Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TACRINE CAP 30MG

Facility

$10.90

Hospital Charge Code	6008817
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 40MG

Facility

$10.90

Hospital Charge Code	6008825
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 40MG

Facility

$10.90

Hospital Charge Code	6008825
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

TACROLIMUS

Facility

$408.85

Service Code	HCPCS 80197
Hospital Charge Code	3006747
Hospital Revenue Code	301
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$204.43
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.56
Rate for Payer: Cigna Commercial	$204.43
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.66
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.33
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.83

TACROLIMUS

Facility

$408.85

Service Code	HCPCS 80197
Hospital Charge Code	3006747
Hospital Revenue Code	301
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$61.33
Rate for Payer: Qualcare PPO/HMO/WC	$61.33

TACROLIMUS

Facility

$303.00

Service Code	HCPCS 80197
Hospital Charge Code	38472920
Hospital Revenue Code	301
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.56
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$8.03

TACROLIMUS

Facility

$303.00

Service Code	HCPCS 80197
Hospital Charge Code	38472920
Hospital Revenue Code	301
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

TACROLIMUS 0.5MG CAP

Facility

$15.75

Hospital Charge Code	606350915
Hospital Revenue Code	636
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.36

TACROLIMUS 0.5MG CAP

Facility

$15.75

Hospital Charge Code	606350915
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.88
Rate for Payer: Aetna Commercial	$5.99
Rate for Payer: Aetna Medicare Advantage	$4.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.02
Rate for Payer: Cigna Commercial	$7.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.36
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

TACROLIMUS 1 MG CAP UD

Facility

$35.04

Service Code	HCPCS J7507
Hospital Charge Code	60629951
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.52
Rate for Payer: Aetna Commercial	$13.32
Rate for Payer: Aetna Medicare Advantage	$10.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.94
Rate for Payer: Cigna Commercial	$17.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.48
Rate for Payer: Qualcare PPO/HMO/WC	$5.26
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

TACROLIMUS 1 MG CAP UD

Facility

$35.04

Service Code	HCPCS J7507
Hospital Charge Code	60629951
Hospital Revenue Code	636
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$8.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.48
Rate for Payer: Qualcare PPO/HMO/WC	$5.26

TACROLIMUS LC/MS/MS

Facility

$390.00

Service Code	HCPCS 80197
Hospital Charge Code	39900011
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TACROLIMUS LC/MS/MS

Facility

$390.00

Service Code	HCPCS 80197
Hospital Charge Code	39900011
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TACROLIUMUS 5MG ORAL

Facility

$149.41

Service Code	HCPCS J7507
Hospital Charge Code	6063943354
Hospital Revenue Code	636
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna Commercial	$56.78
Rate for Payer: Aetna Medicare Advantage	$44.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.10
Rate for Payer: Cigna Commercial	$74.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$22.41
Rate for Payer: UnitedHealthcare Community & State	$3.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.96

TACROLIUMUS 5MG ORAL

Facility

$149.41

Service Code	HCPCS J7507
Hospital Charge Code	6063943354
Hospital Revenue Code	636
Min. Negotiated Rate	$22.41
Max. Negotiated Rate	$36.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$22.41

TACSHIELD 10CMx15CM 31628

Facility

$2,303.75

Hospital Charge Code	270660106
Hospital Revenue Code	278
Min. Negotiated Rate	$345.56
Max. Negotiated Rate	$557.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$557.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.82
Rate for Payer: Qualcare PPO/HMO/WC	$345.56

TACSHIELD 10CMx15CM 31628

Facility

$2,303.75

Hospital Charge Code	270660106
Hospital Revenue Code	278
Min. Negotiated Rate	$55.52
Max. Negotiated Rate	$1,151.88
Rate for Payer: Aetna Commercial	$875.42
Rate for Payer: Aetna Medicare Advantage	$691.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$587.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$587.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$587.46
Rate for Payer: Cigna Commercial	$1,151.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$557.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.82
Rate for Payer: Qualcare PPO/HMO/WC	$345.56
Rate for Payer: UnitedHealthcare Community & State	$55.52
Rate for Payer: Wellpoint Medicaid Managed Care	$61.05

TAC SOL 3ML****

Facility

$164.00

Service Code	HCPCS J3490
Hospital Charge Code	6016232
Hospital Revenue Code	259
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

TAC SOL 3ML****

Facility

$164.00

Service Code	HCPCS J3490
Hospital Charge Code	6016232
Hospital Revenue Code	259
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$82.00
Rate for Payer: Aetna Commercial	$62.32
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.20
Rate for Payer: Oxford Commercial	$32.80
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$32.80
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

TAC SOLUTION 3ML

Facility

$336.00

Hospital Charge Code	60162320
Hospital Revenue Code	250
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

TAC SOLUTION 3ML

Facility

$336.00

Hospital Charge Code	60162320
Hospital Revenue Code	250
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$127.68
Rate for Payer: Aetna Medicare Advantage	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.68
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.80
Rate for Payer: Oxford Commercial	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$67.20
Rate for Payer: UnitedHealthcare Community & State	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$8.90

TACTRA 11MM X 16CM-25CM

Facility

$60,925.00

Service Code	HCPCS C1813
Hospital Charge Code	270689374
Hospital Revenue Code	278
Min. Negotiated Rate	$1,468.29
Max. Negotiated Rate	$30,462.50
Rate for Payer: Aetna Commercial	$23,151.50
Rate for Payer: Aetna Medicare Advantage	$18,277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,535.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,535.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,535.88
Rate for Payer: Cigna Commercial	$30,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,743.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,403.50
Rate for Payer: Qualcare PPO/HMO/WC	$9,138.75
Rate for Payer: UnitedHealthcare Community & State	$1,468.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1,614.51

TACTRA 11MM X 16CM-25CM

Facility

$60,925.00

Service Code	HCPCS C1813
Hospital Charge Code	270689374
Hospital Revenue Code	278
Min. Negotiated Rate	$9,138.75
Max. Negotiated Rate	$14,743.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,743.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,403.50
Rate for Payer: Qualcare PPO/HMO/WC	$9,138.75

TA EXPL PO HEMOR/THRMB/INF,NCK

Facility

$8,183.30

Service Code	HCPCS 35800
Hospital Charge Code	16000939
Hospital Revenue Code	360
Min. Negotiated Rate	$1,227.49
Max. Negotiated Rate	$1,227.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,227.49

TA EXPL PO HEMOR/THRMB/INF,NCK

Facility

$8,183.30

Service Code	HCPCS 35800
Hospital Charge Code	16000939
Hospital Revenue Code	360
Min. Negotiated Rate	$197.22
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,454.99
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,227.49
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$197.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$216.86

Know your out-of-pocket cost for care.

All Charges