Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MASK LARYNGEAL AIRWAY 5 544001

Facility

$1,092.00

Hospital Charge Code	270606111
Hospital Revenue Code	272
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$163.80
Rate for Payer: Qualcare PPO/HMO/WC	$163.80

MASK LARYNGEAL AIRWAY 5 544001

Facility

$1,092.00

Hospital Charge Code	270606111
Hospital Revenue Code	272
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$546.00
Rate for Payer: Aetna Commercial	$414.96
Rate for Payer: Aetna Medicare Advantage	$327.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.46
Rate for Payer: Cigna Commercial	$546.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.60
Rate for Payer: Oxford Commercial	$218.40
Rate for Payer: Qualcare PPO/HMO/WC	$163.80
Rate for Payer: UnitedHealthcare Commercial	$218.40
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$28.94

MASK LARYNGEAL AIRWAY #5 SILI

Facility

$34.75

Hospital Charge Code	270645383
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 #5 SILI

Facility

$34.75

Hospital Charge Code	270645383
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 SOFT SEAL #4

Facility

$47.50

Hospital Charge Code	270633314
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 LARYNGEAL SOFT SEAL #4

Facility

$47.50

Hospital Charge Code	270633314
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

MASK LARYNGEAL SOFT SEAL #5

Facility

$59.75

Hospital Charge Code	270633313
Hospital Revenue Code	272
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$8.96
Rate for Payer: Qualcare PPO/HMO/WC	$8.96

MASK LARYNGEAL SOFT SEAL #5

Facility

$59.75

Hospital Charge Code	270633313
Hospital Revenue Code	272
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$29.88
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.24
Rate for Payer: Cigna Commercial	$29.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.93
Rate for Payer: Oxford Commercial	$11.95
Rate for Payer: Qualcare PPO/HMO/WC	$8.96
Rate for Payer: UnitedHealthcare Commercial	$11.95
Rate for Payer: UnitedHealthcare Community & State	$1.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1.58

MASK LARYNGEAL UNIQUE#5 125050

Facility

$33.97

Hospital Charge Code	270643108
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$16.98
Rate for Payer: Aetna Commercial	$12.91
Rate for Payer: Aetna Medicare Advantage	$10.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.66
Rate for Payer: Cigna Commercial	$16.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.19
Rate for Payer: Oxford Commercial	$6.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

MASK LARYNGEAL UNIQUE#5 125050

Facility

$33.97

Hospital Charge Code	270643108
Hospital Revenue Code	272
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

MASK LMA #2 DISP

Facility

$29.20

Hospital Charge Code	270677272
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.60
Rate for Payer: Aetna Commercial	$11.10
Rate for Payer: Aetna Medicare Advantage	$8.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.45
Rate for Payer: Cigna Commercial	$14.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.76
Rate for Payer: Oxford Commercial	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.38
Rate for Payer: UnitedHealthcare Commercial	$5.84
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

MASK LMA #2 DISP

Facility

$29.20

Hospital Charge Code	270677272
Hospital Revenue Code	272
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.38

MASK LMA #3 DISP

Facility

$45.00

Hospital Charge Code	270660640
Hospital Revenue Code	272
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

MASK LMA #3 DISP

Facility

$45.00

Hospital Charge Code	270660640
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

MASK LMA #3 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627294
Hospital Revenue Code	272
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$13.03
Rate for Payer: Aetna Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.74
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.29
Rate for Payer: Oxford Commercial	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$6.86
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.91

MASK LMA #3 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627294
Hospital Revenue Code	272
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

MASK LMA #4 AURA ST

Facility

$40.90

Hospital Charge Code	270660641
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.45
Rate for Payer: Aetna Commercial	$15.54
Rate for Payer: Aetna Medicare Advantage	$12.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.43
Rate for Payer: Cigna Commercial	$20.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.27
Rate for Payer: Oxford Commercial	$8.18
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$8.18
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

MASK LMA #4 AURA ST

Facility

$40.90

Hospital Charge Code	270660641
Hospital Revenue Code	272
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

MASK LMA #4 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627295
Hospital Revenue Code	272
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$13.03
Rate for Payer: Aetna Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.74
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.29
Rate for Payer: Oxford Commercial	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$6.86
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.91

MASK LMA #4 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627295
Hospital Revenue Code	272
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

MASK LMA DISPOSIBLE SIZE #5

Facility

$90.80

Hospital Charge Code	270660642
Hospital Revenue Code	272
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$13.62

MASK LMA DISPOSIBLE SIZE #5

Facility

$90.80

Hospital Charge Code	270660642
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.40
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$27.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.15
Rate for Payer: Cigna Commercial	$45.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.24
Rate for Payer: Oxford Commercial	$18.16
Rate for Payer: Qualcare PPO/HMO/WC	$13.62
Rate for Payer: UnitedHealthcare Commercial	$18.16
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

MASK LMA SUPREME #3

Facility

$150.00

Hospital Charge Code	270642545
Hospital Revenue Code	272
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

MASK LMA SUPREME #3

Facility

$150.00

Hospital Charge Code	270642545
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MASK LMA SUPREME #4

Facility

$150.00

Hospital Charge Code	270642546
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

Know your out-of-pocket cost for care.

All Charges