Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BUR STRY RD CRB 2.3MM 2296-101

Facility

$19.50

Hospital Charge Code	270601438
Hospital Revenue Code	272
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.92

BUR STRY RD CRB 2.3MM 2296-101

Facility

$19.50

Hospital Charge Code	270601438
Hospital Revenue Code	272
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Commercial	$7.41
Rate for Payer: Aetna Medicare Advantage	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.97
Rate for Payer: Cigna Commercial	$9.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.92
Rate for Payer: UnitedHealthcare Commercial	$3.90
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

BUR STRY ROUND ********

Facility

$166.00

Hospital Charge Code	1606425
Hospital Revenue Code	272
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$63.08
Rate for Payer: Aetna Medicare Advantage	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.80
Rate for Payer: Oxford Commercial	$33.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.20
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

BUR STRY ROUND ********

Facility

$166.00

Hospital Charge Code	1606425
Hospital Revenue Code	272
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

BUR STRY ROUND ******

Facility

$166.00

Hospital Charge Code	1606458
Hospital Revenue Code	272
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$63.08
Rate for Payer: Aetna Medicare Advantage	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.80
Rate for Payer: Oxford Commercial	$33.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.20
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

BUR STRY ROUND ******

Facility

$166.00

Hospital Charge Code	1606458
Hospital Revenue Code	272
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

BUR STRY ROUND 3.0MM 275-831

Facility

$573.65

Hospital Charge Code	270601420
Hospital Revenue Code	272
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$286.82
Rate for Payer: Aetna Commercial	$217.99
Rate for Payer: Aetna Medicare Advantage	$172.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.28
Rate for Payer: Cigna Commercial	$286.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.09
Rate for Payer: Oxford Commercial	$114.73
Rate for Payer: Qualcare PPO/HMO/WC	$86.05
Rate for Payer: UnitedHealthcare Commercial	$114.73
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: Wellpoint Medicaid Managed Care	$15.20

BUR STRY ROUND 3.0MM 275-831

Facility

$573.65

Hospital Charge Code	270601420
Hospital Revenue Code	272
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$86.05
Rate for Payer: Qualcare PPO/HMO/WC	$86.05

BUR SURG OVAL 4MM DIA 48MML

Facility

$141.25

Hospital Charge Code	270655940
Hospital Revenue Code	271
Min. Negotiated Rate	$21.19
Max. Negotiated Rate	$21.19
Rate for Payer: Qualcare PPO/HMO/WC	$21.19

BUR SURG OVAL 4MM DIA 48MML

Facility

$141.25

Hospital Charge Code	270655940
Hospital Revenue Code	271
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$70.62
Rate for Payer: Aetna Commercial	$53.67
Rate for Payer: Aetna Medicare Advantage	$42.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.02
Rate for Payer: Cigna Commercial	$70.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.38
Rate for Payer: Oxford Commercial	$28.25
Rate for Payer: Qualcare PPO/HMO/WC	$21.19
Rate for Payer: UnitedHealthcare Commercial	$28.25
Rate for Payer: UnitedHealthcare Community & State	$3.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.74

BUR TOOL LEGEND 9CM 7.5MM

Facility

$1,909.50

Hospital Charge Code	270691484
Hospital Revenue Code	272
Min. Negotiated Rate	$46.02
Max. Negotiated Rate	$954.75
Rate for Payer: Aetna Commercial	$725.61
Rate for Payer: Aetna Medicare Advantage	$572.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$486.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$486.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$486.92
Rate for Payer: Cigna Commercial	$954.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.85
Rate for Payer: Oxford Commercial	$381.90
Rate for Payer: Qualcare PPO/HMO/WC	$286.43
Rate for Payer: UnitedHealthcare Commercial	$381.90
Rate for Payer: UnitedHealthcare Community & State	$46.02
Rate for Payer: Wellpoint Medicaid Managed Care	$50.60

BUR TOOL LEGEND 9CM 7.5MM

Facility

$1,909.50

Hospital Charge Code	270691484
Hospital Revenue Code	272
Min. Negotiated Rate	$286.43
Max. Negotiated Rate	$286.43
Rate for Payer: Qualcare PPO/HMO/WC	$286.43

BUR ULTPWR WIREPASS 2mm******

Facility

$272.00

Hospital Charge Code	260603867
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Commercial	$103.36
Rate for Payer: Aetna Medicare Advantage	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.36
Rate for Payer: Cigna Commercial	$136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.60
Rate for Payer: Oxford Commercial	$54.40
Rate for Payer: Qualcare PPO/HMO/WC	$40.80
Rate for Payer: UnitedHealthcare Commercial	$54.40
Rate for Payer: UnitedHealthcare Community & State	$6.56
Rate for Payer: Wellpoint Medicaid Managed Care	$7.21

BUR ULTPWR WIREPASS 2mm******

Facility

$272.00

Hospital Charge Code	260603867
Hospital Revenue Code	272
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$40.80

BUR ULTRAPER RD 5mDx8m 7021328

Facility

$330.60

Hospital Charge Code	270629147
Hospital Revenue Code	272
Min. Negotiated Rate	$49.59
Max. Negotiated Rate	$49.59
Rate for Payer: Qualcare PPO/HMO/WC	$49.59

