Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BUR GUARD LONG 00137501100

Facility

$1,531.80

Hospital Charge Code	270647005
Hospital Revenue Code	272
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$765.90
Rate for Payer: Aetna Commercial	$582.08
Rate for Payer: Aetna Medicare Advantage	$459.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$390.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$390.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$390.61
Rate for Payer: Cigna Commercial	$765.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.54
Rate for Payer: Oxford Commercial	$306.36
Rate for Payer: Qualcare PPO/HMO/WC	$229.77
Rate for Payer: UnitedHealthcare Commercial	$306.36
Rate for Payer: UnitedHealthcare Community & State	$36.92
Rate for Payer: Wellpoint Medicaid Managed Care	$40.59

BUR GUARD MEDIUM 00137501200

Facility

$1,326.95

Hospital Charge Code	270647004
Hospital Revenue Code	272
Min. Negotiated Rate	$31.98
Max. Negotiated Rate	$663.48
Rate for Payer: Aetna Commercial	$504.24
Rate for Payer: Aetna Medicare Advantage	$398.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$338.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$338.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$338.37
Rate for Payer: Cigna Commercial	$663.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$398.08
Rate for Payer: Oxford Commercial	$265.39
Rate for Payer: Qualcare PPO/HMO/WC	$199.04
Rate for Payer: UnitedHealthcare Commercial	$265.39
Rate for Payer: UnitedHealthcare Community & State	$31.98
Rate for Payer: Wellpoint Medicaid Managed Care	$35.16

BUR GUARD MEDIUM 00137501200

Facility

$1,326.95

Hospital Charge Code	270647004
Hospital Revenue Code	272
Min. Negotiated Rate	$199.04
Max. Negotiated Rate	$199.04
Rate for Payer: Qualcare PPO/HMO/WC	$199.04

BUR HOODED ABRASION SM JOINT

Facility

$1,435.00

Hospital Charge Code	270658016
Hospital Revenue Code	278
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$717.50
Rate for Payer: Aetna Commercial	$545.30
Rate for Payer: Aetna Medicare Advantage	$430.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.93
Rate for Payer: Cigna Commercial	$717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.70
Rate for Payer: Qualcare PPO/HMO/WC	$215.25
Rate for Payer: UnitedHealthcare Community & State	$34.58
Rate for Payer: Wellpoint Medicaid Managed Care	$38.03

BUR HOODED ABRASION SM JOINT

Facility

$1,435.00

Hospital Charge Code	270658016
Hospital Revenue Code	278
Min. Negotiated Rate	$215.25
Max. Negotiated Rate	$347.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.70
Rate for Payer: Qualcare PPO/HMO/WC	$215.25

BUR HOODED ABRS SM JOINT 3.0MM

Facility

$1,435.00

Hospital Charge Code	270658021
Hospital Revenue Code	278
Min. Negotiated Rate	$215.25
Max. Negotiated Rate	$347.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.70
Rate for Payer: Qualcare PPO/HMO/WC	$215.25

BUR HOODED ABRS SM JOINT 3.0MM

Facility

$1,435.00

Hospital Charge Code	270658021
Hospital Revenue Code	278
Min. Negotiated Rate	$34.58
Max. Negotiated Rate	$717.50
Rate for Payer: Aetna Commercial	$545.30
Rate for Payer: Aetna Medicare Advantage	$430.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.93
Rate for Payer: Cigna Commercial	$717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.70
Rate for Payer: Qualcare PPO/HMO/WC	$215.25
Rate for Payer: UnitedHealthcare Community & State	$34.58
Rate for Payer: Wellpoint Medicaid Managed Care	$38.03

BUR LEGEND 10CM 6MM MIDAS REX

Facility

$731.50

Hospital Charge Code	270660510
Hospital Revenue Code	272
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$365.75
Rate for Payer: Aetna Commercial	$277.97
Rate for Payer: Aetna Medicare Advantage	$219.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.53
Rate for Payer: Cigna Commercial	$365.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.45
Rate for Payer: Oxford Commercial	$146.30
Rate for Payer: Qualcare PPO/HMO/WC	$109.72
Rate for Payer: UnitedHealthcare Commercial	$146.30
Rate for Payer: UnitedHealthcare Community & State	$17.63
Rate for Payer: Wellpoint Medicaid Managed Care	$19.38

BUR LEGEND 10CM 6MM MIDAS REX

Facility

$731.50

Hospital Charge Code	270660510
Hospital Revenue Code	272
Min. Negotiated Rate	$109.72
Max. Negotiated Rate	$109.72
Rate for Payer: Qualcare PPO/HMO/WC	$109.72

BUR LVT CRB RND 1 48 5056164

Facility

$492.85

Hospital Charge Code	270622541
Hospital Revenue Code	272
Min. Negotiated Rate	$73.93
Max. Negotiated Rate	$73.93
Rate for Payer: Qualcare PPO/HMO/WC	$73.93

