Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

O2 VENT MASK CONT INIT W/SUP**

Facility

$66.00

Service Code	HCPCS A4620
Hospital Charge Code	9500407
Hospital Revenue Code	279
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

O2 VENT MASK CONT INIT W/SUP**

Facility

$66.00

Service Code	HCPCS A4620
Hospital Charge Code	9500407
Hospital Revenue Code	279
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

OATS 10MM

Facility

$3,540.00

Hospital Charge Code	270663600
Hospital Revenue Code	270
Min. Negotiated Rate	$531.00
Max. Negotiated Rate	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$531.00

OATS 10MM

Facility

$3,540.00

Hospital Charge Code	270663600
Hospital Revenue Code	270
Min. Negotiated Rate	$85.31
Max. Negotiated Rate	$1,770.00
Rate for Payer: Aetna Commercial	$1,345.20
Rate for Payer: Aetna Medicare Advantage	$1,062.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$902.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$902.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$902.70
Rate for Payer: Cigna Commercial	$1,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,062.00
Rate for Payer: Oxford Commercial	$708.00
Rate for Payer: Qualcare PPO/HMO/WC	$531.00
Rate for Payer: UnitedHealthcare Commercial	$708.00
Rate for Payer: UnitedHealthcare Community & State	$85.31
Rate for Payer: Wellpoint Medicaid Managed Care	$93.81

OAT SET. 10MM

Facility

$2,600.00

Hospital Charge Code	270671283
Hospital Revenue Code	272
Min. Negotiated Rate	$390.00
Max. Negotiated Rate	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$390.00

OAT SET. 10MM

Facility

$2,600.00

Hospital Charge Code	270671283
Hospital Revenue Code	272
Min. Negotiated Rate	$62.66
Max. Negotiated Rate	$1,300.00
Rate for Payer: Aetna Commercial	$988.00
Rate for Payer: Aetna Medicare Advantage	$780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$663.00
Rate for Payer: Cigna Commercial	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.00
Rate for Payer: Oxford Commercial	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$390.00
Rate for Payer: UnitedHealthcare Commercial	$520.00
Rate for Payer: UnitedHealthcare Community & State	$62.66
Rate for Payer: Wellpoint Medicaid Managed Care	$68.90

OAT SET. 6MM

Facility

$3,715.00

Hospital Charge Code	270671281
Hospital Revenue Code	272
Min. Negotiated Rate	$557.25
Max. Negotiated Rate	$557.25
Rate for Payer: Qualcare PPO/HMO/WC	$557.25

OAT SET. 6MM

Facility

$3,715.00

Hospital Charge Code	270671281
Hospital Revenue Code	272
Min. Negotiated Rate	$89.53
Max. Negotiated Rate	$1,857.50
Rate for Payer: Aetna Commercial	$1,411.70
Rate for Payer: Aetna Medicare Advantage	$1,114.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$947.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$947.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$947.33
Rate for Payer: Cigna Commercial	$1,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.50
Rate for Payer: Oxford Commercial	$743.00
Rate for Payer: Qualcare PPO/HMO/WC	$557.25
Rate for Payer: UnitedHealthcare Commercial	$743.00
Rate for Payer: UnitedHealthcare Community & State	$89.53
Rate for Payer: Wellpoint Medicaid Managed Care	$98.45

OAT SET. 8MM

Facility

$3,715.00

Hospital Charge Code	270671282
Hospital Revenue Code	272
Min. Negotiated Rate	$557.25
Max. Negotiated Rate	$557.25
Rate for Payer: Qualcare PPO/HMO/WC	$557.25

OAT SET. 8MM

Facility

$3,715.00

Hospital Charge Code	270671282
Hospital Revenue Code	272
Min. Negotiated Rate	$89.53
Max. Negotiated Rate	$1,857.50
Rate for Payer: Aetna Commercial	$1,411.70
Rate for Payer: Aetna Medicare Advantage	$1,114.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$947.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$947.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$947.33
Rate for Payer: Cigna Commercial	$1,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.50
Rate for Payer: Oxford Commercial	$743.00
Rate for Payer: Qualcare PPO/HMO/WC	$557.25
Rate for Payer: UnitedHealthcare Commercial	$743.00
Rate for Payer: UnitedHealthcare Community & State	$89.53
Rate for Payer: Wellpoint Medicaid Managed Care	$98.45

OATS KIT 8MM

Facility

$3,250.00

Hospital Charge Code	270704124
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

OATS KIT 8MM

Facility

$3,250.00

Hospital Charge Code	270704124
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