BUR ULTRAPER RD 5mDx8m 7021328

Facility

$330.60

Hospital Charge Code	270629147
Hospital Revenue Code	272
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$165.30
Rate for Payer: Aetna Commercial	$125.63
Rate for Payer: Aetna Medicare Advantage	$99.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.30
Rate for Payer: Cigna Commercial	$165.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.18
Rate for Payer: Oxford Commercial	$66.12
Rate for Payer: Qualcare PPO/HMO/WC	$49.59
Rate for Payer: UnitedHealthcare Commercial	$66.12
Rate for Payer: UnitedHealthcare Community & State	$7.97
Rate for Payer: Wellpoint Medicaid Managed Care	$8.76

BUR ULTRAPOWER DI 4.0m 7021264

Facility

$302.65

Hospital Charge Code	270632491
Hospital Revenue Code	272
Min. Negotiated Rate	$45.40
Max. Negotiated Rate	$45.40
Rate for Payer: Qualcare PPO/HMO/WC	$45.40

BUR ULTRAPOWER DI 4.0m 7021264

Facility

$302.65

Hospital Charge Code	270632491
Hospital Revenue Code	272
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$151.32
Rate for Payer: Aetna Commercial	$115.01
Rate for Payer: Aetna Medicare Advantage	$90.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.18
Rate for Payer: Cigna Commercial	$151.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.80
Rate for Payer: Oxford Commercial	$60.53
Rate for Payer: Qualcare PPO/HMO/WC	$45.40
Rate for Payer: UnitedHealthcare Commercial	$60.53
Rate for Payer: UnitedHealthcare Community & State	$7.29
Rate for Payer: Wellpoint Medicaid Managed Care	$8.02

BUR ULTRAPOWER RD 3.0m 7021226

Facility

$159.65

Hospital Charge Code	270632487
Hospital Revenue Code	272
Min. Negotiated Rate	$23.95
Max. Negotiated Rate	$23.95
Rate for Payer: Qualcare PPO/HMO/WC	$23.95

BUR ULTRAPOWER RD 3.0m 7021226

Facility

$159.65

Hospital Charge Code	270632487
Hospital Revenue Code	272
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$79.83
Rate for Payer: Aetna Commercial	$60.67
Rate for Payer: Aetna Medicare Advantage	$47.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.71
Rate for Payer: Cigna Commercial	$79.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.90
Rate for Payer: Oxford Commercial	$31.93
Rate for Payer: Qualcare PPO/HMO/WC	$23.95
Rate for Payer: UnitedHealthcare Commercial	$31.93
Rate for Payer: UnitedHealthcare Community & State	$3.85
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

BUR ULTRAPOWER RD 4.0m 7021227

Facility

$172.25

Hospital Charge Code	270632489
Hospital Revenue Code	272
Min. Negotiated Rate	$25.84
Max. Negotiated Rate	$25.84
Rate for Payer: Qualcare PPO/HMO/WC	$25.84

BUR ULTRAPOWER RD 4.0m 7021227

Facility

$172.25

Hospital Charge Code	270632489
Hospital Revenue Code	272
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$86.12
Rate for Payer: Aetna Commercial	$65.45
Rate for Payer: Aetna Medicare Advantage	$51.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.92
Rate for Payer: Cigna Commercial	$86.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.67
Rate for Payer: Oxford Commercial	$34.45
Rate for Payer: Qualcare PPO/HMO/WC	$25.84
Rate for Payer: UnitedHealthcare Commercial	$34.45
Rate for Payer: UnitedHealthcare Community & State	$4.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

BUR ULTRAPOWER RD 5.0m 7021228

Facility

$339.90

Hospital Charge Code	270632490
Hospital Revenue Code	272
Min. Negotiated Rate	$50.98
Max. Negotiated Rate	$50.98
Rate for Payer: Qualcare PPO/HMO/WC	$50.98

BUR ULTRAPOWER RD 5.0m 7021228

Facility

$339.90

Hospital Charge Code	270632490
Hospital Revenue Code	272
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$169.95
Rate for Payer: Aetna Commercial	$129.16
Rate for Payer: Aetna Medicare Advantage	$101.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.67
Rate for Payer: Cigna Commercial	$169.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.97
Rate for Payer: Oxford Commercial	$67.98
Rate for Payer: Qualcare PPO/HMO/WC	$50.98
Rate for Payer: UnitedHealthcare Commercial	$67.98
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

BUR ULTRAPOWER TAPERED 3MMX36M

Facility

$190.90

Hospital Charge Code	270669745
Hospital Revenue Code	272
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$95.45
Rate for Payer: Aetna Commercial	$72.54
Rate for Payer: Aetna Medicare Advantage	$57.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.68
Rate for Payer: Cigna Commercial	$95.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.27
Rate for Payer: Oxford Commercial	$38.18
Rate for Payer: Qualcare PPO/HMO/WC	$28.64
Rate for Payer: UnitedHealthcare Commercial	$38.18
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

Know your out-of-pocket cost for care.

All Charges