Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BUR LVT DMD RND 4 38 5056148

Facility

$565.00

Hospital Charge Code	270622538
Hospital Revenue Code	272
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$282.50
Rate for Payer: Aetna Commercial	$214.70
Rate for Payer: Aetna Medicare Advantage	$169.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.07
Rate for Payer: Cigna Commercial	$282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.50
Rate for Payer: Oxford Commercial	$113.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.75
Rate for Payer: UnitedHealthcare Commercial	$113.00
Rate for Payer: UnitedHealthcare Community & State	$13.62
Rate for Payer: Wellpoint Medicaid Managed Care	$14.97

BUR LVT DMD RND 4 38 5056148

Facility

$565.00

Hospital Charge Code	270622538
Hospital Revenue Code	272
Min. Negotiated Rate	$84.75
Max. Negotiated Rate	$84.75
Rate for Payer: Qualcare PPO/HMO/WC	$84.75

BUR LVT DMD RND 4 48 5056146

Facility

$519.25

Hospital Charge Code	270622536
Hospital Revenue Code	272
Min. Negotiated Rate	$77.89
Max. Negotiated Rate	$77.89
Rate for Payer: Qualcare PPO/HMO/WC	$77.89

BUR LVT DMD RND 4 48 5056146

Facility

$519.25

Hospital Charge Code	270622536
Hospital Revenue Code	272
Min. Negotiated Rate	$12.51
Max. Negotiated Rate	$259.62
Rate for Payer: Aetna Commercial	$197.31
Rate for Payer: Aetna Medicare Advantage	$155.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.41
Rate for Payer: Cigna Commercial	$259.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.78
Rate for Payer: Oxford Commercial	$103.85
Rate for Payer: Qualcare PPO/HMO/WC	$77.89
Rate for Payer: UnitedHealthcare Commercial	$103.85
Rate for Payer: UnitedHealthcare Community & State	$12.51
Rate for Payer: Wellpoint Medicaid Managed Care	$13.76

BUR LVT DMD RND 5 48 5056150

Facility

$567.25

Hospital Charge Code	270621861
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 5 48 5056150

Facility

$567.25

Hospital Charge Code	270621861
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 UP RD DIAM 4 702134

Facility

$518.45

Hospital Charge Code	270629149
Hospital Revenue Code	272
Min. Negotiated Rate	$77.77
Max. Negotiated Rate	$77.77
Rate for Payer: Qualcare PPO/HMO/WC	$77.77

BUR LVT UP RD DIAM 4 702134

Facility

$518.45

Hospital Charge Code	270629149
Hospital Revenue Code	272
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$259.23
Rate for Payer: Aetna Commercial	$197.01
Rate for Payer: Aetna Medicare Advantage	$155.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.20
Rate for Payer: Cigna Commercial	$259.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.53
Rate for Payer: Oxford Commercial	$103.69
Rate for Payer: Qualcare PPO/HMO/WC	$77.77
Rate for Payer: UnitedHealthcare Commercial	$103.69
Rate for Payer: UnitedHealthcare Community & State	$12.49
Rate for Payer: Wellpoint Medicaid Managed Care	$13.74

BUR MACH 3MM 15CM

Facility

$1,350.00

Hospital Charge Code	270692470
Hospital Revenue Code	272
Min. Negotiated Rate	$32.53
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$513.00
Rate for Payer: Aetna Medicare Advantage	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$405.00
Rate for Payer: Oxford Commercial	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Commercial	$270.00
Rate for Payer: UnitedHealthcare Community & State	$32.53
Rate for Payer: Wellpoint Medicaid Managed Care	$35.77

BUR MACH 3MM 15CM

Facility

$1,350.00

Hospital Charge Code	270692470
Hospital Revenue Code	272
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

BUR MED ROUND END

Facility

$207.50

Hospital Charge Code	270675968
Hospital Revenue Code	272
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$103.75
Rate for Payer: Aetna Commercial	$78.85
Rate for Payer: Aetna Medicare Advantage	$62.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.91
Rate for Payer: Cigna Commercial	$103.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.25
Rate for Payer: Oxford Commercial	$41.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.12
Rate for Payer: UnitedHealthcare Commercial	$41.50
Rate for Payer: UnitedHealthcare Community & State	$5.00
Rate for Payer: Wellpoint Medicaid Managed Care	$5.50

