Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TPTLC 133 T1PPS SO 13X146MMTP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682727
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

TPTLC 133 T1PPS SO 13X146MMTP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682727
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TRACH 6.0 XLT PROXIMAL CUFFED

Facility

$317.75

Hospital Charge Code	270639966
Hospital Revenue Code	272
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$158.88
Rate for Payer: Aetna Commercial	$120.75
Rate for Payer: Aetna Medicare Advantage	$95.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.03
Rate for Payer: Cigna Commercial	$158.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.33
Rate for Payer: Oxford Commercial	$63.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.66
Rate for Payer: UnitedHealthcare Commercial	$63.55
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: Wellpoint Medicaid Managed Care	$8.42

TRACH 6.0 XLT PROXIMAL CUFFED

Facility

$317.75

Hospital Charge Code	270639966
Hospital Revenue Code	272
Min. Negotiated Rate	$47.66
Max. Negotiated Rate	$47.66
Rate for Payer: Qualcare PPO/HMO/WC	$47.66

TRACH CARE

Facility

$88.00

Hospital Charge Code	8001729
Hospital Revenue Code	270
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.40
Rate for Payer: Oxford Commercial	$17.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$17.60
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

TRACH CARE

Facility

$88.00

Hospital Charge Code	8001729
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

TRACH CARE BALLARD 221

Facility

$30.83

Hospital Charge Code	270645434
Hospital Revenue Code	272
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$4.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.62

TRACH CARE BALLARD 221

Facility

$30.83

Hospital Charge Code	270645434
Hospital Revenue Code	272
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.41
Rate for Payer: Aetna Commercial	$11.72
Rate for Payer: Aetna Medicare Advantage	$9.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.86
Rate for Payer: Cigna Commercial	$15.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.25
Rate for Payer: Oxford Commercial	$6.17
Rate for Payer: Qualcare PPO/HMO/WC	$4.62
Rate for Payer: UnitedHealthcare Commercial	$6.17
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

TRACH CARE KIT 14FR. WITH

Facility

$120.00

Hospital Charge Code	270330844
Hospital Revenue Code	272
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

TRACH CARE KIT 14FR. WITH

Facility

$120.00

Hospital Charge Code	270330844
Hospital Revenue Code	272
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

TRACH CARE KIT 16FR. WITH

Facility

$180.00

Hospital Charge Code	270330843
Hospital Revenue Code	272
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

TRACH CARE KIT 16FR. WITH

Facility

$180.00

Hospital Charge Code	270330843
Hospital Revenue Code	272
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$36.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

TRACH CARE T-P ENDO 0598000220

Facility

$33.50

Hospital Charge Code	270633414
Hospital Revenue Code	272
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.03

TRACH CARE T-P ENDO 0598000220

Facility

$33.50

Hospital Charge Code	270633414
Hospital Revenue Code	272
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.75
Rate for Payer: Aetna Commercial	$12.73
Rate for Payer: Aetna Medicare Advantage	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.54
Rate for Payer: Cigna Commercial	$16.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.05
Rate for Payer: Oxford Commercial	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.03
Rate for Payer: UnitedHealthcare Commercial	$6.70
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

TRACH CARE TP TRACH 0598220135

Facility

$31.00

Hospital Charge Code	270633413
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.30
Rate for Payer: Oxford Commercial	$6.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$6.20
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

TRACH CARE TP TRACH 0598220135

Facility

$31.00

Hospital Charge Code	270633413
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

TRACH CLS SYS DIR TIP W/ CLR

Facility

$37.85

Hospital Charge Code	270659655
Hospital Revenue Code	272
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$5.68
Rate for Payer: Qualcare PPO/HMO/WC	$5.68

TRACH CLS SYS DIR TIP W/ CLR

Facility

$37.85

Hospital Charge Code	270659655
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.93
Rate for Payer: Aetna Commercial	$14.38
Rate for Payer: Aetna Medicare Advantage	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.65
Rate for Payer: Cigna Commercial	$18.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.36
Rate for Payer: Oxford Commercial	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$5.68
Rate for Payer: UnitedHealthcare Commercial	$7.57
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

