Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TUBE TRACH #6DCT

Facility

$194.55

Hospital Charge Code	270649905
Hospital Revenue Code	272
Min. Negotiated Rate	$29.18
Max. Negotiated Rate	$29.18
Rate for Payer: Qualcare PPO/HMO/WC	$29.18

TUBE TRACH 7.0mm XLT CUFFED

Facility

$319.30

Hospital Charge Code	270643231
Hospital Revenue Code	272
Min. Negotiated Rate	$47.90
Max. Negotiated Rate	$47.90
Rate for Payer: Qualcare PPO/HMO/WC	$47.90

TUBE TRACH 7.0mm XLT CUFFED

Facility

$319.30

Hospital Charge Code	270643231
Hospital Revenue Code	272
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$159.65
Rate for Payer: Aetna Commercial	$121.33
Rate for Payer: Aetna Medicare Advantage	$95.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.42
Rate for Payer: Cigna Commercial	$159.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.79
Rate for Payer: Oxford Commercial	$63.86
Rate for Payer: Qualcare PPO/HMO/WC	$47.90
Rate for Payer: UnitedHealthcare Commercial	$63.86
Rate for Payer: UnitedHealthcare Community & State	$7.70
Rate for Payer: Wellpoint Medicaid Managed Care	$8.46

TUBE TRACH #7 W/SINGLE CANNULA

Facility

$120.00

Hospital Charge Code	270620412
Hospital Revenue Code	272
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

TUBE TRACH #7 W/SINGLE CANNULA

Facility

$120.00

Hospital Charge Code	270620412
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

TUBE TRACH 8.0 DBL CUFF 531080

Facility

$325.00

Hospital Charge Code	270617486
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

TUBE TRACH 8.0 DBL CUFF 531080

Facility

$325.00

Hospital Charge Code	270617486
Hospital Revenue Code	272
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$65.00
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

TUBE TRACH CUFFED 7MM

Facility

$549.85

Service Code	HCPCS A7521
Hospital Charge Code	270699906
Hospital Revenue Code	272
Min. Negotiated Rate	$82.48
Max. Negotiated Rate	$82.48
Rate for Payer: Qualcare PPO/HMO/WC	$82.48

TUBE TRACH CUFFED 7MM

Facility

$549.85

Service Code	HCPCS A7521
Hospital Charge Code	270699906
Hospital Revenue Code	272
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$274.93
Rate for Payer: Aetna Commercial	$208.94
Rate for Payer: Aetna Medicare Advantage	$164.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.21
Rate for Payer: Cigna Commercial	$274.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.96
Rate for Payer: Oxford Commercial	$109.97
Rate for Payer: Qualcare PPO/HMO/WC	$82.48
Rate for Payer: UnitedHealthcare Commercial	$109.97
Rate for Payer: UnitedHealthcare Community & State	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

TUBE TRACH CUFFED FEN SZ6

Facility

$250.55

Hospital Charge Code	270649903
Hospital Revenue Code	272
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$125.28
Rate for Payer: Aetna Commercial	$95.21
Rate for Payer: Aetna Medicare Advantage	$75.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.89
Rate for Payer: Cigna Commercial	$125.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.17
Rate for Payer: Oxford Commercial	$50.11
Rate for Payer: Qualcare PPO/HMO/WC	$37.58
Rate for Payer: UnitedHealthcare Commercial	$50.11
Rate for Payer: UnitedHealthcare Community & State	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$6.64

TUBE TRACH CUFFED FEN SZ6

Facility

$250.55

Hospital Charge Code	270649903
Hospital Revenue Code	272
Min. Negotiated Rate	$37.58
Max. Negotiated Rate	$37.58
Rate for Payer: Qualcare PPO/HMO/WC	$37.58

TUBE TRACH CUFF FENEST SZ4

Facility

$207.65

Hospital Charge Code	270649308
Hospital Revenue Code	272
Min. Negotiated Rate	$31.15
Max. Negotiated Rate	$31.15
Rate for Payer: Qualcare PPO/HMO/WC	$31.15

TUBE TRACH CUFF FENEST SZ4

Facility

$207.65

Hospital Charge Code	270649308
Hospital Revenue Code	272
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$103.83
Rate for Payer: Aetna Commercial	$78.91
Rate for Payer: Aetna Medicare Advantage	$62.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.95
Rate for Payer: Cigna Commercial	$103.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.30
Rate for Payer: Oxford Commercial	$41.53
Rate for Payer: Qualcare PPO/HMO/WC	$31.15
Rate for Payer: UnitedHealthcare Commercial	$41.53
Rate for Payer: UnitedHealthcare Community & State	$5.00
Rate for Payer: Wellpoint Medicaid Managed Care	$5.50

