Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BRA SURGI SUPPORT QUEEN 958

Facility

$173.65

Hospital Charge Code	270615326
Hospital Revenue Code	272
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

BRA SURGI SUPPORT QUEEN 958

Facility

$173.65

Hospital Charge Code	270615326
Hospital Revenue Code	272
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$65.99
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.09
Rate for Payer: Oxford Commercial	$34.73
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$34.73
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.60

BRA SURGI SUPP W VEL SZ XL 958

Facility

$215.80

Hospital Charge Code	270616011
Hospital Revenue Code	272
Min. Negotiated Rate	$32.37
Max. Negotiated Rate	$32.37
Rate for Payer: Qualcare PPO/HMO/WC	$32.37

BRA SURGI SUPP W VEL SZ XL 958

Facility

$215.80

Hospital Charge Code	270616011
Hospital Revenue Code	272
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$107.90
Rate for Payer: Aetna Commercial	$82.00
Rate for Payer: Aetna Medicare Advantage	$64.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.03
Rate for Payer: Cigna Commercial	$107.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.74
Rate for Payer: Oxford Commercial	$43.16
Rate for Payer: Qualcare PPO/HMO/WC	$32.37
Rate for Payer: UnitedHealthcare Commercial	$43.16
Rate for Payer: UnitedHealthcare Community & State	$5.20
Rate for Payer: Wellpoint Medicaid Managed Care	$5.72

BRA SURGI SZ 2X

Facility

$503.25

Hospital Charge Code	270600427
Hospital Revenue Code	272
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$251.62
Rate for Payer: Aetna Commercial	$191.24
Rate for Payer: Aetna Medicare Advantage	$150.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.33
Rate for Payer: Cigna Commercial	$251.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.97
Rate for Payer: Oxford Commercial	$100.65
Rate for Payer: Qualcare PPO/HMO/WC	$75.49
Rate for Payer: UnitedHealthcare Commercial	$100.65
Rate for Payer: UnitedHealthcare Community & State	$12.13
Rate for Payer: Wellpoint Medicaid Managed Care	$13.34

BRA SURGI SZ 2X

Facility

$503.25

Hospital Charge Code	270600427
Hospital Revenue Code	272
Min. Negotiated Rate	$75.49
Max. Negotiated Rate	$75.49
Rate for Payer: Qualcare PPO/HMO/WC	$75.49

BRA SURGI SZ 3X

Facility

$420.00

Hospital Charge Code	270600428
Hospital Revenue Code	272
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.00
Rate for Payer: Oxford Commercial	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Commercial	$84.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

BRA SURGI SZ 3X

Facility

$420.00

Hospital Charge Code	270600428
Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

BRA SURGI SZ LG

Facility

$192.20

Hospital Charge Code	270600425
Hospital Revenue Code	272
Min. Negotiated Rate	$28.83
Max. Negotiated Rate	$28.83
Rate for Payer: Qualcare PPO/HMO/WC	$28.83

BRA SURGI SZ LG

Facility

$192.20

Hospital Charge Code	270600425
Hospital Revenue Code	272
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$96.10
Rate for Payer: Aetna Commercial	$73.04
Rate for Payer: Aetna Medicare Advantage	$57.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.01
Rate for Payer: Cigna Commercial	$96.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.66
Rate for Payer: Oxford Commercial	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$28.83
Rate for Payer: UnitedHealthcare Commercial	$38.44
Rate for Payer: UnitedHealthcare Community & State	$4.63
Rate for Payer: Wellpoint Medicaid Managed Care	$5.09

BRA SURGI SZ MED

Facility

$503.25

Hospital Charge Code	270604488
Hospital Revenue Code	272
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$251.62
Rate for Payer: Aetna Commercial	$191.24
Rate for Payer: Aetna Medicare Advantage	$150.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.33
Rate for Payer: Cigna Commercial	$251.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.97
Rate for Payer: Oxford Commercial	$100.65
Rate for Payer: Qualcare PPO/HMO/WC	$75.49
Rate for Payer: UnitedHealthcare Commercial	$100.65
Rate for Payer: UnitedHealthcare Community & State	$12.13
Rate for Payer: Wellpoint Medicaid Managed Care	$13.34

BRA SURGI SZ MED

Facility

$503.25

Hospital Charge Code	270604488
Hospital Revenue Code	272
Min. Negotiated Rate	$75.49
Max. Negotiated Rate	$75.49
Rate for Payer: Qualcare PPO/HMO/WC	$75.49

BRA SURGI SZ SM

Facility

$503.25

Hospital Charge Code	270600424
Hospital Revenue Code	272
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$251.62
Rate for Payer: Aetna Commercial	$191.24
Rate for Payer: Aetna Medicare Advantage	$150.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.33
Rate for Payer: Cigna Commercial	$251.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.97
Rate for Payer: Oxford Commercial	$100.65
Rate for Payer: Qualcare PPO/HMO/WC	$75.49
Rate for Payer: UnitedHealthcare Commercial	$100.65
Rate for Payer: UnitedHealthcare Community & State	$12.13
Rate for Payer: Wellpoint Medicaid Managed Care	$13.34

