Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MASK AEROSOL PEDS W/O TUBE

Facility

$2.06

Hospital Charge Code	270650004
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.03
Rate for Payer: Aetna Commercial	$0.78
Rate for Payer: Aetna Medicare Advantage	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.53
Rate for Payer: Cigna Commercial	$1.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.62
Rate for Payer: Oxford Commercial	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.31
Rate for Payer: UnitedHealthcare Commercial	$0.41
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

MASK AEROSOL PEDS W/O TUBE

Facility

$2.06

Hospital Charge Code	270650004
Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.31

MASK ANESTHE ADLT SM DISP 5240

Facility

$7.28

Hospital Charge Code	270649452
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.64
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Oxford Commercial	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

MASK ANESTHE ADLT SM DISP 5240

Facility

$7.28

Hospital Charge Code	270649452
Hospital Revenue Code	270
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

MASK ANESTHE NEONATE DISP 5210

Facility

$7.62

Hospital Charge Code	270649450
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.14

MASK ANESTHE NEONATE DISP 5210

Facility

$7.62

Hospital Charge Code	270649450
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.81
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.94
Rate for Payer: Cigna Commercial	$3.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.29
Rate for Payer: Oxford Commercial	$1.52
Rate for Payer: Qualcare PPO/HMO/WC	$1.14
Rate for Payer: UnitedHealthcare Commercial	$1.52
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

MASK ANESTHESIA ADLT DISP SZ 5

Facility

$7.44

Hospital Charge Code	270649449
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.72
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.49
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

MASK ANESTHESIA ADLT DISP SZ 5

Facility

$7.44

Hospital Charge Code	270649449
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

MASK ANESTHESIA ADULT SIZE 5

Facility

$145.35

Hospital Charge Code	270645629
Hospital Revenue Code	272
Min. Negotiated Rate	$21.80
Max. Negotiated Rate	$21.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.80

MASK ANESTHESIA ADULT SIZE 5

Facility

$145.35

Hospital Charge Code	270645629
Hospital Revenue Code	272
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$72.67
Rate for Payer: Aetna Commercial	$55.23
Rate for Payer: Aetna Medicare Advantage	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.06
Rate for Payer: Cigna Commercial	$72.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.60
Rate for Payer: Oxford Commercial	$29.07
Rate for Payer: Qualcare PPO/HMO/WC	$21.80
Rate for Payer: UnitedHealthcare Commercial	$29.07
Rate for Payer: UnitedHealthcare Community & State	$3.50
Rate for Payer: Wellpoint Medicaid Managed Care	$3.85

MASK ANESTHESIA CHILD SIZE 4

Facility

$659.20

Hospital Charge Code	270655723
Hospital Revenue Code	272
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$329.60
Rate for Payer: Aetna Commercial	$250.50
Rate for Payer: Aetna Medicare Advantage	$197.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.10
Rate for Payer: Cigna Commercial	$329.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.76
Rate for Payer: Oxford Commercial	$131.84
Rate for Payer: Qualcare PPO/HMO/WC	$98.88
Rate for Payer: UnitedHealthcare Commercial	$131.84
Rate for Payer: UnitedHealthcare Community & State	$15.89
Rate for Payer: Wellpoint Medicaid Managed Care	$17.47

MASK ANESTHESIA CHILD SIZE 4

Facility

$659.20

Hospital Charge Code	270655723
Hospital Revenue Code	272
Min. Negotiated Rate	$98.88
Max. Negotiated Rate	$98.88
Rate for Payer: Qualcare PPO/HMO/WC	$98.88

MASK ANESTHESIA CIRCUT LG 5045

Facility

$7.85

Hospital Charge Code	270070061
Hospital Revenue Code	272
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.18

MASK ANESTHESIA CIRCUT LG 5045

Facility

$7.85

Hospital Charge Code	270070061
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$2.98
Rate for Payer: Aetna Medicare Advantage	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.00
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Oxford Commercial	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.18
Rate for Payer: UnitedHealthcare Commercial	$1.57
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

MASK ANESTHESIA PED 1274

Facility

$9.25

Hospital Charge Code	270605258
Hospital Revenue Code	272
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

MASK ANESTHESIA PED 1274

Facility

$9.25

Hospital Charge Code	270605258
Hospital Revenue Code	272
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.62
Rate for Payer: Aetna Commercial	$3.52
Rate for Payer: Aetna Medicare Advantage	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.36
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.77
Rate for Payer: Oxford Commercial	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.39
Rate for Payer: UnitedHealthcare Commercial	$1.85
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

MASK ANESTHES INFANT DISP 5220

Facility

$7.62

Hospital Charge Code	270649451
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.14

MASK ANESTHES INFANT DISP 5220

Facility

$7.62

Hospital Charge Code	270649451
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.81
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.94
Rate for Payer: Cigna Commercial	$3.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.29
Rate for Payer: Oxford Commercial	$1.52
Rate for Payer: Qualcare PPO/HMO/WC	$1.14
Rate for Payer: UnitedHealthcare Commercial	$1.52
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

MASK ANES TODDLER FACE 5230

Facility

$7.26

Hospital Charge Code	270649453
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.63
Rate for Payer: Aetna Commercial	$2.76
Rate for Payer: Aetna Medicare Advantage	$2.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

MASK ANES TODDLER FACE 5230

Facility

$7.26

Hospital Charge Code	270649453
Hospital Revenue Code	270
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

MASK ANETHESIA TODDLER SIZE 3

Facility

$113.63

Hospital Charge Code	270655715
Hospital Revenue Code	272
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.81
Rate for Payer: Aetna Commercial	$43.18
Rate for Payer: Aetna Medicare Advantage	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.98
Rate for Payer: Cigna Commercial	$56.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.09
Rate for Payer: Oxford Commercial	$22.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.04
Rate for Payer: UnitedHealthcare Commercial	$22.73
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

MASK ANETHESIA TODDLER SIZE 3

Facility

$113.63

Hospital Charge Code	270655715
Hospital Revenue Code	272
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$17.04
Rate for Payer: Qualcare PPO/HMO/WC	$17.04

MASK BIPAP LG DISP HG 1012529

Facility

$275.00

Hospital Charge Code	270637978
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

MASK BIPAP LG DISP HG 1012529

Facility

$275.00

Hospital Charge Code	270637978
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

MASK BIPAP LG NON-VENTED

Facility

$120.45

Hospital Charge Code	270655468
Hospital Revenue Code	270
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$18.07
Rate for Payer: Qualcare PPO/HMO/WC	$18.07

Know your out-of-pocket cost for care.

All Charges