Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CIRCUIT IPPB***

Facility

$110.00

Service Code	HCPCS 94650
Hospital Charge Code	9500018
Hospital Revenue Code	419
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

CIRCUIT IPPB***

Facility

$16.00

Hospital Charge Code	9501156
Hospital Revenue Code	279
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

CIRCUIT IPPB***

Facility

$16.00

Hospital Charge Code	9501156
Hospital Revenue Code	279
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

CIRCUIT M2M OT CRCT W/O PEEP

Facility

$49.13

Hospital Charge Code	270689055
Hospital Revenue Code	272
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.57
Rate for Payer: Aetna Commercial	$18.67
Rate for Payer: Aetna Medicare Advantage	$14.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.53
Rate for Payer: Cigna Commercial	$24.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.74
Rate for Payer: Oxford Commercial	$9.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.37
Rate for Payer: UnitedHealthcare Commercial	$9.83
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

CIRCUIT M2M OT CRCT W/O PEEP

Facility

$49.13

Hospital Charge Code	270689055
Hospital Revenue Code	272
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$7.37

CIRCUIT M2M OT CRCT W PEEP

Facility

$49.13

Hospital Charge Code	270689046
Hospital Revenue Code	272
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.57
Rate for Payer: Aetna Commercial	$18.67
Rate for Payer: Aetna Medicare Advantage	$14.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.53
Rate for Payer: Cigna Commercial	$24.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.74
Rate for Payer: Oxford Commercial	$9.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.37
Rate for Payer: UnitedHealthcare Commercial	$9.83
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

CIRCUIT M2M OT CRCT W PEEP

Facility

$49.13

Hospital Charge Code	270689046
Hospital Revenue Code	272
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$7.37

CIRCUIT MONITORING W/SZ.6 MASK

Facility

$2,183.60

Hospital Charge Code	270657360
Hospital Revenue Code	272
Min. Negotiated Rate	$52.62
Max. Negotiated Rate	$1,091.80
Rate for Payer: Aetna Commercial	$829.77
Rate for Payer: Aetna Medicare Advantage	$655.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.82
Rate for Payer: Cigna Commercial	$1,091.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.08
Rate for Payer: Oxford Commercial	$436.72
Rate for Payer: Qualcare PPO/HMO/WC	$327.54
Rate for Payer: UnitedHealthcare Commercial	$436.72
Rate for Payer: UnitedHealthcare Community & State	$52.62
Rate for Payer: Wellpoint Medicaid Managed Care	$57.87

CIRCUIT MONITORING W/SZ.6 MASK

Facility

$2,183.60

Hospital Charge Code	270657360
Hospital Revenue Code	272
Min. Negotiated Rate	$327.54
Max. Negotiated Rate	$327.54
Rate for Payer: Qualcare PPO/HMO/WC	$327.54

CIRCUIT PATIENT HIGH FLOW DISP

Facility

$510.00

Hospital Charge Code	270664879
Hospital Revenue Code	270
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$76.50
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

CIRCUIT PATIENT HIGH FLOW DISP

Facility

$510.00

Hospital Charge Code	270664879
Hospital Revenue Code	270
Min. Negotiated Rate	$12.29
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.05
Rate for Payer: Cigna Commercial	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.00
Rate for Payer: Oxford Commercial	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.50
Rate for Payer: UnitedHealthcare Commercial	$102.00
Rate for Payer: UnitedHealthcare Community & State	$12.29
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

CIRCUIT PATIENT LOW FLOW DISP

Facility

$500.00

Hospital Charge Code	270664880
Hospital Revenue Code	270
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

CIRCUIT PATIENT LOW FLOW DISP

Facility

$500.00

Hospital Charge Code	270664880
Hospital Revenue Code	270
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CIRCUIT PORT VNT 36HS

Facility

$15.25

Hospital Charge Code	270689036
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.62
Rate for Payer: Aetna Commercial	$5.79
Rate for Payer: Aetna Medicare Advantage	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.89
Rate for Payer: Cigna Commercial	$7.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.58
Rate for Payer: Oxford Commercial	$3.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.29
Rate for Payer: UnitedHealthcare Commercial	$3.05
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

CIRCUIT PORT VNT 36HS

Facility

$15.25

Hospital Charge Code	270689036
Hospital Revenue Code	272
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$2.29
Rate for Payer: Qualcare PPO/HMO/WC	$2.29

CIRCUIT PT W/ PEPP 22MM

Facility

$118.00

Hospital Charge Code	270688987
Hospital Revenue Code	272
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

CIRCUIT PT W/ PEPP 22MM

Facility

$118.00

Hospital Charge Code	270688987
Hospital Revenue Code	272
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.40
Rate for Payer: Oxford Commercial	$23.60
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$23.60
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

CIRCUIT RESP HEATED INFANT

Facility

$183.73

Hospital Charge Code	270651823
Hospital Revenue Code	270
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$27.56
Rate for Payer: Qualcare PPO/HMO/WC	$27.56

CIRCUIT RESP HEATED INFANT

Facility

$183.73

Hospital Charge Code	270651823
Hospital Revenue Code	270
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$91.86
Rate for Payer: Aetna Commercial	$69.82
Rate for Payer: Aetna Medicare Advantage	$55.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.85
Rate for Payer: Cigna Commercial	$91.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.12
Rate for Payer: Oxford Commercial	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.56
Rate for Payer: UnitedHealthcare Commercial	$36.75
Rate for Payer: UnitedHealthcare Community & State	$4.43
Rate for Payer: Wellpoint Medicaid Managed Care	$4.87

CIRCUIT SMOOTH BORE AIRLIFE

Facility

$34.16

Hospital Charge Code	270652282
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.08
Rate for Payer: Aetna Commercial	$12.98
Rate for Payer: Aetna Medicare Advantage	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.71
Rate for Payer: Cigna Commercial	$17.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.25
Rate for Payer: Oxford Commercial	$6.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$6.83
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.91

CIRCUIT SMOOTH BORE AIRLIFE

Facility

$34.16

Hospital Charge Code	270652282
Hospital Revenue Code	272
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

CIRCUIT VENT ADULT CROSS DISP

Facility

$103.35

Hospital Charge Code	270668502
Hospital Revenue Code	270
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$15.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.50

CIRCUIT VENT ADULT CROSS DISP

Facility

$103.35

Hospital Charge Code	270668502
Hospital Revenue Code	270
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$51.67
Rate for Payer: Aetna Commercial	$39.27
Rate for Payer: Aetna Medicare Advantage	$31.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.35
Rate for Payer: Cigna Commercial	$51.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.00
Rate for Payer: Oxford Commercial	$20.67
Rate for Payer: Qualcare PPO/HMO/WC	$15.50
Rate for Payer: UnitedHealthcare Commercial	$20.67
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

CIRCUIT VENTED UNIVERSAL

Facility

$60.00

Hospital Charge Code	270331646
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

CIRCUIT VENTED UNIVERSAL

Facility

$60.00

Hospital Charge Code	270331646
Hospital Revenue Code	272
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

Know your out-of-pocket cost for care.

All Charges