BRA SURGI SZ SM

Facility

$503.25

Hospital Charge Code	270600424
Hospital Revenue Code	272
Min. Negotiated Rate	$75.49
Max. Negotiated Rate	$75.49
Rate for Payer: Qualcare PPO/HMO/WC	$75.49

BRA SURGI SZ XLG

Facility

$204.50

Hospital Charge Code	270600426
Hospital Revenue Code	272
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$102.25
Rate for Payer: Aetna Commercial	$77.71
Rate for Payer: Aetna Medicare Advantage	$61.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.15
Rate for Payer: Cigna Commercial	$102.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.35
Rate for Payer: Oxford Commercial	$40.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.68
Rate for Payer: UnitedHealthcare Commercial	$40.90
Rate for Payer: UnitedHealthcare Community & State	$4.93
Rate for Payer: Wellpoint Medicaid Managed Care	$5.42

BRA SURGI SZ XLG

Facility

$204.50

Hospital Charge Code	270600426
Hospital Revenue Code	272
Min. Negotiated Rate	$30.68
Max. Negotiated Rate	$30.68
Rate for Payer: Qualcare PPO/HMO/WC	$30.68

BRAVO DELIVERY DEV CF

Facility

$7,765.00

Hospital Charge Code	270691424
Hospital Revenue Code	272
Min. Negotiated Rate	$1,164.75
Max. Negotiated Rate	$1,164.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.75

BRAVO DELIVERY DEV CF

Facility

$7,765.00

Hospital Charge Code	270691424
Hospital Revenue Code	272
Min. Negotiated Rate	$187.14
Max. Negotiated Rate	$3,882.50
Rate for Payer: Aetna Commercial	$2,950.70
Rate for Payer: Aetna Medicare Advantage	$2,329.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,980.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,980.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,980.08
Rate for Payer: Cigna Commercial	$3,882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,329.50
Rate for Payer: Oxford Commercial	$1,553.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.75
Rate for Payer: UnitedHealthcare Commercial	$1,553.00
Rate for Payer: UnitedHealthcare Community & State	$187.14
Rate for Payer: Wellpoint Medicaid Managed Care	$205.77

BRCA COMPREHENSIVE A

Facility

$10,196.45

Service Code	HCPCS 81162
Hospital Charge Code	39708013A
Hospital Revenue Code	310
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$6,587.27
Rate for Payer: Aetna Commercial	$4,963.67
Rate for Payer: Aetna Medicare Advantage	$5,912.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,587.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,587.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,824.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,587.27
Rate for Payer: Cigna Commercial	$5,098.23
Rate for Payer: Cigna Medicare Advantage	$1,824.88
Rate for Payer: Clover Medicare Advantage	$1,733.64
Rate for Payer: EmblemHealth Commercial	$5,474.64
Rate for Payer: Humana Medicare Advantage	$1,879.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,824.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,058.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,529.47
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$1,459.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,824.88
Rate for Payer: Wellcare Medicare Advantage	$1,824.88
Rate for Payer: Wellpoint Medicaid Managed Care	$270.21

BRCA COMPREHENSIVE A

Facility

$10,196.45

Service Code	HCPCS 81162
Hospital Charge Code	39708013A
Hospital Revenue Code	310
Min. Negotiated Rate	$1,529.47
Max. Negotiated Rate	$1,529.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,529.47

BRCA COMPREHENSIVE B

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39708013B
Hospital Revenue Code	310
Min. Negotiated Rate	$437.04
Max. Negotiated Rate	$437.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.04

BRCA COMPREHENSIVE B

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39708013B
Hospital Revenue Code	310
Min. Negotiated Rate	$70.22
Max. Negotiated Rate	$1,456.80
Rate for Payer: Aetna Commercial	$1,107.17
Rate for Payer: Aetna Medicare Advantage	$874.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.97
Rate for Payer: Cigna Commercial	$1,456.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$437.04
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$70.22
Rate for Payer: Wellpoint Medicaid Managed Care	$77.21

BREAK OFF SCREW 1/2 THD 2X11MM

Facility

$991.95

Service Code	HCPCS C1713
Hospital Charge Code	270702742
Hospital Revenue Code	278
Min. Negotiated Rate	$23.91
Max. Negotiated Rate	$495.98
Rate for Payer: Aetna Commercial	$376.94
Rate for Payer: Aetna Medicare Advantage	$297.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.95
Rate for Payer: Cigna Commercial	$495.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$218.23
Rate for Payer: Qualcare PPO/HMO/WC	$148.79
Rate for Payer: UnitedHealthcare Community & State	$23.91
Rate for Payer: Wellpoint Medicaid Managed Care	$26.29

BREAK OFF SCREW 1/2 THD 2X11MM

Facility

$991.95

Service Code	HCPCS C1713
Hospital Charge Code	270702742
Hospital Revenue Code	278
Min. Negotiated Rate	$148.79
Max. Negotiated Rate	$240.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$218.23
Rate for Payer: Qualcare PPO/HMO/WC	$148.79

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

Know your out-of-pocket cost for care.

All Charges