Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BURR CYL FISSURE L 1.6x4.3MM

Facility

$430.50

Hospital Charge Code	270674472
Hospital Revenue Code	272
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$215.25
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$129.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.78
Rate for Payer: Cigna Commercial	$215.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.15
Rate for Payer: Oxford Commercial	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$64.58
Rate for Payer: UnitedHealthcare Commercial	$86.10
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.41

BURR CYL FISSURE L 3.0x16MM

Facility

$430.50

Hospital Charge Code	270674475
Hospital Revenue Code	272
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$64.58

BURR CYL FISSURE L 3.0x16MM

Facility

$430.50

Hospital Charge Code	270674475
Hospital Revenue Code	272
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$215.25
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$129.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.78
Rate for Payer: Cigna Commercial	$215.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.15
Rate for Payer: Oxford Commercial	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$64.58
Rate for Payer: UnitedHealthcare Commercial	$86.10
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.41

BURR CYL FISSURE M 1.6x4.3MM

Facility

$430.50

Hospital Charge Code	270674471
Hospital Revenue Code	272
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$215.25
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$129.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.78
Rate for Payer: Cigna Commercial	$215.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.15
Rate for Payer: Oxford Commercial	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$64.58
Rate for Payer: UnitedHealthcare Commercial	$86.10
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.41

BURR CYL FISSURE M 1.6x4.3MM

Facility

$430.50

Hospital Charge Code	270674471
Hospital Revenue Code	272
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$64.58

BURR CYL FISSURE M 3.0x16MM

Facility

$430.50

Hospital Charge Code	270674474
Hospital Revenue Code	272
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$64.58

BURR CYL FISSURE M 3.0x16MM

Facility

$430.50

Hospital Charge Code	270674474
Hospital Revenue Code	272
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$215.25
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$129.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.78
Rate for Payer: Cigna Commercial	$215.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.15
Rate for Payer: Oxford Commercial	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$64.58
Rate for Payer: UnitedHealthcare Commercial	$86.10
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.41

BURR CYL FISSURE S 1.6x4.3MM

Facility

$430.50

Hospital Charge Code	270674470
Hospital Revenue Code	272
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$64.58

BURR CYL FISSURE S 1.6x4.3MM

Facility

$430.50

Hospital Charge Code	270674470
Hospital Revenue Code	272
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$215.25
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$129.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.78
Rate for Payer: Cigna Commercial	$215.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.15
Rate for Payer: Oxford Commercial	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$64.58
Rate for Payer: UnitedHealthcare Commercial	$86.10
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.41

BURR CYL FISSURE S 3.0x16MM

Facility

$430.50

Hospital Charge Code	270674473
Hospital Revenue Code	272
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$64.58

BURR CYL FISSURE S 3.0x16MM

Facility

$430.50

Hospital Charge Code	270674473
Hospital Revenue Code	272
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$215.25
Rate for Payer: Aetna Commercial	$163.59
Rate for Payer: Aetna Medicare Advantage	$129.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.78
Rate for Payer: Cigna Commercial	$215.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.15
Rate for Payer: Oxford Commercial	$86.10
Rate for Payer: Qualcare PPO/HMO/WC	$64.58
Rate for Payer: UnitedHealthcare Commercial	$86.10
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.41

BUR RD DIAD 3D 140GRIT 7021363

Facility

$362.15

Hospital Charge Code	270629148
Hospital Revenue Code	272
Min. Negotiated Rate	$54.32
Max. Negotiated Rate	$54.32
Rate for Payer: Qualcare PPO/HMO/WC	$54.32

BUR RD DIAD 3D 140GRIT 7021363

Facility

$362.15

Hospital Charge Code	270629148
Hospital Revenue Code	272
Min. Negotiated Rate	$8.73
Max. Negotiated Rate	$181.07
Rate for Payer: Aetna Commercial	$137.62
Rate for Payer: Aetna Medicare Advantage	$108.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.35
Rate for Payer: Cigna Commercial	$181.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.64
Rate for Payer: Oxford Commercial	$72.43
Rate for Payer: Qualcare PPO/HMO/WC	$54.32
Rate for Payer: UnitedHealthcare Commercial	$72.43
Rate for Payer: UnitedHealthcare Community & State	$8.73
Rate for Payer: Wellpoint Medicaid Managed Care	$9.60

