Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TUBE TRACH CUFFL #8 FEN

Facility

$511.00

Service Code	HCPCS A4622
Hospital Charge Code	270600050
Hospital Revenue Code	274
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$255.50
Rate for Payer: Aetna Commercial	$194.18
Rate for Payer: Aetna Medicare Advantage	$153.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.31
Rate for Payer: Cigna Commercial	$255.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.42
Rate for Payer: Qualcare PPO/HMO/WC	$76.65
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$13.54

TUBE TRACH CUFFL #8 FEN

Facility

$511.00

Service Code	HCPCS A4622
Hospital Charge Code	270600050
Hospital Revenue Code	274
Min. Negotiated Rate	$76.65
Max. Negotiated Rate	$123.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.42
Rate for Payer: Qualcare PPO/HMO/WC	$76.65

TUBE TRACH CUFFL #8 NON-FEN

Facility

$486.00

Service Code	HCPCS A4622
Hospital Charge Code	270600042
Hospital Revenue Code	274
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.92
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

TUBE TRACH CUFFL #8 NON-FEN

Facility

$486.00

Service Code	HCPCS A4622
Hospital Charge Code	270600042
Hospital Revenue Code	274
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$117.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.92
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

TUBE TRACH CUFFLESS 6CFN

Facility

$222.45

Hospital Charge Code	270646379
Hospital Revenue Code	271
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$33.37
Rate for Payer: Qualcare PPO/HMO/WC	$33.37

TUBE TRACH CUFFLESS 6CFN

Facility

$222.45

Hospital Charge Code	270646379
Hospital Revenue Code	271
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$111.22
Rate for Payer: Aetna Commercial	$84.53
Rate for Payer: Aetna Medicare Advantage	$66.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.72
Rate for Payer: Cigna Commercial	$111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.73
Rate for Payer: Oxford Commercial	$44.49
Rate for Payer: Qualcare PPO/HMO/WC	$33.37
Rate for Payer: UnitedHealthcare Commercial	$44.49
Rate for Payer: UnitedHealthcare Community & State	$5.36
Rate for Payer: Wellpoint Medicaid Managed Care	$5.89

TUBE TRACH CUFFLESS FE 8 8DCFN

Facility

$173.65

Hospital Charge Code	270302423
Hospital Revenue Code	272
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

TUBE TRACH CUFFLESS FE 8 8DCFN

Facility

$173.65

Hospital Charge Code	270302423
Hospital Revenue Code	272
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$65.99
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.09
Rate for Payer: Oxford Commercial	$34.73
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$34.73
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.60

TUBE TRACH CUFFLESS FEN 10DCFN

Facility

$186.90

Hospital Charge Code	270302424
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$93.45
Rate for Payer: Aetna Commercial	$71.02
Rate for Payer: Aetna Medicare Advantage	$56.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.66
Rate for Payer: Cigna Commercial	$93.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.07
Rate for Payer: Oxford Commercial	$37.38
Rate for Payer: Qualcare PPO/HMO/WC	$28.04
Rate for Payer: UnitedHealthcare Commercial	$37.38
Rate for Payer: UnitedHealthcare Community & State	$4.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.95

TUBE TRACH CUFFLESS FEN 10DCFN

Facility

$186.90

Hospital Charge Code	270302424
Hospital Revenue Code	272
Min. Negotiated Rate	$28.04
Max. Negotiated Rate	$28.04
Rate for Payer: Qualcare PPO/HMO/WC	$28.04

TUBE TRACH CUFFLESS FENS 6DCFN

Facility

$232.05

Hospital Charge Code	270302422
Hospital Revenue Code	272
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$116.03
Rate for Payer: Aetna Commercial	$88.18
Rate for Payer: Aetna Medicare Advantage	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.17
Rate for Payer: Cigna Commercial	$116.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.61
Rate for Payer: Oxford Commercial	$46.41
Rate for Payer: Qualcare PPO/HMO/WC	$34.81
Rate for Payer: UnitedHealthcare Commercial	$46.41
Rate for Payer: UnitedHealthcare Community & State	$5.59
Rate for Payer: Wellpoint Medicaid Managed Care	$6.15

TUBE TRACH CUFFLESS FENS 6DCFN

Facility

$232.05

Hospital Charge Code	270302422
Hospital Revenue Code	272
Min. Negotiated Rate	$34.81
Max. Negotiated Rate	$34.81
Rate for Payer: Qualcare PPO/HMO/WC	$34.81

