Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MODULE INTUBATION WHITE

Facility

$150.00

Hospital Charge Code	270613336
Hospital Revenue Code	271
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MODULE INTUBATION WHITE

Facility

$150.00

Hospital Charge Code	270613336
Hospital Revenue Code	271
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

MODULE INTUBATION YELLOW

Facility

$150.00

Hospital Charge Code	270613335
Hospital Revenue Code	271
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

MODULE INTUBATION YELLOW

Facility

$150.00

Hospital Charge Code	270613335
Hospital Revenue Code	271
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MODULE IV DELIVERY BLUE

Facility

$167.50

Hospital Charge Code	270613360
Hospital Revenue Code	271
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$25.12
Rate for Payer: Qualcare PPO/HMO/WC	$25.12

MODULE IV DELIVERY BLUE

Facility

$167.50

Hospital Charge Code	270613360
Hospital Revenue Code	271
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$83.75
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare Advantage	$50.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.71
Rate for Payer: Cigna Commercial	$83.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.25
Rate for Payer: Oxford Commercial	$33.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.12
Rate for Payer: UnitedHealthcare Commercial	$33.50
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$4.44

MODULE IV DELIVERY GREEN

Facility

$167.50

Hospital Charge Code	270613362
Hospital Revenue Code	271
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$83.75
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare Advantage	$50.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.71
Rate for Payer: Cigna Commercial	$83.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.25
Rate for Payer: Oxford Commercial	$33.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.12
Rate for Payer: UnitedHealthcare Commercial	$33.50
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$4.44

MODULE IV DELIVERY GREEN

Facility

$167.50

Hospital Charge Code	270613362
Hospital Revenue Code	271
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$25.12
Rate for Payer: Qualcare PPO/HMO/WC	$25.12

MODULE IV DELIVERY ORANGE

Facility

$167.50

Hospital Charge Code	270613361
Hospital Revenue Code	271
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$83.75
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare Advantage	$50.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.71
Rate for Payer: Cigna Commercial	$83.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.25
Rate for Payer: Oxford Commercial	$33.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.12
Rate for Payer: UnitedHealthcare Commercial	$33.50
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$4.44

MODULE IV DELIVERY ORANGE

Facility

$167.50

Hospital Charge Code	270613361
Hospital Revenue Code	271
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$25.12
Rate for Payer: Qualcare PPO/HMO/WC	$25.12

MODULE IV DELIVERY PURPLE

Facility

$167.50

Hospital Charge Code	270613341
Hospital Revenue Code	271
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$25.12
Rate for Payer: Qualcare PPO/HMO/WC	$25.12

MODULE IV DELIVERY PURPLE

Facility

$167.50

Hospital Charge Code	270613341
Hospital Revenue Code	271
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$83.75
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare Advantage	$50.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.71
Rate for Payer: Cigna Commercial	$83.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.25
Rate for Payer: Oxford Commercial	$33.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.12
Rate for Payer: UnitedHealthcare Commercial	$33.50
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$4.44

MODULE IV DELIVERY RED

Facility

$167.50

Hospital Charge Code	270613340
Hospital Revenue Code	271
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$83.75
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare Advantage	$50.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.71
Rate for Payer: Cigna Commercial	$83.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.25
Rate for Payer: Oxford Commercial	$33.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.12
Rate for Payer: UnitedHealthcare Commercial	$33.50
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$4.44

MODULE IV DELIVERY RED

Facility

$167.50

Hospital Charge Code	270613340
Hospital Revenue Code	271
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$25.12
Rate for Payer: Qualcare PPO/HMO/WC	$25.12

MODULE IV DELIVERY YELLOW

Facility

$167.50

Hospital Charge Code	270613342
Hospital Revenue Code	271
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$25.12
Rate for Payer: Qualcare PPO/HMO/WC	$25.12

MODULE IV DELIVERY YELLOW

Facility

$167.50

Hospital Charge Code	270613342
Hospital Revenue Code	271
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$83.75
Rate for Payer: Aetna Commercial	$63.65
Rate for Payer: Aetna Medicare Advantage	$50.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.71
Rate for Payer: Cigna Commercial	$83.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.25
Rate for Payer: Oxford Commercial	$33.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.12
Rate for Payer: UnitedHealthcare Commercial	$33.50
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$4.44

MODULE NVM5 NEXT GEN EMG

Facility

$5,500.00

Hospital Charge Code	270691454
Hospital Revenue Code	270
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

MODULE NVM5 NEXT GEN EMG

Facility

$5,500.00

Hospital Charge Code	270691454
Hospital Revenue Code	270
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,650.00
Rate for Payer: Oxford Commercial	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Commercial	$1,100.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

MODULE OXYGEN DELIVERY BLUE

Facility

$60.00

Hospital Charge Code	270613278
Hospital Revenue Code	270
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

MODULE OXYGEN DELIVERY BLUE

Facility

$60.00

Hospital Charge Code	270613278
Hospital Revenue Code	270
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

MODULE OXYGEN DELIVERY GREEN

Facility

$120.00

Hospital Charge Code	270613280
Hospital Revenue Code	271
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.00
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$24.00
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

MODULE OXYGEN DELIVERY GREEN

Facility

$120.00

Hospital Charge Code	270613280
Hospital Revenue Code	271
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

MODULE OXYGEN DELIVERY ORANGE

Facility

$60.00

Hospital Charge Code	270613279
Hospital Revenue Code	270
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

MODULE OXYGEN DELIVERY ORANGE

Facility

$60.00

Hospital Charge Code	270613279
Hospital Revenue Code	270
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

MODULE OXYGEN DELIVERY PURPLE

Facility

$60.00

Hospital Charge Code	270613275
Hospital Revenue Code	270
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare Advantage	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.30
Rate for Payer: Cigna Commercial	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.00
Rate for Payer: Oxford Commercial	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Commercial	$12.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

Know your out-of-pocket cost for care.

All Charges