BUR LVT CRB RND 1 48 5056164

Facility

$492.85

Hospital Charge Code	270622541
Hospital Revenue Code	272
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$246.43
Rate for Payer: Aetna Commercial	$187.28
Rate for Payer: Aetna Medicare Advantage	$147.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.68
Rate for Payer: Cigna Commercial	$246.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.85
Rate for Payer: Oxford Commercial	$98.57
Rate for Payer: Qualcare PPO/HMO/WC	$73.93
Rate for Payer: UnitedHealthcare Commercial	$98.57
Rate for Payer: UnitedHealthcare Community & State	$11.88
Rate for Payer: Wellpoint Medicaid Managed Care	$13.06

BUR LVT CRB RND 2.5 48 5056149

Facility

$520.00

Hospital Charge Code	270622537
Hospital Revenue Code	272
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

BUR LVT CRB RND 2.5 48 5056149

Facility

$520.00

Hospital Charge Code	270622537
Hospital Revenue Code	272
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Oxford Commercial	$104.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Commercial	$104.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

BUR LVT CRB RND 3 30 5056116

Facility

$520.00

Hospital Charge Code	270621859
Hospital Revenue Code	272
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Oxford Commercial	$104.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Commercial	$104.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

BUR LVT CRB RND 3 30 5056116

Facility

$520.00

Hospital Charge Code	270621859
Hospital Revenue Code	272
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

BUR LVT CRB RND 4 30 5056119

Facility

$495.00

Hospital Charge Code	270622535
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

BUR LVT CRB RND 4 30 5056119

Facility

$495.00

Hospital Charge Code	270622535
Hospital Revenue Code	272
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.50
Rate for Payer: Oxford Commercial	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$99.00
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

BUR LVT CRB RND 5 30 5056118

Facility

$423.70

Hospital Charge Code	270621858
Hospital Revenue Code	272
Min. Negotiated Rate	$10.21
Max. Negotiated Rate	$211.85
Rate for Payer: Aetna Commercial	$161.01
Rate for Payer: Aetna Medicare Advantage	$127.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.04
Rate for Payer: Cigna Commercial	$211.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.11
Rate for Payer: Oxford Commercial	$84.74
Rate for Payer: Qualcare PPO/HMO/WC	$63.55
Rate for Payer: UnitedHealthcare Commercial	$84.74
Rate for Payer: UnitedHealthcare Community & State	$10.21
Rate for Payer: Wellpoint Medicaid Managed Care	$11.23

BUR LVT CRB RND 5 30 5056118

Facility

$423.70

Hospital Charge Code	270621858
Hospital Revenue Code	272
Min. Negotiated Rate	$63.55
Max. Negotiated Rate	$63.55
Rate for Payer: Qualcare PPO/HMO/WC	$63.55

BUR LVT CRB RND 6.5 30 5056117

Facility

$495.00

Hospital Charge Code	270622534
Hospital Revenue Code	272
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.50
Rate for Payer: Oxford Commercial	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$99.00
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

BUR LVT CRB RND 6.5 30 5056117

Facility

$495.00

Hospital Charge Code	270622534
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

BUR LVT DMD RND 2 48 5056162

Facility

$567.25

Hospital Charge Code	270621860
Hospital Revenue Code	272
Min. Negotiated Rate	$13.67
Max. Negotiated Rate	$283.62
Rate for Payer: Aetna Commercial	$215.56
Rate for Payer: Aetna Medicare Advantage	$170.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.65
Rate for Payer: Cigna Commercial	$283.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.18
Rate for Payer: Oxford Commercial	$113.45
Rate for Payer: Qualcare PPO/HMO/WC	$85.09
Rate for Payer: UnitedHealthcare Commercial	$113.45
Rate for Payer: UnitedHealthcare Community & State	$13.67
Rate for Payer: Wellpoint Medicaid Managed Care	$15.03

BUR LVT DMD RND 2 48 5056162

Facility

$567.25

Hospital Charge Code	270621860
Hospital Revenue Code	272
Min. Negotiated Rate	$85.09
Max. Negotiated Rate	$85.09
Rate for Payer: Qualcare PPO/HMO/WC	$85.09

BUR LVT DMD RND 3 48 5056159

Facility

$566.45

Hospital Charge Code	270622540
Hospital Revenue Code	272
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$283.23
Rate for Payer: Aetna Commercial	$215.25
Rate for Payer: Aetna Medicare Advantage	$169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.44
Rate for Payer: Cigna Commercial	$283.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.94
Rate for Payer: Oxford Commercial	$113.29
Rate for Payer: Qualcare PPO/HMO/WC	$84.97
Rate for Payer: UnitedHealthcare Commercial	$113.29
Rate for Payer: UnitedHealthcare Community & State	$13.65
Rate for Payer: Wellpoint Medicaid Managed Care	$15.01

BUR LVT DMD RND 3 48 5056159

Facility

$566.45

Hospital Charge Code	270622540
Hospital Revenue Code	272
Min. Negotiated Rate	$84.97
Max. Negotiated Rate	$84.97
Rate for Payer: Qualcare PPO/HMO/WC	$84.97

Know your out-of-pocket cost for care.

All Charges