TUBE TRACH CUFFLESS FNES 4DCFN

Facility

$229.85

Hospital Charge Code	270302421
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$114.92
Rate for Payer: Aetna Commercial	$87.34
Rate for Payer: Aetna Medicare Advantage	$68.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.61
Rate for Payer: Cigna Commercial	$114.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.95
Rate for Payer: Oxford Commercial	$45.97
Rate for Payer: Qualcare PPO/HMO/WC	$34.48
Rate for Payer: UnitedHealthcare Commercial	$45.97
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

TUBE TRACH CUFFLESS FNES 4DCFN

Facility

$229.85

Hospital Charge Code	270302421
Hospital Revenue Code	272
Min. Negotiated Rate	$34.48
Max. Negotiated Rate	$34.48
Rate for Payer: Qualcare PPO/HMO/WC	$34.48

TUBE TRACH CUFFLESS N/F 4DCFS

Facility

$182.05

Hospital Charge Code	270602428
Hospital Revenue Code	272
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$91.03
Rate for Payer: Aetna Commercial	$69.18
Rate for Payer: Aetna Medicare Advantage	$54.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.42
Rate for Payer: Cigna Commercial	$91.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.62
Rate for Payer: Oxford Commercial	$36.41
Rate for Payer: Qualcare PPO/HMO/WC	$27.31
Rate for Payer: UnitedHealthcare Commercial	$36.41
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.82

TUBE TRACH CUFFLESS N/F 4DCFS

Facility

$182.05

Hospital Charge Code	270602428
Hospital Revenue Code	272
Min. Negotiated Rate	$27.31
Max. Negotiated Rate	$27.31
Rate for Payer: Qualcare PPO/HMO/WC	$27.31

TUBE TRACH CUFFLESS N/F 8DCFS

Facility

$176.75

Hospital Charge Code	270602430
Hospital Revenue Code	272
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Qualcare PPO/HMO/WC	$26.51

TUBE TRACH CUFFLESS N/F 8DCFS

Facility

$176.75

Hospital Charge Code	270602430
Hospital Revenue Code	272
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$88.38
Rate for Payer: Aetna Commercial	$67.17
Rate for Payer: Aetna Medicare Advantage	$53.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.07
Rate for Payer: Cigna Commercial	$88.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.02
Rate for Payer: Oxford Commercial	$35.35
Rate for Payer: Qualcare PPO/HMO/WC	$26.51
Rate for Payer: UnitedHealthcare Commercial	$35.35
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: Wellpoint Medicaid Managed Care	$4.68

TUBE TRACH CUFFLESS N/FENES 10

Facility

$173.65

Hospital Charge Code	270302431
Hospital Revenue Code	272
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$65.99
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.09
Rate for Payer: Oxford Commercial	$34.73
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$34.73
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.60

TUBE TRACH CUFFLESS N/FENES 10

Facility

$173.65

Hospital Charge Code	270302431
Hospital Revenue Code	272
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

TUBE TRACH CUFFLESS N/FENES 6

Facility

$174.40

Hospital Charge Code	270302429
Hospital Revenue Code	272
Min. Negotiated Rate	$26.16
Max. Negotiated Rate	$26.16
Rate for Payer: Qualcare PPO/HMO/WC	$26.16

TUBE TRACH CUFFLESS N/FENES 6

Facility

$174.40

Hospital Charge Code	270302429
Hospital Revenue Code	272
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$87.20
Rate for Payer: Aetna Commercial	$66.27
Rate for Payer: Aetna Medicare Advantage	$52.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.47
Rate for Payer: Cigna Commercial	$87.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.32
Rate for Payer: Oxford Commercial	$34.88
Rate for Payer: Qualcare PPO/HMO/WC	$26.16
Rate for Payer: UnitedHealthcare Commercial	$34.88
Rate for Payer: UnitedHealthcare Community & State	$4.20
Rate for Payer: Wellpoint Medicaid Managed Care	$4.62

TUBE TRACH CUFFLESS N/FENES 8

Facility

$173.65

Hospital Charge Code	270302430
Hospital Revenue Code	272
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$65.99
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.09
Rate for Payer: Oxford Commercial	$34.73
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Commercial	$34.73
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.60

TUBE TRACH CUFFLESS N/FENES 8

Facility

$173.65

Hospital Charge Code	270302430
Hospital Revenue Code	272
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

TUBE TRACH CUFFL FENES #4-8***

Facility

$219.00

Hospital Charge Code	8004319
Hospital Revenue Code	274
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$109.50
Rate for Payer: Aetna Commercial	$83.22
Rate for Payer: Aetna Medicare Advantage	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.84
Rate for Payer: Cigna Commercial	$109.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.18
Rate for Payer: Qualcare PPO/HMO/WC	$32.85
Rate for Payer: UnitedHealthcare Community & State	$5.28
Rate for Payer: Wellpoint Medicaid Managed Care	$5.80

Know your out-of-pocket cost for care.

All Charges