Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MASK PERFORMATRAK LARGE WITH

Facility

$156.29

Hospital Charge Code	270641430
Hospital Revenue Code	272
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$23.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.44

MASK PERFORMATRAK MEDIUM WITH

Facility

$111.48

Hospital Charge Code	270641429
Hospital Revenue Code	272
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$16.72
Rate for Payer: Qualcare PPO/HMO/WC	$16.72

MASK PERFORMATRAK MEDIUM WITH

Facility

$111.48

Hospital Charge Code	270641429
Hospital Revenue Code	272
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$55.74
Rate for Payer: Aetna Commercial	$42.36
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.43
Rate for Payer: Cigna Commercial	$55.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.44
Rate for Payer: Oxford Commercial	$22.30
Rate for Payer: Qualcare PPO/HMO/WC	$16.72
Rate for Payer: UnitedHealthcare Commercial	$22.30
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.95

MASK PERFORMATRAK SMALL WITH

Facility

$156.29

Hospital Charge Code	270641428
Hospital Revenue Code	272
Min. Negotiated Rate	$23.44
Max. Negotiated Rate	$23.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.44

MASK PERFORMATRAK SMALL WITH

Facility

$156.29

Hospital Charge Code	270641428
Hospital Revenue Code	272
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$78.14
Rate for Payer: Aetna Commercial	$59.39
Rate for Payer: Aetna Medicare Advantage	$46.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.85
Rate for Payer: Cigna Commercial	$78.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.89
Rate for Payer: Oxford Commercial	$31.26
Rate for Payer: Qualcare PPO/HMO/WC	$23.44
Rate for Payer: UnitedHealthcare Commercial	$31.26
Rate for Payer: UnitedHealthcare Community & State	$3.77
Rate for Payer: Wellpoint Medicaid Managed Care	$4.14

MASK PERFORMAX FACE LG 105532

Facility

$220.00

Hospital Charge Code	270643112
Hospital Revenue Code	270
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.00
Rate for Payer: Oxford Commercial	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Commercial	$44.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$5.83

MASK PERFORMAX FACE LG 105532

Facility

$220.00

Hospital Charge Code	270643112
Hospital Revenue Code	270
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

MASK PERFORMAX LG SPU W/EE

Facility

$214.25

Hospital Charge Code	270644965
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 PERFORMAX LG SPU W/EE

Facility

$214.25

Hospital Charge Code	270644965
Hospital Revenue Code	272
Min. Negotiated Rate	$32.14
Max. Negotiated Rate	$32.14
Rate for Payer: Qualcare PPO/HMO/WC	$32.14

MASK PERFORMAX SMALL 1052531

Facility

$175.07

Hospital Charge Code	270650775
Hospital Revenue Code	272
Min. Negotiated Rate	$26.26
Max. Negotiated Rate	$26.26
Rate for Payer: Qualcare PPO/HMO/WC	$26.26

MASK PERFORMAX SMALL 1052531

Facility

$175.07

Hospital Charge Code	270650775
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$87.53
Rate for Payer: Aetna Commercial	$66.53
Rate for Payer: Aetna Medicare Advantage	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.64
Rate for Payer: Cigna Commercial	$87.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.52
Rate for Payer: Oxford Commercial	$35.01
Rate for Payer: Qualcare PPO/HMO/WC	$26.26
Rate for Payer: UnitedHealthcare Commercial	$35.01
Rate for Payer: UnitedHealthcare Community & State	$4.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

MASK PROCEDURE W/FLUID SHIELD

Facility

$70.23

Hospital Charge Code	270301251C
Hospital Revenue Code	270
Min. Negotiated Rate	$10.53
Max. Negotiated Rate	$10.53
Rate for Payer: Qualcare PPO/HMO/WC	$10.53

MASK PROCEDURE W/FLUID SHIELD

Facility

$70.23

Hospital Charge Code	270301251C
Hospital Revenue Code	270
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$35.12
Rate for Payer: Aetna Commercial	$26.69
Rate for Payer: Aetna Medicare Advantage	$21.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.91
Rate for Payer: Cigna Commercial	$35.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.07
Rate for Payer: Oxford Commercial	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.53
Rate for Payer: UnitedHealthcare Commercial	$14.05
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1.86

MASK RESPIRATOR NEG N95 1870

Facility

$57.63

Hospital Charge Code	270649447
Hospital Revenue Code	272
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$28.82
Rate for Payer: Aetna Commercial	$21.90
Rate for Payer: Aetna Medicare Advantage	$17.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.70
Rate for Payer: Cigna Commercial	$28.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.29
Rate for Payer: Oxford Commercial	$11.53
Rate for Payer: Qualcare PPO/HMO/WC	$8.64
Rate for Payer: UnitedHealthcare Commercial	$11.53
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

MASK RESPIRATOR NEG N95 1870

Facility

$57.63

Hospital Charge Code	270649447
Hospital Revenue Code	272
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$8.64
Rate for Payer: Qualcare PPO/HMO/WC	$8.64

MASK RESPIRATOR PFR95 REGULAR

Facility

$2.20

Hospital Charge Code	270301254
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna Commercial	$0.84
Rate for Payer: Aetna Medicare Advantage	$0.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.56
Rate for Payer: Cigna Commercial	$1.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.66
Rate for Payer: Oxford Commercial	$0.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.33
Rate for Payer: UnitedHealthcare Commercial	$0.44
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

MASK RESPIRATOR PFR95 REGULAR

Facility

$2.20

Hospital Charge Code	270301254
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.33

MASK RESPIRATOR PFR95 SMALL

Facility

$2.20

Hospital Charge Code	270301247
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.33

MASK RESPIRATOR PFR95 SMALL

Facility

$2.20

Hospital Charge Code	270301247
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.10
Rate for Payer: Aetna Commercial	$0.84
Rate for Payer: Aetna Medicare Advantage	$0.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.56
Rate for Payer: Cigna Commercial	$1.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.66
Rate for Payer: Oxford Commercial	$0.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.33
Rate for Payer: UnitedHealthcare Commercial	$0.44
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

MASK RESPIRATOR REGULAR SIZE

Facility

$51.75

Hospital Charge Code	270652718
Hospital Revenue Code	270
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$7.76
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

MASK RESPIRATOR REGULAR SIZE

Facility

$51.75

Hospital Charge Code	270652718
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$25.88
Rate for Payer: Aetna Commercial	$19.66
Rate for Payer: Aetna Medicare Advantage	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.20
Rate for Payer: Cigna Commercial	$25.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.53
Rate for Payer: Oxford Commercial	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.76
Rate for Payer: UnitedHealthcare Commercial	$10.35
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

MASK SHIELD VISOR FACE

Facility

$5.92

Hospital Charge Code	270649459
Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

MASK SHIELD VISOR FACE

Facility

$5.92

Hospital Charge Code	270649459
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.96
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare Advantage	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.51
Rate for Payer: Cigna Commercial	$2.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.78
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 SML PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642446
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 SML PERFORMATRAK HEADGEAR

Facility

$146.60

Hospital Charge Code	270642446
Hospital Revenue Code	272
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$21.99
Rate for Payer: Qualcare PPO/HMO/WC	$21.99

Know your out-of-pocket cost for care.

All Charges