Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MASK LMA SUPREME #4

Facility

$150.00

Hospital Charge Code	270642546
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 #5

Facility

$150.00

Hospital Charge Code	270642547
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 #5

Facility

$150.00

Hospital Charge Code	270642547
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 LRG PERFORMATRAK 1018594

Facility

$117.48

Hospital Charge Code	270647577
Hospital Revenue Code	272
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$58.74
Rate for Payer: Aetna Commercial	$44.64
Rate for Payer: Aetna Medicare Advantage	$35.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.96
Rate for Payer: Cigna Commercial	$58.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.24
Rate for Payer: Oxford Commercial	$23.50
Rate for Payer: Qualcare PPO/HMO/WC	$17.62
Rate for Payer: UnitedHealthcare Commercial	$23.50
Rate for Payer: UnitedHealthcare Community & State	$2.83
Rate for Payer: Wellpoint Medicaid Managed Care	$3.11

MASK LRG PERFORMATRAK 1018594

Facility

$117.48

Hospital Charge Code	270647577
Hospital Revenue Code	272
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$17.62
Rate for Payer: Qualcare PPO/HMO/WC	$17.62

MASK LRG PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642448
Hospital Revenue Code	272
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$73.30
Rate for Payer: Aetna Commercial	$55.71
Rate for Payer: Aetna Medicare Advantage	$43.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.38
Rate for Payer: Cigna Commercial	$73.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.98
Rate for Payer: Oxford Commercial	$29.32
Rate for Payer: Qualcare PPO/HMO/WC	$21.99
Rate for Payer: UnitedHealthcare Commercial	$29.32
Rate for Payer: UnitedHealthcare Community & State	$3.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.88

MASK LRG PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642448
Hospital Revenue Code	272
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$21.99
Rate for Payer: Qualcare PPO/HMO/WC	$21.99

MASK MASK COMFORT GEL CUSHION

Facility

$5.00

Hospital Charge Code	270657819
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

MASK MASK COMFORT GEL CUSHION

Facility

$5.00

Hospital Charge Code	270657819
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

MASK MDM PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642447
Hospital Revenue Code	272
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$73.30
Rate for Payer: Aetna Commercial	$55.71
Rate for Payer: Aetna Medicare Advantage	$43.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.38
Rate for Payer: Cigna Commercial	$73.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.98
Rate for Payer: Oxford Commercial	$29.32
Rate for Payer: Qualcare PPO/HMO/WC	$21.99
Rate for Payer: UnitedHealthcare Commercial	$29.32
Rate for Payer: UnitedHealthcare Community & State	$3.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.88

MASK MDM PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642447
Hospital Revenue Code	272
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$21.99
Rate for Payer: Qualcare PPO/HMO/WC	$21.99

MASK MED PERFORMATRAK 1018593

Facility

$117.48

Hospital Charge Code	270647576
Hospital Revenue Code	272
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$17.62
Rate for Payer: Qualcare PPO/HMO/WC	$17.62

MASK MED PERFORMATRAK 1018593

Facility

$117.48

Hospital Charge Code	270647576
Hospital Revenue Code	272
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$58.74
Rate for Payer: Aetna Commercial	$44.64
Rate for Payer: Aetna Medicare Advantage	$35.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.96
Rate for Payer: Cigna Commercial	$58.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.24
Rate for Payer: Oxford Commercial	$23.50
Rate for Payer: Qualcare PPO/HMO/WC	$17.62
Rate for Payer: UnitedHealthcare Commercial	$23.50
Rate for Payer: UnitedHealthcare Community & State	$2.83
Rate for Payer: Wellpoint Medicaid Managed Care	$3.11

MASK MULTI LOW CONCENTRATION**

Facility

$7.40

Hospital Charge Code	270600645
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.11

MASK MULTI LOW CONCENTRATION**

Facility

$7.40

Hospital Charge Code	270600645
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.70
Rate for Payer: Aetna Commercial	$2.81
Rate for Payer: Aetna Medicare Advantage	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.89
Rate for Payer: Cigna Commercial	$3.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.22
Rate for Payer: Oxford Commercial	$1.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.11
Rate for Payer: UnitedHealthcare Commercial	$1.48
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

MASK MULTI LOW CONC - VENTI

Facility

$5.90

Hospital Charge Code	270200155
Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

MASK MULTI LOW CONC - VENTI

Facility

$5.90

Hospital Charge Code	270200155
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.95
Rate for Payer: Aetna Commercial	$2.24
Rate for Payer: Aetna Medicare Advantage	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.50
Rate for Payer: Cigna Commercial	$2.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$1.18
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

MASK NASAL MED/LG DISP

Facility

$72.31

Hospital Charge Code	270614760
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$10.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

MASK NASAL MED/LG DISP

Facility

$72.31

Hospital Charge Code	270614760
Hospital Revenue Code	272
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.16
Rate for Payer: Aetna Commercial	$27.48
Rate for Payer: Aetna Medicare Advantage	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.44
Rate for Payer: Cigna Commercial	$36.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.69
Rate for Payer: Oxford Commercial	$14.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Commercial	$14.46
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

MASK NIVAIRO FULL FACE SMALL

Facility

$136.63

Hospital Charge Code	270683683
Hospital Revenue Code	272
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.31
Rate for Payer: Aetna Commercial	$51.92
Rate for Payer: Aetna Medicare Advantage	$40.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.84
Rate for Payer: Cigna Commercial	$68.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.99
Rate for Payer: Oxford Commercial	$27.33
Rate for Payer: Qualcare PPO/HMO/WC	$20.49
Rate for Payer: UnitedHealthcare Commercial	$27.33
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.62

MASK NIVAIRO FULL FACE SMALL

Facility

$136.63

Hospital Charge Code	270683683
Hospital Revenue Code	272
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$20.49
Rate for Payer: Qualcare PPO/HMO/WC	$20.49

MASK NON REBREATHER

Facility

$7.02

Hospital Charge Code	270200135
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna Medicare Advantage	$2.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.79
Rate for Payer: Cigna Commercial	$3.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.11
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

MASK NON REBREATHER

Facility

$7.02

Hospital Charge Code	270200135
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MASK NON-REBREATHER ADULT

Facility

$16.85

Hospital Charge Code	270600640
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

MASK NON-REBREATHER ADULT

Facility

$16.85

Hospital Charge Code	270600640
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

Know your out-of-pocket cost for care.

All Charges