BURR DIAMOND 2mm

Facility

$755.00

Hospital Charge Code	270669540
Hospital Revenue Code	272
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$113.25
Rate for Payer: Qualcare PPO/HMO/WC	$113.25

BURR DIAMOND 2mm

Facility

$755.00

Hospital Charge Code	270669540
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$377.50
Rate for Payer: Aetna Commercial	$286.90
Rate for Payer: Aetna Medicare Advantage	$226.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.53
Rate for Payer: Cigna Commercial	$377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.50
Rate for Payer: Oxford Commercial	$151.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.25
Rate for Payer: UnitedHealthcare Commercial	$151.00
Rate for Payer: UnitedHealthcare Community & State	$18.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.01

BURR DIAMOND 3mm

Facility

$755.00

Hospital Charge Code	270669536
Hospital Revenue Code	272
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$113.25
Rate for Payer: Qualcare PPO/HMO/WC	$113.25

BURR DIAMOND 3mm

Facility

$755.00

Hospital Charge Code	270669536
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$377.50
Rate for Payer: Aetna Commercial	$286.90
Rate for Payer: Aetna Medicare Advantage	$226.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.53
Rate for Payer: Cigna Commercial	$377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.50
Rate for Payer: Oxford Commercial	$151.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.25
Rate for Payer: UnitedHealthcare Commercial	$151.00
Rate for Payer: UnitedHealthcare Community & State	$18.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.01

BURR DIAMOND 4mm

Facility

$755.00

Hospital Charge Code	270669541
Hospital Revenue Code	272
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$113.25
Rate for Payer: Qualcare PPO/HMO/WC	$113.25

BURR DIAMOND 4mm

Facility

$755.00

Hospital Charge Code	270669541
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$377.50
Rate for Payer: Aetna Commercial	$286.90
Rate for Payer: Aetna Medicare Advantage	$226.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.53
Rate for Payer: Cigna Commercial	$377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.50
Rate for Payer: Oxford Commercial	$151.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.25
Rate for Payer: UnitedHealthcare Commercial	$151.00
Rate for Payer: UnitedHealthcare Community & State	$18.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.01

BURR DIAMOND 5.0MM ROUND

Facility

$948.90

Hospital Charge Code	270692940
Hospital Revenue Code	272
Min. Negotiated Rate	$22.87
Max. Negotiated Rate	$474.45
Rate for Payer: Aetna Commercial	$360.58
Rate for Payer: Aetna Medicare Advantage	$284.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.97
Rate for Payer: Cigna Commercial	$474.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.67
Rate for Payer: Oxford Commercial	$189.78
Rate for Payer: Qualcare PPO/HMO/WC	$142.34
Rate for Payer: UnitedHealthcare Commercial	$189.78
Rate for Payer: UnitedHealthcare Community & State	$22.87
Rate for Payer: Wellpoint Medicaid Managed Care	$25.15

BURR DIAMOND 5.0MM ROUND

Facility

$948.90

Hospital Charge Code	270692940
Hospital Revenue Code	272
Min. Negotiated Rate	$142.34
Max. Negotiated Rate	$142.34
Rate for Payer: Qualcare PPO/HMO/WC	$142.34

BURR DIAMOND 5mm

Facility

$755.00

Hospital Charge Code	270669542
Hospital Revenue Code	272
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$113.25
Rate for Payer: Qualcare PPO/HMO/WC	$113.25

BURR DIAMOND 5mm

Facility

$755.00

Hospital Charge Code	270669542
Hospital Revenue Code	272
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$377.50
Rate for Payer: Aetna Commercial	$286.90
Rate for Payer: Aetna Medicare Advantage	$226.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.53
Rate for Payer: Cigna Commercial	$377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.50
Rate for Payer: Oxford Commercial	$151.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.25
Rate for Payer: UnitedHealthcare Commercial	$151.00
Rate for Payer: UnitedHealthcare Community & State	$18.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.01

BURR DIAMOND OVAL 3X330MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703127
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

BURR DIAMOND OVAL 3X330MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703127
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

Know your out-of-pocket cost for care.

All Charges