hospital Charge Code	270655462
Hospital Revenue Code	270
Min. Negotiated Rate	$24.34
Max. Negotiated Rate	$24.34
Rate for Payer: Qualcare PPO/HMO/WC	$24.34

BRA SURGICAL SUPPORT SURGI MED

Facility

$209.10

Hospital Charge Code	270650798
Hospital Revenue Code	272
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$31.36
Rate for Payer: Qualcare PPO/HMO/WC	$31.36

BRA SURGICAL SUPPORT SURGI MED

Facility

$209.10

Hospital Charge Code	270650798
Hospital Revenue Code	272
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$104.55
Rate for Payer: Aetna Commercial	$79.46
Rate for Payer: Aetna Medicare Advantage	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.32
Rate for Payer: Cigna Commercial	$104.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.73
Rate for Payer: Oxford Commercial	$41.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.36
Rate for Payer: UnitedHealthcare Commercial	$41.82
Rate for Payer: UnitedHealthcare Community & State	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

BRA SURGICAL SUPPORT SURGI SM.

Facility

$209.10

Hospital Charge Code	270655494
Hospital Revenue Code	272
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$31.36
Rate for Payer: Qualcare PPO/HMO/WC	$31.36

BRA SURGICAL SUPPORT SURGI SM.

Facility

$209.10

Hospital Charge Code	270655494
Hospital Revenue Code	272
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$104.55
Rate for Payer: Aetna Commercial	$79.46
Rate for Payer: Aetna Medicare Advantage	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.32
Rate for Payer: Cigna Commercial	$104.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.73
Rate for Payer: Oxford Commercial	$41.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.36
Rate for Payer: UnitedHealthcare Commercial	$41.82
Rate for Payer: UnitedHealthcare Community & State	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

BRA SURGICAL SUPPORT SURGI XL

Facility

$183.65

Hospital Charge Code	270655491
Hospital Revenue Code	270
Min. Negotiated Rate	$27.55
Max. Negotiated Rate	$27.55
Rate for Payer: Qualcare PPO/HMO/WC	$27.55

BRA SURGICAL SUPPORT SURGI XL

Facility

$183.65

Hospital Charge Code	270655491
Hospital Revenue Code	270
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$91.83
Rate for Payer: Aetna Commercial	$69.79
Rate for Payer: Aetna Medicare Advantage	$55.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.83
Rate for Payer: Cigna Commercial	$91.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.09
Rate for Payer: Oxford Commercial	$36.73
Rate for Payer: Qualcare PPO/HMO/WC	$27.55
Rate for Payer: UnitedHealthcare Commercial	$36.73
Rate for Payer: UnitedHealthcare Community & State	$4.43
Rate for Payer: Wellpoint Medicaid Managed Care	$4.87

Know your out-of-pocket cost for care.

All Charges