Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MASKS PKG BOX *******

Facility

$33.00

Hospital Charge Code	8001125
Hospital Revenue Code	279
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

MASKS PKG BOX *******

Facility

$33.00

Hospital Charge Code	8001125
Hospital Revenue Code	279
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.90
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$6.60
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

MASK SURGICAL ANTI-FOG DISP

Facility

$22.96

Hospital Charge Code	270649446
Hospital Revenue Code	270
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.48
Rate for Payer: Aetna Commercial	$8.72
Rate for Payer: Aetna Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.85
Rate for Payer: Cigna Commercial	$11.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.89
Rate for Payer: Oxford Commercial	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$4.59
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

MASK SURGICAL ANTI-FOG DISP

Facility

$22.96

Hospital Charge Code	270649446
Hospital Revenue Code	270
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

MASK SURGICAL FACE DISP

Facility

$17.28

Hospital Charge Code	270649456
Hospital Revenue Code	270
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.41
Rate for Payer: Cigna Commercial	$8.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Oxford Commercial	$3.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Commercial	$3.46
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

MASK SURGICAL FACE DISP

Facility

$17.28

Hospital Charge Code	270649456
Hospital Revenue Code	270
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

MASK SURG W/O SPLASHGUARD DISP

Facility

$38.94

Hospital Charge Code	270649455
Hospital Revenue Code	270
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$5.84

MASK SURG W/O SPLASHGUARD DISP

Facility

$38.94

Hospital Charge Code	270649455
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$19.47
Rate for Payer: Aetna Commercial	$14.80
Rate for Payer: Aetna Medicare Advantage	$11.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.93
Rate for Payer: Cigna Commercial	$19.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.68
Rate for Payer: Oxford Commercial	$7.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.84
Rate for Payer: UnitedHealthcare Commercial	$7.79
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

MASK TRACH ADULT

Facility

$5.28

Hospital Charge Code	270651423
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

MASK TRACH ADULT

Facility

$22.45

Hospital Charge Code	9500075
Hospital Revenue Code	270
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$4.49
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

MASK TRACH ADULT

Facility

$22.45

Hospital Charge Code	9500075
Hospital Revenue Code	270
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

MASK TRACH ADULT

Facility

$5.28

Hospital Charge Code	270651423
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.64
Rate for Payer: Aetna Commercial	$2.01
Rate for Payer: Aetna Medicare Advantage	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.58
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

MASK TRACHEOSTOMY ADULT

Facility

$11.25

Hospital Charge Code	270606305
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

MASK TRACHEOSTOMY ADULT

Facility

$11.25

Hospital Charge Code	270606305
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

MASK VENTURI***

Facility

$32.40

Hospital Charge Code	9500281
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.20
Rate for Payer: Aetna Commercial	$12.31
Rate for Payer: Aetna Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.26
Rate for Payer: Cigna Commercial	$16.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.72
Rate for Payer: Oxford Commercial	$6.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.86
Rate for Payer: UnitedHealthcare Commercial	$6.48
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

MASK VENTURI***

Facility

$32.40

Hospital Charge Code	9500281
Hospital Revenue Code	272
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$4.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

MASK VINYL NASAL MED

Facility

$130.45

Hospital Charge Code	270600642
Hospital Revenue Code	272
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

MASK VINYL NASAL MED

Facility

$130.45

Hospital Charge Code	270600642
Hospital Revenue Code	272
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$65.22
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$39.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.26
Rate for Payer: Cigna Commercial	$65.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.13
Rate for Payer: Oxford Commercial	$26.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$26.09
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.46

MASK VINYL NASAL MED/SM

Facility

$130.45

Hospital Charge Code	270600643
Hospital Revenue Code	272
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

MASK VINYL NASAL MED/SM

Facility

$130.45

Hospital Charge Code	270600643
Hospital Revenue Code	272
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$65.22
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$39.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.26
Rate for Payer: Cigna Commercial	$65.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.13
Rate for Payer: Oxford Commercial	$26.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$26.09
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.46

MASK VINYL NASAL SM

Facility

$130.45

Hospital Charge Code	270600641
Hospital Revenue Code	272
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$65.22
Rate for Payer: Aetna Commercial	$49.57
Rate for Payer: Aetna Medicare Advantage	$39.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.26
Rate for Payer: Cigna Commercial	$65.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.13
Rate for Payer: Oxford Commercial	$26.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$26.09
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.46

MASK VINYL NASAL SM

Facility

$130.45

Hospital Charge Code	270600641
Hospital Revenue Code	272
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

MASK W/HEADGEAR CIRCUIT FILTER

Facility

$227.70

Hospital Charge Code	270648511
Hospital Revenue Code	272
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$113.85
Rate for Payer: Aetna Commercial	$86.53
Rate for Payer: Aetna Medicare Advantage	$68.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.06
Rate for Payer: Cigna Commercial	$113.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.31
Rate for Payer: Oxford Commercial	$45.54
Rate for Payer: Qualcare PPO/HMO/WC	$34.16
Rate for Payer: UnitedHealthcare Commercial	$45.54
Rate for Payer: UnitedHealthcare Community & State	$5.49
Rate for Payer: Wellpoint Medicaid Managed Care	$6.03

MASK W/HEADGEAR CIRCUIT FILTER

Facility

$227.70

Hospital Charge Code	270648511
Hospital Revenue Code	272
Min. Negotiated Rate	$34.16
Max. Negotiated Rate	$34.16
Rate for Payer: Qualcare PPO/HMO/WC	$34.16

MAS PLIF FIXATION ROD, 40MM

Facility

$2,980.00

Hospital Charge Code	270667571
Hospital Revenue Code	278
Min. Negotiated Rate	$447.00
Max. Negotiated Rate	$721.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$596.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$655.60
Rate for Payer: Qualcare PPO/HMO/WC	$447.00

Know your out-of-pocket cost for care.

All Charges