Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MARKER TRIMARK CLIP TI TD13MR

Facility

$388.00

Service Code	HCPCS A4648
Hospital Charge Code	270673749R
Hospital Revenue Code	278
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$194.00
Rate for Payer: Aetna Commercial	$147.44
Rate for Payer: Aetna Medicare Advantage	$116.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.94
Rate for Payer: Cigna Commercial	$194.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.36
Rate for Payer: Qualcare PPO/HMO/WC	$58.20
Rate for Payer: UnitedHealthcare Community & State	$9.35
Rate for Payer: Wellpoint Medicaid Managed Care	$10.28

MARKERTUMARKCLIPUSHAPE18G10CM

Facility

$375.00

Service Code	HCPCS A4648
Hospital Charge Code	270673704R
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MARKERTUMARKCLIPUSHAPE18G10CM

Facility

$375.00

Service Code	HCPCS A4648
Hospital Charge Code	270673704R
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

MARLEX MESH 1 X 4

Facility

$821.00

Hospital Charge Code	270335117
Hospital Revenue Code	278
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$410.50
Rate for Payer: Aetna Commercial	$311.98
Rate for Payer: Aetna Medicare Advantage	$246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.35
Rate for Payer: Cigna Commercial	$410.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.62
Rate for Payer: Qualcare PPO/HMO/WC	$123.15
Rate for Payer: UnitedHealthcare Community & State	$19.79
Rate for Payer: Wellpoint Medicaid Managed Care	$21.76

MARLEX MESH 1 X 4

Facility

$821.00

Hospital Charge Code	270335117
Hospital Revenue Code	278
Min. Negotiated Rate	$123.15
Max. Negotiated Rate	$198.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.62
Rate for Payer: Qualcare PPO/HMO/WC	$123.15

MASK 1032 TODDLER SZ 3

Facility

$15.00

Hospital Charge Code	270667185
Hospital Revenue Code	270
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

MASK 1032 TODDLER SZ 3

Facility

$15.00

Hospital Charge Code	270667185
Hospital Revenue Code	270
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

MASK 1145 CHILD SZ4 BUBBLE

Facility

$15.80

Hospital Charge Code	270667184
Hospital Revenue Code	270
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.37

MASK 1145 CHILD SZ4 BUBBLE

Facility

$15.80

Hospital Charge Code	270667184
Hospital Revenue Code	270
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.90
Rate for Payer: Aetna Commercial	$6.00
Rate for Payer: Aetna Medicare Advantage	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.03
Rate for Payer: Cigna Commercial	$7.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.74
Rate for Payer: Oxford Commercial	$3.16
Rate for Payer: Qualcare PPO/HMO/WC	$2.37
Rate for Payer: UnitedHealthcare Commercial	$3.16
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

MASK 5-PT HYBRID HEAD/NECK/SHO

Facility

$450.00

Hospital Charge Code	270676902
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

MASK 5-PT HYBRID HEAD/NECK/SHO

Facility

$450.00

Hospital Charge Code	270676902
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

MASK 5 PTS HYBRID HEAD

Facility

$450.00

Hospital Charge Code	270675791
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

MASK 5 PTS HYBRID HEAD

Facility

$450.00

Hospital Charge Code	270675791
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

MASK ADULT HIOX O2 WADP 508001

Facility

$85.60

Hospital Charge Code	270637487
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$12.84
Rate for Payer: Qualcare PPO/HMO/WC	$12.84

MASK ADULT HIOX O2 WADP 508001

Facility

$85.60

Hospital Charge Code	270637487
Hospital Revenue Code	272
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$42.80
Rate for Payer: Aetna Commercial	$32.53
Rate for Payer: Aetna Medicare Advantage	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.83
Rate for Payer: Cigna Commercial	$42.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.68
Rate for Payer: Oxford Commercial	$17.12
Rate for Payer: Qualcare PPO/HMO/WC	$12.84
Rate for Payer: UnitedHealthcare Commercial	$17.12
Rate for Payer: UnitedHealthcare Community & State	$2.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

MASK ADULT HIOX OXYGEN 50-8001

Facility

$88.35

Hospital Charge Code	270643016
Hospital Revenue Code	272
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$13.25
Rate for Payer: Qualcare PPO/HMO/WC	$13.25

MASK ADULT HIOX OXYGEN 50-8001

Facility

$88.35

Hospital Charge Code	270643016
Hospital Revenue Code	272
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$44.17
Rate for Payer: Aetna Commercial	$33.57
Rate for Payer: Aetna Medicare Advantage	$26.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.53
Rate for Payer: Cigna Commercial	$44.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.50
Rate for Payer: Oxford Commercial	$17.67
Rate for Payer: Qualcare PPO/HMO/WC	$13.25
Rate for Payer: UnitedHealthcare Commercial	$17.67
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

MASK ADULT TAVISH FILTER

Facility

$14.75

Hospital Charge Code	270643040
Hospital Revenue Code	270
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$5.61
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$2.95
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

MASK ADULT TAVISH FILTER

Facility

$14.75

Hospital Charge Code	270643040
Hospital Revenue Code	270
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

MASK AEROSOL ADULT 00126

Facility

$5.65

Hospital Charge Code	270200105
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

MASK AEROSOL ADULT 00126

Facility

$5.65

Hospital Charge Code	270200105
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

MASK AEROSOL INFANT 2D4820

Facility

$13.65

Hospital Charge Code	270606453
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

MASK AEROSOL INFANT 2D4820

Facility

$13.65

Hospital Charge Code	270606453
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

MASK AEROSOL PEDIATRIC 001263

Facility

$9.65

Hospital Charge Code	270600638
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

MASK AEROSOL PEDIATRIC 001263

Facility

$9.65

Hospital Charge Code	270600638
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

Know your out-of-pocket cost for care.

All Charges