TUBE TRACH CUFF FENEST SZ8

Facility

$184.50

Hospital Charge Code	270649307
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$92.25
Rate for Payer: Aetna Commercial	$70.11
Rate for Payer: Aetna Medicare Advantage	$55.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.05
Rate for Payer: Cigna Commercial	$92.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.35
Rate for Payer: Oxford Commercial	$36.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.68
Rate for Payer: UnitedHealthcare Commercial	$36.90
Rate for Payer: UnitedHealthcare Community & State	$4.45
Rate for Payer: Wellpoint Medicaid Managed Care	$4.89

TUBE TRACH CUFF FENEST SZ8

Facility

$184.50

Hospital Charge Code	270649307
Hospital Revenue Code	272
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$27.68
Rate for Payer: Qualcare PPO/HMO/WC	$27.68

TUBE TRACH CUFFL #4

Facility

$408.85

Hospital Charge Code	270600045
Hospital Revenue Code	274
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$98.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.95
Rate for Payer: Qualcare PPO/HMO/WC	$61.33

TUBE TRACH CUFFL #4

Facility

$408.85

Hospital Charge Code	270600045
Hospital Revenue Code	274
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$204.43
Rate for Payer: Aetna Commercial	$155.36
Rate for Payer: Aetna Medicare Advantage	$122.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.26
Rate for Payer: Cigna Commercial	$204.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.95
Rate for Payer: Qualcare PPO/HMO/WC	$61.33
Rate for Payer: UnitedHealthcare Community & State	$9.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.83

TUBE TRACH CUFFL #4 NON-FEN

Facility

$388.85

Hospital Charge Code	270600037
Hospital Revenue Code	272
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$194.43
Rate for Payer: Aetna Commercial	$147.76
Rate for Payer: Aetna Medicare Advantage	$116.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.16
Rate for Payer: Cigna Commercial	$194.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.66
Rate for Payer: Oxford Commercial	$77.77
Rate for Payer: Qualcare PPO/HMO/WC	$58.33
Rate for Payer: UnitedHealthcare Commercial	$77.77
Rate for Payer: UnitedHealthcare Community & State	$9.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.30

TUBE TRACH CUFFL #4 NON-FEN

Facility

$388.85

Hospital Charge Code	270600037
Hospital Revenue Code	272
Min. Negotiated Rate	$58.33
Max. Negotiated Rate	$58.33
Rate for Payer: Qualcare PPO/HMO/WC	$58.33

TUBE TRACH CUFFL 5.0

Facility

$1,189.00

Service Code	HCPCS A4622
Hospital Charge Code	270600884
Hospital Revenue Code	274
Min. Negotiated Rate	$178.35
Max. Negotiated Rate	$287.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$261.58
Rate for Payer: Qualcare PPO/HMO/WC	$178.35

TUBE TRACH CUFFL 5.0

Facility

$1,189.00

Service Code	HCPCS A4622
Hospital Charge Code	270600884
Hospital Revenue Code	274
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$594.50
Rate for Payer: Aetna Commercial	$451.82
Rate for Payer: Aetna Medicare Advantage	$356.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.19
Rate for Payer: Cigna Commercial	$594.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$261.58
Rate for Payer: Qualcare PPO/HMO/WC	$178.35
Rate for Payer: UnitedHealthcare Community & State	$28.65
Rate for Payer: Wellpoint Medicaid Managed Care	$31.51

TUBE TRACH CUFFL #6 FEN

Facility

$408.85

Hospital Charge Code	270600048
Hospital Revenue Code	274
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$204.43
Rate for Payer: Aetna Commercial	$155.36
Rate for Payer: Aetna Medicare Advantage	$122.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.26
Rate for Payer: Cigna Commercial	$204.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.95
Rate for Payer: Qualcare PPO/HMO/WC	$61.33
Rate for Payer: UnitedHealthcare Community & State	$9.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.83

TUBE TRACH CUFFL #6 FEN

Facility

$408.85

Hospital Charge Code	270600048
Hospital Revenue Code	274
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$98.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.95
Rate for Payer: Qualcare PPO/HMO/WC	$61.33

TUBE TRACH CUFFL #6 NON-FEN

Facility

$388.85

Hospital Charge Code	270600040
Hospital Revenue Code	274
Min. Negotiated Rate	$58.33
Max. Negotiated Rate	$94.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.55
Rate for Payer: Qualcare PPO/HMO/WC	$58.33

TUBE TRACH CUFFL #6 NON-FEN

Facility

$388.85

Hospital Charge Code	270600040
Hospital Revenue Code	274
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$194.43
Rate for Payer: Aetna Commercial	$147.76
Rate for Payer: Aetna Medicare Advantage	$116.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.16
Rate for Payer: Cigna Commercial	$194.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.55
Rate for Payer: Qualcare PPO/HMO/WC	$58.33
Rate for Payer: UnitedHealthcare Community & State	$9.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.30

Know your out-of-pocket cost for care.

All Charges