Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MASK FULL FACE LG DISP VENTED

Facility

$108.15

Hospital Charge Code	270652265
Hospital Revenue Code	270
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$16.22
Rate for Payer: Qualcare PPO/HMO/WC	$16.22

MASK FULL FACE MD. 1004849

Facility

$121.45

Hospital Charge Code	270618251
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$60.73
Rate for Payer: Aetna Commercial	$46.15
Rate for Payer: Aetna Medicare Advantage	$36.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.97
Rate for Payer: Cigna Commercial	$60.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.44
Rate for Payer: Oxford Commercial	$24.29
Rate for Payer: Qualcare PPO/HMO/WC	$18.22
Rate for Payer: UnitedHealthcare Commercial	$24.29
Rate for Payer: UnitedHealthcare Community & State	$2.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.22

MASK FULL FACE MD. 1004849

Facility

$121.45

Hospital Charge Code	270618251
Hospital Revenue Code	272
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$18.22
Rate for Payer: Qualcare PPO/HMO/WC	$18.22

MASK FULL FACE MED DISP VENTED

Facility

$113.73

Hospital Charge Code	270652271
Hospital Revenue Code	270
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$17.06

MASK FULL FACE MED DISP VENTED

Facility

$113.73

Hospital Charge Code	270652271
Hospital Revenue Code	270
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.87
Rate for Payer: Aetna Commercial	$43.22
Rate for Payer: Aetna Medicare Advantage	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.00
Rate for Payer: Cigna Commercial	$56.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.12
Rate for Payer: Oxford Commercial	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$17.06
Rate for Payer: UnitedHealthcare Commercial	$22.75
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

MASK FULL FACE PETITE DISP

Facility

$139.35

Hospital Charge Code	270618249
Hospital Revenue Code	272
Min. Negotiated Rate	$20.90
Max. Negotiated Rate	$20.90
Rate for Payer: Qualcare PPO/HMO/WC	$20.90

MASK FULL FACE PETITE DISP

Facility

$139.35

Hospital Charge Code	270618249
Hospital Revenue Code	272
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$69.67
Rate for Payer: Aetna Commercial	$52.95
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.53
Rate for Payer: Cigna Commercial	$69.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.80
Rate for Payer: Oxford Commercial	$27.87
Rate for Payer: Qualcare PPO/HMO/WC	$20.90
Rate for Payer: UnitedHealthcare Commercial	$27.87
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

MASK FULL FACE SM DISP VENTED

Facility

$111.66

Hospital Charge Code	270652272
Hospital Revenue Code	270
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$55.83
Rate for Payer: Aetna Commercial	$42.43
Rate for Payer: Aetna Medicare Advantage	$33.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.47
Rate for Payer: Cigna Commercial	$55.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.50
Rate for Payer: Oxford Commercial	$22.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.75
Rate for Payer: UnitedHealthcare Commercial	$22.33
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

MASK FULL FACE SM DISP VENTED

Facility

$111.66

Hospital Charge Code	270652272
Hospital Revenue Code	270
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$16.75
Rate for Payer: Qualcare PPO/HMO/WC	$16.75

MASK INFANT BLD8854

Facility

$24.85

Hospital Charge Code	270600639
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

MASK INFANT BLD8854

Facility

$24.85

Hospital Charge Code	270600639
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

MASK LAR ST SEAL SZ5 321500000

Facility

$47.50

Hospital Charge Code	270640279
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.25
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

MASK LAR ST SEAL SZ5 321500000

Facility

$47.50

Hospital Charge Code	270640279
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

MASK LARYL SFTSL SZ3 100220300

Facility

$56.65

Hospital Charge Code	270634373
Hospital Revenue Code	272
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.50

MASK LARYL SFTSL SZ3 100220300

Facility

$56.65

Hospital Charge Code	270634373
Hospital Revenue Code	272
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.32
Rate for Payer: Aetna Commercial	$21.53
Rate for Payer: Aetna Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.45
Rate for Payer: Cigna Commercial	$28.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.00
Rate for Payer: Oxford Commercial	$11.33
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$11.33
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

MASK LARYL SFTSL SZ4 100220400

Facility

$55.00

Hospital Charge Code	270634374
Hospital Revenue Code	272
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

MASK LARYL SFTSL SZ4 100220400

Facility

$55.00

Hospital Charge Code	270634374
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$11.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

MASK LARYN AIRWAY SZ #2 125020

Facility

$33.32

Hospital Charge Code	270642066
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.66
Rate for Payer: Aetna Commercial	$12.66
Rate for Payer: Aetna Medicare Advantage	$10.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.50
Rate for Payer: Cigna Commercial	$16.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.00
Rate for Payer: Oxford Commercial	$6.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.00
Rate for Payer: UnitedHealthcare Commercial	$6.66
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

MASK LARYN AIRWAY SZ #2 125020

Facility

$33.32

Hospital Charge Code	270642066
Hospital Revenue Code	272
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.00

MASK LARYNGEAL AIRWAY #3 SILI

Facility

$34.75

Hospital Charge Code	270645379
Hospital Revenue Code	272
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$5.21
Rate for Payer: Qualcare PPO/HMO/WC	$5.21

MASK LARYNGEAL AIRWAY #3 SILI

Facility

$34.75

Hospital Charge Code	270645379
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.38
Rate for Payer: Aetna Commercial	$13.21
Rate for Payer: Aetna Medicare Advantage	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.86
Rate for Payer: Cigna Commercial	$17.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.43
Rate for Payer: Oxford Commercial	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.21
Rate for Payer: UnitedHealthcare Commercial	$6.95
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

MASK LARYNGEAL AIRWAY #3 SILI-

Facility

$210.00

Hospital Charge Code	2706453779
Hospital Revenue Code	272
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

MASK LARYNGEAL AIRWAY #3 SILI-

Facility

$210.00

Hospital Charge Code	2706453779
Hospital Revenue Code	272
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.00
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$42.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5.57

MASK LARYNGEAL AIRWAY #4 SILI

Facility

$34.75

Hospital Charge Code	270645382
Hospital Revenue Code	272
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$5.21
Rate for Payer: Qualcare PPO/HMO/WC	$5.21

MASK LARYNGEAL AIRWAY #4 SILI

Facility

$34.75

Hospital Charge Code	270645382
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.38
Rate for Payer: Aetna Commercial	$13.21
Rate for Payer: Aetna Medicare Advantage	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.86
Rate for Payer: Cigna Commercial	$17.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.43
Rate for Payer: Oxford Commercial	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.21
Rate for Payer: UnitedHealthcare Commercial	$6.95
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

Know your out-of-pocket cost for care.

All Charges