Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MASK COMFORTLITE 2 COMBO WITH

Facility

$1,196.85

Hospital Charge Code	270643158
Hospital Revenue Code	272
Min. Negotiated Rate	$28.84
Max. Negotiated Rate	$598.42
Rate for Payer: Aetna Commercial	$454.80
Rate for Payer: Aetna Medicare Advantage	$359.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$305.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$305.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$305.20
Rate for Payer: Cigna Commercial	$598.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.06
Rate for Payer: Oxford Commercial	$239.37
Rate for Payer: Qualcare PPO/HMO/WC	$179.53
Rate for Payer: UnitedHealthcare Commercial	$239.37
Rate for Payer: UnitedHealthcare Community & State	$28.84
Rate for Payer: Wellpoint Medicaid Managed Care	$31.72

MASK COMFORTLITE 2 COMBO WITH

Facility

$1,196.85

Hospital Charge Code	270643158
Hospital Revenue Code	272
Min. Negotiated Rate	$179.53
Max. Negotiated Rate	$179.53
Rate for Payer: Qualcare PPO/HMO/WC	$179.53

MASK CUSHION INFANT 20 EA

Facility

$30.43

Hospital Charge Code	270684076
Hospital Revenue Code	272
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$4.56

MASK CUSHION INFANT 20 EA

Facility

$30.43

Hospital Charge Code	270684076
Hospital Revenue Code	272
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.21
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$6.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.56
Rate for Payer: UnitedHealthcare Commercial	$6.09
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

MASK FACE FILTER DUCK BILL

Facility

$19.25

Hospital Charge Code	270061035C
Hospital Revenue Code	270
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

MASK FACE FILTER DUCK BILL

Facility

$19.25

Hospital Charge Code	270061035C
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

MASK FACE FULL LG DISP RTO4OL

Facility

$125.00

Hospital Charge Code	270638050
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

MASK FACE FULL LG DISP RTO4OL

Facility

$125.00

Hospital Charge Code	270638050
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

MASK FACE FULL MED DISP RTO4OM

Facility

$125.00

Hospital Charge Code	270638051
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

MASK FACE FULL MED DISP RTO4OM

Facility

$125.00

Hospital Charge Code	270638051
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

MASK FACE HEADGEAR KIT 1010609

Facility

$73.50

Hospital Charge Code	270641265
Hospital Revenue Code	270
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$11.03
Rate for Payer: Qualcare PPO/HMO/WC	$11.03

MASK FACE HEADGEAR KIT 1010609

Facility

$73.50

Hospital Charge Code	270641265
Hospital Revenue Code	270
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna Commercial	$27.93
Rate for Payer: Aetna Medicare Advantage	$22.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.74
Rate for Payer: Cigna Commercial	$36.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.05
Rate for Payer: Oxford Commercial	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.03
Rate for Payer: UnitedHealthcare Commercial	$14.70
Rate for Payer: UnitedHealthcare Community & State	$1.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.95

MASK FACE PERFORMAX ADULT SM

Facility

$214.25

Hospital Charge Code	270647351
Hospital Revenue Code	272
Min. Negotiated Rate	$32.14
Max. Negotiated Rate	$32.14
Rate for Payer: Qualcare PPO/HMO/WC	$32.14

MASK FACE PERFORMAX ADULT SM

Facility

$214.25

Hospital Charge Code	270647351
Hospital Revenue Code	272
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$107.12
Rate for Payer: Aetna Commercial	$81.42
Rate for Payer: Aetna Medicare Advantage	$64.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.63
Rate for Payer: Cigna Commercial	$107.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.28
Rate for Payer: Oxford Commercial	$42.85
Rate for Payer: Qualcare PPO/HMO/WC	$32.14
Rate for Payer: UnitedHealthcare Commercial	$42.85
Rate for Payer: UnitedHealthcare Community & State	$5.16
Rate for Payer: Wellpoint Medicaid Managed Care	$5.68

MASK FACE SURGICAL ANTIFOG GR

Facility

$343.15

Hospital Charge Code	270655821
Hospital Revenue Code	272
Min. Negotiated Rate	$51.47
Max. Negotiated Rate	$51.47
Rate for Payer: Qualcare PPO/HMO/WC	$51.47

MASK FACE SURGICAL ANTIFOG GR

Facility

$343.15

Hospital Charge Code	270655821
Hospital Revenue Code	272
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$171.57
Rate for Payer: Aetna Commercial	$130.40
Rate for Payer: Aetna Medicare Advantage	$102.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.50
Rate for Payer: Cigna Commercial	$171.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.94
Rate for Payer: Oxford Commercial	$68.63
Rate for Payer: Qualcare PPO/HMO/WC	$51.47
Rate for Payer: UnitedHealthcare Commercial	$68.63
Rate for Payer: UnitedHealthcare Community & State	$8.27
Rate for Payer: Wellpoint Medicaid Managed Care	$9.09

MASK FACE TENT - AIRLIFE

Facility

$10.45

Hospital Charge Code	270600878
Hospital Revenue Code	272
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

MASK FACE TENT - AIRLIFE

Facility

$10.45

Hospital Charge Code	270600878
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

MASK FACE TENT W/O TENT DISP

Facility

$3.25

Hospital Charge Code	270626228
Hospital Revenue Code	272
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$1.24
Rate for Payer: Aetna Medicare Advantage	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.83
Rate for Payer: Cigna Commercial	$1.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.49
Rate for Payer: UnitedHealthcare Commercial	$0.65
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

MASK FACE TENT W/O TENT DISP

Facility

$3.25

Hospital Charge Code	270626228
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.49

MASK FLUIDSHIELD W/SPLSH GUARD

Facility

$58.35

Hospital Charge Code	270649457
Hospital Revenue Code	270
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$8.75
Rate for Payer: Qualcare PPO/HMO/WC	$8.75

MASK FLUIDSHIELD W/SPLSH GUARD

Facility

$58.35

Hospital Charge Code	270649457
Hospital Revenue Code	270
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$29.18
Rate for Payer: Aetna Commercial	$22.17
Rate for Payer: Aetna Medicare Advantage	$17.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.88
Rate for Payer: Cigna Commercial	$29.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.50
Rate for Payer: Oxford Commercial	$11.67
Rate for Payer: Qualcare PPO/HMO/WC	$8.75
Rate for Payer: UnitedHealthcare Commercial	$11.67
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

MASK FULL FACE LARGE DISP

Facility

$122.73

Hospital Charge Code	270621361
Hospital Revenue Code	272
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

MASK FULL FACE LARGE DISP

Facility

$122.73

Hospital Charge Code	270621361
Hospital Revenue Code	272
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.37
Rate for Payer: Aetna Commercial	$46.64
Rate for Payer: Aetna Medicare Advantage	$36.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.30
Rate for Payer: Cigna Commercial	$61.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.82
Rate for Payer: Oxford Commercial	$24.55
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$24.55
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.25

MASK FULL FACE LG DISP VENTED

Facility

$108.15

Hospital Charge Code	270652265
Hospital Revenue Code	270
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$54.08
Rate for Payer: Aetna Commercial	$41.10
Rate for Payer: Aetna Medicare Advantage	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.58
Rate for Payer: Cigna Commercial	$54.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.45
Rate for Payer: Oxford Commercial	$21.63
Rate for Payer: Qualcare PPO/HMO/WC	$16.22
Rate for Payer: UnitedHealthcare Commercial	$21.63
Rate for Payer: UnitedHealthcare Community & State	$2.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.87

Know your out-of-pocket cost for care.

All Charges