Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TA 55 3.5/4.8 LOAD UNIT *****

Facility

$140.00

Hospital Charge Code	1601012
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TA 55 3.5/4.8 LOAD UNIT *****

Facility

$140.00

Hospital Charge Code	1601012
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.00
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$28.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

TA 55 3.5 MULTIF STAPLE ******

Facility

$505.00

Hospital Charge Code	1600998
Hospital Revenue Code	272
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$101.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

TA 55 3.5 MULTIF STAPLE ******

Facility

$505.00

Hospital Charge Code	1600998
Hospital Revenue Code	272
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

TA 90 LONG 3.5 4.8 *****

Facility

$301.00

Hospital Charge Code	1600949
Hospital Revenue Code	272
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$150.50
Rate for Payer: Aetna Commercial	$114.38
Rate for Payer: Aetna Medicare Advantage	$90.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.75
Rate for Payer: Cigna Commercial	$150.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.30
Rate for Payer: Oxford Commercial	$60.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.15
Rate for Payer: UnitedHealthcare Commercial	$60.20
Rate for Payer: UnitedHealthcare Community & State	$7.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

TA 90 LONG 3.5 4.8 *****

Facility

$301.00

Hospital Charge Code	1600949
Hospital Revenue Code	272
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$45.15
Rate for Payer: Qualcare PPO/HMO/WC	$45.15

T & A,AGE 12 OR MORE

Facility

$22,732.05

Service Code	HCPCS 42821
Hospital Charge Code	1600000630
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.81
Max. Negotiated Rate	$3,409.81
Rate for Payer: Qualcare PPO/HMO/WC	$3,409.81

T & A,AGE 12 OR MORE

Facility

$22,732.05

Service Code	HCPCS 42821
Hospital Charge Code	1600000630
Hospital Revenue Code	360
Min. Negotiated Rate	$547.84
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	$1,742.00
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	$6,819.61
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,409.81
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$547.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$602.40

TA ARTHRODESIS P/PL- 1L,BLW C2

Facility

$40,491.68

Service Code	HCPCS 22600
Hospital Charge Code	16000673
Hospital Revenue Code	360
Min. Negotiated Rate	$975.85
Max. Negotiated Rate	$75,192.36
Rate for Payer: Aetna Commercial	$56,659.34
Rate for Payer: Aetna Medicare Advantage	$67,491.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,192.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,192.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,830.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75,192.36
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: Cigna Medicare Advantage	$20,830.64
Rate for Payer: Clover Medicare Advantage	$19,789.11
Rate for Payer: EmblemHealth Commercial	$62,491.92
Rate for Payer: Humana Medicare Advantage	$21,455.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,830.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,147.50
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,073.75
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$975.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,830.64
Rate for Payer: Wellcare Medicare Advantage	$20,830.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1,073.03

TA ARTHRODESIS P/PL- 1L,BLW C2

Facility

$40,491.68

Service Code	HCPCS 22600
Hospital Charge Code	16000673
Hospital Revenue Code	360
Min. Negotiated Rate	$6,073.75
Max. Negotiated Rate	$6,073.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,073.75

TA ARTIFIC DISC ADDL

Facility

$47,548.90

Service Code	HCPCS 22857
Hospital Charge Code	1600000870
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

TA ARTIFIC DISC ADDL

Facility

$47,548.90

Service Code	HCPCS 22857
Hospital Charge Code	1600000870
Hospital Revenue Code	360
Min. Negotiated Rate	$1,145.93
Max. Negotiated Rate	$75,192.36
Rate for Payer: Aetna Commercial	$56,659.34
Rate for Payer: Aetna Medicare Advantage	$67,491.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,192.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,192.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,830.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75,192.36
Rate for Payer: Cigna Commercial	$41,754.94
Rate for Payer: Cigna Medicare Advantage	$20,830.64
Rate for Payer: Clover Medicare Advantage	$19,789.11
Rate for Payer: EmblemHealth Commercial	$62,491.92
Rate for Payer: Humana Medicare Advantage	$21,455.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,830.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,264.67
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,145.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,830.64
Rate for Payer: Wellcare Medicare Advantage	$20,830.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1,260.05

TAB ELECTRODE ADAPTOR TO LEAD

Facility

$9.00

Hospital Charge Code	270616942
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

TAB ELECTRODE ADAPTOR TO LEAD

Facility

$9.00

Hospital Charge Code	270616942
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TAB EXTENSION

Facility

$1,187.50

Service Code	HCPCS C1713
Hospital Charge Code	270705517
Hospital Revenue Code	278
Min. Negotiated Rate	$28.62
Max. Negotiated Rate	$593.75
Rate for Payer: Aetna Commercial	$451.25
Rate for Payer: Aetna Medicare Advantage	$356.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$302.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$302.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$302.81
Rate for Payer: Cigna Commercial	$593.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$261.25
Rate for Payer: Qualcare PPO/HMO/WC	$178.12
Rate for Payer: UnitedHealthcare Community & State	$28.62
Rate for Payer: Wellpoint Medicaid Managed Care	$31.47

TAB EXTENSION

Facility

$1,187.50

Service Code	HCPCS C1713
Hospital Charge Code	270705517
Hospital Revenue Code	278
Min. Negotiated Rate	$178.12
Max. Negotiated Rate	$287.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$261.25
Rate for Payer: Qualcare PPO/HMO/WC	$178.12

TACE/25MG/CAP

Facility

$8.00

Hospital Charge Code	60633950
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

TACE/25MG/CAP

Facility

$8.00

Hospital Charge Code	60633950
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

TACK BNX PATELLA 3.5 20 523520

Facility

$1,250.00

Hospital Charge Code	270620668
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

TACK BNX PATELLA 3.5 20 523520

Facility

$1,250.00

Hospital Charge Code	270620668
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

TACK PLATE

Facility

$770.00

Service Code	HCPCS C1713
Hospital Charge Code	270676418
Hospital Revenue Code	278
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$186.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$115.50

TACK PLATE

Facility

$770.00

Service Code	HCPCS C1713
Hospital Charge Code	270676418
Hospital Revenue Code	278
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$385.00
Rate for Payer: Aetna Commercial	$292.60
Rate for Payer: Aetna Medicare Advantage	$231.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.35
Rate for Payer: Cigna Commercial	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$115.50
Rate for Payer: UnitedHealthcare Community & State	$18.56
Rate for Payer: Wellpoint Medicaid Managed Care	$20.41

TACRINE CAP 20MG

Facility

$10.90

Hospital Charge Code	6008809
Hospital Revenue Code	252
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

TACRINE CAP 20MG

Facility

$10.90

Hospital Charge Code	6008809
Hospital Revenue Code	252
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

TACRINE CAP 30MG

Facility

$10.90

Hospital Charge Code	6008817
Hospital Revenue Code	252
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

Know your out-of-pocket cost for care.

All Charges