TRACH DBLE CUFF 9 0 100784090

Facility

$215.20

Hospital Charge Code	270638058
Hospital Revenue Code	272
Min. Negotiated Rate	$32.28
Max. Negotiated Rate	$32.28
Rate for Payer: Qualcare PPO/HMO/WC	$32.28

TRACH DBLE CUFF 9 0 100784090

Facility

$215.20

Hospital Charge Code	270638058
Hospital Revenue Code	272
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$107.60
Rate for Payer: Aetna Commercial	$81.78
Rate for Payer: Aetna Medicare Advantage	$64.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.88
Rate for Payer: Cigna Commercial	$107.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.56
Rate for Payer: Oxford Commercial	$43.04
Rate for Payer: Qualcare PPO/HMO/WC	$32.28
Rate for Payer: UnitedHealthcare Commercial	$43.04
Rate for Payer: UnitedHealthcare Community & State	$5.19
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

TRACHEOBRONCH THRU OLD INCISN

Facility

$7,383.40

Service Code	HCPCS 31615
Hospital Charge Code	1600000575
Hospital Revenue Code	360
Min. Negotiated Rate	$177.94
Max. Negotiated Rate	$2,312.88
Rate for Payer: Aetna Commercial	$1,742.81
Rate for Payer: Aetna Medicare Advantage	$2,076.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$640.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,312.88
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: Cigna Medicare Advantage	$640.74
Rate for Payer: Clover Medicare Advantage	$608.70
Rate for Payer: EmblemHealth Commercial	$1,922.22
Rate for Payer: Humana Medicare Advantage	$659.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$640.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,215.02
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,107.51
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$177.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$640.74
Rate for Payer: Wellcare Medicare Advantage	$640.74
Rate for Payer: Wellpoint Medicaid Managed Care	$195.66

TRACHEOBRONCH THRU OLD INCISN

Facility

$7,383.40

Service Code	HCPCS 31615
Hospital Charge Code	1600000575
Hospital Revenue Code	360
Min. Negotiated Rate	$1,107.51
Max. Negotiated Rate	$1,107.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,107.51

TRACHEOSTOMMY

Facility

$22,083.40

Service Code	HCPCS 31600
Hospital Charge Code	160000244
Hospital Revenue Code	360
Min. Negotiated Rate	$532.21
Max. Negotiated Rate	$14,218.07
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,218.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,218.07
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,625.02
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$532.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,864.72
Rate for Payer: Wellpoint Medicaid Managed Care	$7,710.51

TRACHEOSTOMMY

Facility

$22,083.40

Service Code	HCPCS 31600
Hospital Charge Code	160000244
Hospital Revenue Code	360
Min. Negotiated Rate	$3,312.51
Max. Negotiated Rate	$3,312.51
Rate for Payer: Qualcare PPO/HMO/WC	$3,312.51

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$138,402.17

Service Code	MSDRG 012
Min. Negotiated Rate	$42,141.69
Max. Negotiated Rate	$138,402.17
Rate for Payer: Aetna Medicare Advantage	$138,402.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44,359.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93,044.00
Rate for Payer: Cigna Commercial	$78,898.22
Rate for Payer: Cigna Medicare Advantage	$44,359.67
Rate for Payer: Clover Medicare Advantage	$42,141.69
Rate for Payer: EmblemHealth Commercial	$133,079.01
Rate for Payer: Humana Medicare Advantage	$45,690.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44,359.67
Rate for Payer: Oxford Commercial	$56,705.20
Rate for Payer: UnitedHealthcare Commercial	$99,434.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$44,359.67
Rate for Payer: Wellcare Medicare Advantage	$44,359.67

Know your out-of-pocket cost for care.

All Charges