OB LIMITED STUDY

Facility

$756.00

Service Code	HCPCS 76815
Hospital Charge Code	94061173
Hospital Revenue Code	402
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$113.40
Rate for Payer: Qualcare PPO/HMO/WC	$113.40

OB LIMITED STUDY

Facility

$756.00

Service Code	HCPCS 76815
Hospital Charge Code	94061173
Hospital Revenue Code	402
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.80
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.40
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$18.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.03

OBS ACCUCHECK (EACH TIME)

Facility

$56.00

Hospital Charge Code	910980
Hospital Revenue Code	301
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

OBS ACCUCHECK (EACH TIME)

Facility

$56.00

Hospital Charge Code	910980
Hospital Revenue Code	301
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

OBS BLOOD TRANSFUSION

Facility

$4,031.23

Service Code	HCPCS 36430
Hospital Charge Code	910925
Hospital Revenue Code	391
Min. Negotiated Rate	$604.68
Max. Negotiated Rate	$604.68
Rate for Payer: Qualcare PPO/HMO/WC	$604.68

OBS BLOOD TRANSFUSION

Facility

$4,031.23

Service Code	HCPCS 36430
Hospital Charge Code	910925
Hospital Revenue Code	391
Min. Negotiated Rate	$97.15
Max. Negotiated Rate	$1,891.95
Rate for Payer: Aetna Commercial	$1,425.63
Rate for Payer: Aetna Medicare Advantage	$1,698.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,891.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,891.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$524.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,891.95
Rate for Payer: Cigna Commercial	$1,050.61
Rate for Payer: Cigna Medicare Advantage	$524.13
Rate for Payer: Clover Medicare Advantage	$497.92
Rate for Payer: EmblemHealth Commercial	$1,572.39
Rate for Payer: Humana Medicare Advantage	$539.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$524.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,209.37
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$604.68
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$97.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$524.13
Rate for Payer: Wellcare Medicare Advantage	$524.13
Rate for Payer: Wellpoint Medicaid Managed Care	$106.83

OBS CARDIAC MONITOR 3 LEAD

Facility

$138.00

Hospital Charge Code	910990
Hospital Revenue Code	730
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.70

OBS CARDIAC MONITOR 3 LEAD

Facility

$138.00

Hospital Charge Code	910990
Hospital Revenue Code	730
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$697.00
Rate for Payer: Aetna Commercial	$52.44
Rate for Payer: Aetna Medicare Advantage	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.19
Rate for Payer: Cigna Commercial	$69.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.40
Rate for Payer: Oxford Commercial	$531.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.70
Rate for Payer: UnitedHealthcare Commercial	$697.00
Rate for Payer: UnitedHealthcare Community & State	$3.33
Rate for Payer: Wellpoint Medicaid Managed Care	$3.66

OBS CATH INSERT-COMPLICATED

Facility

$358.00

Hospital Charge Code	910965
Hospital Revenue Code	761
Min. Negotiated Rate	$53.70
Max. Negotiated Rate	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$53.70

OBS CATH INSERT-COMPLICATED

Facility

$358.00

Hospital Charge Code	910965
Hospital Revenue Code	761
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$179.00
Rate for Payer: Aetna Commercial	$136.04
Rate for Payer: Aetna Medicare Advantage	$107.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.29
Rate for Payer: Cigna Commercial	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.40
Rate for Payer: Oxford Commercial	$71.60
Rate for Payer: Qualcare PPO/HMO/WC	$53.70
Rate for Payer: UnitedHealthcare Commercial	$71.60
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

OBS CATH INSERT-SIMPLE-FOLEY

Facility

$221.00

Hospital Charge Code	910960
Hospital Revenue Code	761
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

OBS CATH INSERT-SIMPLE-FOLEY

Facility

$221.00

Hospital Charge Code	910960
Hospital Revenue Code	761
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$110.50
Rate for Payer: Aetna Commercial	$83.98
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$44.20
Rate for Payer: Qualcare PPO/HMO/WC	$33.15
Rate for Payer: UnitedHealthcare Commercial	$44.20
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

OBS CATH INSERT-STRAIGHT

Facility

$221.00

Hospital Charge Code	910955
Hospital Revenue Code	761
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$110.50
Rate for Payer: Aetna Commercial	$83.98
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$44.20
Rate for Payer: Qualcare PPO/HMO/WC	$33.15
Rate for Payer: UnitedHealthcare Commercial	$44.20
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

Know your out-of-pocket cost for care.

All Charges