Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

O2 CANNULA CONTINOUS SUBSEQ***

Facility

$33.00

Service Code	HCPCS A4615
Hospital Charge Code	9500367
Hospital Revenue Code	279
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

O2 CANNULA CONTINUOUS

Facility

$106.00

Service Code	HCPCS A4615
Hospital Charge Code	9500364
Hospital Revenue Code	279
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Oxford Commercial	$21.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$21.20
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

O2 CANNULA CONTINUOUS

Facility

$106.00

Service Code	HCPCS A4615
Hospital Charge Code	9500364
Hospital Revenue Code	279
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

O2 CANNULA PRN***

Facility

$33.00

Hospital Charge Code	9500372
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

O2 CANNULA PRN***

Facility

$33.00

Hospital Charge Code	9500372
Hospital Revenue Code	279
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

O2 HUMIDIFIER

Facility

$16.85

Hospital Charge Code	270604476
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

O2 HUMIDIFIER

Facility

$16.85

Hospital Charge Code	270604476
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

O2 MASK CONT INIT W/SUPPL*****

Facility

$60.00

Service Code	HCPCS A4620
Hospital Charge Code	9500381
Hospital Revenue Code	279
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

O2 MASK CONT INIT W/SUPPL*****

Facility

$60.00

Service Code	HCPCS A4620
Hospital Charge Code	9500381
Hospital Revenue Code	279
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

O2 MASK CONTINOUS - SUBSEQ***

Facility

$36.30

Service Code	HCPCS A4620
Hospital Charge Code	9500382
Hospital Revenue Code	279
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$5.45

O2 MASK CONTINOUS - SUBSEQ***

Facility

$36.30

Service Code	HCPCS A4620
Hospital Charge Code	9500382
Hospital Revenue Code	279
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.15
Rate for Payer: Aetna Commercial	$13.79
Rate for Payer: Aetna Medicare Advantage	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.26
Rate for Payer: Cigna Commercial	$18.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Oxford Commercial	$7.26
Rate for Payer: Qualcare PPO/HMO/WC	$5.45
Rate for Payer: UnitedHealthcare Commercial	$7.26
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

O2 MASK CONTINUOUS

Facility

$111.00

Service Code	HCPCS A4620
Hospital Charge Code	9500380
Hospital Revenue Code	279
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$55.50
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$22.20
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

O2 MASK CONTINUOUS

Facility

$111.00

Service Code	HCPCS A4620
Hospital Charge Code	9500380
Hospital Revenue Code	279
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

O2 MASK PRN***

Facility

$52.80

Hospital Charge Code	9500398
Hospital Revenue Code	279
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.40
Rate for Payer: Aetna Commercial	$20.06
Rate for Payer: Aetna Medicare Advantage	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.46
Rate for Payer: Cigna Commercial	$26.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.84
Rate for Payer: Oxford Commercial	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$7.92
Rate for Payer: UnitedHealthcare Commercial	$10.56
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

O2 MASK PRN***

Facility

$52.80

Hospital Charge Code	9500398
Hospital Revenue Code	279
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$7.92
Rate for Payer: Qualcare PPO/HMO/WC	$7.92

O2 SENSOR OHMEDA ASR113P90

Facility

$1,000.00

Hospital Charge Code	270660188
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

O2 SENSOR OHMEDA ASR113P90

Facility

$1,000.00

Hospital Charge Code	270660188
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

O2 THERAPY INITIAL

Facility

$93.05

Hospital Charge Code	9509902
Hospital Revenue Code	270
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$46.52
Rate for Payer: Aetna Commercial	$35.36
Rate for Payer: Aetna Medicare Advantage	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.73
Rate for Payer: Cigna Commercial	$46.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.91
Rate for Payer: Oxford Commercial	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$13.96
Rate for Payer: UnitedHealthcare Commercial	$18.61
Rate for Payer: UnitedHealthcare Community & State	$2.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.47

O2 THERAPY INITIAL

Facility

$93.05

Hospital Charge Code	9509902
Hospital Revenue Code	270
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$13.96
Rate for Payer: Qualcare PPO/HMO/WC	$13.96

O2 VENTI MASK CONTINOUS

Facility

$137.00

Service Code	HCPCS A4620
Hospital Charge Code	9500406
Hospital Revenue Code	279
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

O2 VENTI MASK CONTINOUS

Facility

$137.00

Service Code	HCPCS A4620
Hospital Charge Code	9500406
Hospital Revenue Code	279
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$68.50
Rate for Payer: Aetna Commercial	$52.06
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.10
Rate for Payer: Oxford Commercial	$27.40
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Commercial	$27.40
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

O2 VENTI MASK CONT SUBSEQ****

Facility

$33.00

Service Code	HCPCS A4620
Hospital Charge Code	9500408
Hospital Revenue Code	419
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1,550.00
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	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

O2 VENTI MASK CONT SUBSEQ****

Facility

$33.00

Service Code	HCPCS A4620
Hospital Charge Code	9500408
Hospital Revenue Code	419
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

O2 VENTI MASK PRN*****

Facility

$40.80

Hospital Charge Code	9500414
Hospital Revenue Code	279
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$6.12
Rate for Payer: Qualcare PPO/HMO/WC	$6.12

O2 VENTI MASK PRN*****

Facility

$40.80

Hospital Charge Code	9500414
Hospital Revenue Code	279
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$20.40
Rate for Payer: Aetna Commercial	$15.50
Rate for Payer: Aetna Medicare Advantage	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.40
Rate for Payer: Cigna Commercial	$20.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.24
Rate for Payer: Oxford Commercial	$8.16
Rate for Payer: Qualcare PPO/HMO/WC	$6.12
Rate for Payer: UnitedHealthcare Commercial	$8.16
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.08

Know your out-of-pocket cost for care.

All Charges