BUR MED ROUND END

Facility

$207.50

Hospital Charge Code	270675968
Hospital Revenue Code	272
Min. Negotiated Rate	$31.12
Max. Negotiated Rate	$31.12
Rate for Payer: Qualcare PPO/HMO/WC	$31.12

BUR MIDAS REX TOOL 10CM 4MM

Facility

$745.75

Hospital Charge Code	270654985
Hospital Revenue Code	272
Min. Negotiated Rate	$17.97
Max. Negotiated Rate	$372.88
Rate for Payer: Aetna Commercial	$283.38
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$190.17
Rate for Payer: Cigna Commercial	$372.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.72
Rate for Payer: Oxford Commercial	$149.15
Rate for Payer: Qualcare PPO/HMO/WC	$111.86
Rate for Payer: UnitedHealthcare Commercial	$149.15
Rate for Payer: UnitedHealthcare Community & State	$17.97
Rate for Payer: Wellpoint Medicaid Managed Care	$19.76

BUR MIDAS REX TOOL 10CM 4MM

Facility

$745.75

Hospital Charge Code	270654985
Hospital Revenue Code	272
Min. Negotiated Rate	$111.86
Max. Negotiated Rate	$111.86
Rate for Payer: Qualcare PPO/HMO/WC	$111.86

BUR MIDUS REX TOOL 10CM 5MM

Facility

$717.25

Hospital Charge Code	270654834
Hospital Revenue Code	272
Min. Negotiated Rate	$17.29
Max. Negotiated Rate	$358.62
Rate for Payer: Aetna Commercial	$272.56
Rate for Payer: Aetna Medicare Advantage	$215.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.90
Rate for Payer: Cigna Commercial	$358.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.18
Rate for Payer: Oxford Commercial	$143.45
Rate for Payer: Qualcare PPO/HMO/WC	$107.59
Rate for Payer: UnitedHealthcare Commercial	$143.45
Rate for Payer: UnitedHealthcare Community & State	$17.29
Rate for Payer: Wellpoint Medicaid Managed Care	$19.01

BUR MIDUS REX TOOL 10CM 5MM

Facility

$717.25

Hospital Charge Code	270654834
Hospital Revenue Code	272
Min. Negotiated Rate	$107.59
Max. Negotiated Rate	$107.59
Rate for Payer: Qualcare PPO/HMO/WC	$107.59

BURN CARE GOWN ********

Facility

$21.00

Hospital Charge Code	8000168
Hospital Revenue Code	279
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

BURN CARE GOWN ********

Facility

$21.00

Hospital Charge Code	8000168
Hospital Revenue Code	279
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

BURN CARE PILLOW*****

Facility

$9.00

Hospital Charge Code	8000176
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

BURN CARE PILLOW*****

Facility

$9.00

Hospital Charge Code	8000176
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

BUR NEURO OVAL 4.0/8 5091-236

Facility

$89.00

Hospital Charge Code	1604875
Hospital Revenue Code	272
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

BUR NEURO OVAL 4.0/8 5091-236

Facility

$89.00

Hospital Charge Code	1604875
Hospital Revenue Code	272
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$17.80
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

BUR NEURO PRECISION 3x3.8MM

Facility

$621.00

Hospital Charge Code	270672681
Hospital Revenue Code	272
Min. Negotiated Rate	$14.97
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna Commercial	$235.98
Rate for Payer: Aetna Medicare Advantage	$186.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.35
Rate for Payer: Cigna Commercial	$310.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.30
Rate for Payer: Oxford Commercial	$124.20
Rate for Payer: Qualcare PPO/HMO/WC	$93.15
Rate for Payer: UnitedHealthcare Commercial	$124.20
Rate for Payer: UnitedHealthcare Community & State	$14.97
Rate for Payer: Wellpoint Medicaid Managed Care	$16.46

BUR NEURO PRECISION 3x3.8MM

Facility

$621.00

Hospital Charge Code	270672681
Hospital Revenue Code	272
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$93.15
Rate for Payer: Qualcare PPO/HMO/WC	$93.15

BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$14,771.50

Service Code	APR-DRG 8421
Min. Negotiated Rate	$14,481.86
Max. Negotiated Rate	$14,771.50
Rate for Payer: UnitedHealthcare Community & State	$14,481.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,771.50
Rate for Payer: Wellpoint Medicaid Managed Care	$14,481.86

Know your out-of-pocket cost for care.

All Charges