Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TAGAMET/400MG/TAB

Facility

$5.00

Hospital Charge Code	60633960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TAGAMET/400MG/TAB

Facility

$7.00

Hospital Charge Code	60633952
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

TAGAMET/400MG/TAB

Facility

$5.00

Hospital Charge Code	60633960
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TAGAMET/400MG/TAB

Facility

$6.00

Hospital Charge Code	60633958
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TAGAMET/400MG/TAB

Facility

$6.00

Hospital Charge Code	60633958
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TAGAMET HB 200 M LIQ

Facility

$5.00

Hospital Charge Code	60635343
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TAGAMET HB 200 M LIQ

Facility

$5.00

Hospital Charge Code	60635343
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TAKE DOWN SPLN FLXRE WP CLTMY

Facility

$2,513.20

Service Code	HCPCS 44139
Hospital Charge Code	1600000569
Hospital Revenue Code	360
Min. Negotiated Rate	$376.98
Max. Negotiated Rate	$376.98
Rate for Payer: Qualcare PPO/HMO/WC	$376.98

TAKE DOWN SPLN FLXRE WP CLTMY

Facility

$2,513.20

Service Code	HCPCS 44139
Hospital Charge Code	1600000569
Hospital Revenue Code	360
Min. Negotiated Rate	$60.57
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$955.02
Rate for Payer: Aetna Medicare Advantage	$753.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$640.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$640.87
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	$640.87
Rate for Payer: Cigna Commercial	$1,256.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$753.96
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$376.98
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$60.57
Rate for Payer: Wellpoint Medicaid Managed Care	$66.60

TALAR DOME FLAT CUT SZ 3

Facility

$69,143.90

Service Code	HCPCS C1713
Hospital Charge Code	270704972
Hospital Revenue Code	278
Min. Negotiated Rate	$10,371.58
Max. Negotiated Rate	$16,732.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,828.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,732.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,211.66
Rate for Payer: Qualcare PPO/HMO/WC	$10,371.58

TALAR DOME FLAT CUT SZ 3

Facility

$69,143.90

Service Code	HCPCS C1713
Hospital Charge Code	270704972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,666.37
Max. Negotiated Rate	$34,571.95
Rate for Payer: Aetna Commercial	$26,274.68
Rate for Payer: Aetna Medicare Advantage	$20,743.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,631.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,631.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,828.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,631.69
Rate for Payer: Cigna Commercial	$34,571.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,732.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,211.66
Rate for Payer: Qualcare PPO/HMO/WC	$10,371.58
Rate for Payer: UnitedHealthcare Community & State	$1,666.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1,832.31

TALAR DOME SZ 1 SULCUS

Facility

$18,895.00

Service Code	HCPCS C1776
Hospital Charge Code	270670888
Hospital Revenue Code	278
Min. Negotiated Rate	$2,834.25
Max. Negotiated Rate	$4,572.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,779.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,572.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,156.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,834.25

TALAR DOME SZ 1 SULCUS

Facility

$18,895.00

Service Code	HCPCS C1776
Hospital Charge Code	270670888
Hospital Revenue Code	278
Min. Negotiated Rate	$455.37
Max. Negotiated Rate	$9,447.50
Rate for Payer: Aetna Commercial	$7,180.10
Rate for Payer: Aetna Medicare Advantage	$5,668.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,818.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,818.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,818.23
Rate for Payer: Cigna Commercial	$9,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,572.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,156.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,834.25
Rate for Payer: UnitedHealthcare Community & State	$455.37
Rate for Payer: Wellpoint Medicaid Managed Care	$500.72

TALC 5 GM STERILE POWDER

Facility

$666.65

Service Code	NDC 63256020005
Hospital Charge Code	60628553
Hospital Revenue Code	250
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$333.32
Rate for Payer: Aetna Commercial	$253.33
Rate for Payer: Aetna Medicare Advantage	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.00
Rate for Payer: Cigna Commercial	$333.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.00
Rate for Payer: Oxford Commercial	$133.33
Rate for Payer: Qualcare PPO/HMO/WC	$100.00
Rate for Payer: UnitedHealthcare Commercial	$133.33
Rate for Payer: UnitedHealthcare Community & State	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$17.67

TALC 5 GM STERILE POWDER

Facility

$666.65

Service Code	NDC 63256020005
Hospital Charge Code	60628553
Hospital Revenue Code	250
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.00

TA LONG 90-3.5 STAPLER BLUE

Facility

$653.00

Hospital Charge Code	270334730
Hospital Revenue Code	272
Min. Negotiated Rate	$97.95
Max. Negotiated Rate	$97.95
Rate for Payer: Qualcare PPO/HMO/WC	$97.95

TA LONG 90-3.5 STAPLER BLUE

Facility

$653.00

Hospital Charge Code	270334730
Hospital Revenue Code	272
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$326.50
Rate for Payer: Aetna Commercial	$248.14
Rate for Payer: Aetna Medicare Advantage	$195.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.51
Rate for Payer: Cigna Commercial	$326.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.90
Rate for Payer: Oxford Commercial	$130.60
Rate for Payer: Qualcare PPO/HMO/WC	$97.95
Rate for Payer: UnitedHealthcare Commercial	$130.60
Rate for Payer: UnitedHealthcare Community & State	$15.74
Rate for Payer: Wellpoint Medicaid Managed Care	$17.30

TA LONG 90-4.8 STAPLER GREEN

Facility

$597.00

Hospital Charge Code	270334731
Hospital Revenue Code	272
Min. Negotiated Rate	$89.55
Max. Negotiated Rate	$89.55
Rate for Payer: Qualcare PPO/HMO/WC	$89.55

TA LONG 90-4.8 STAPLER GREEN

Facility

$597.00

Hospital Charge Code	270334731
Hospital Revenue Code	272
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$298.50
Rate for Payer: Aetna Commercial	$226.86
Rate for Payer: Aetna Medicare Advantage	$179.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.24
Rate for Payer: Cigna Commercial	$298.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.10
Rate for Payer: Oxford Commercial	$119.40
Rate for Payer: Qualcare PPO/HMO/WC	$89.55
Rate for Payer: UnitedHealthcare Commercial	$119.40
Rate for Payer: UnitedHealthcare Community & State	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$15.82

TALUS SZ 5 ANKLE TOTAL

Facility

$29,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697284
Hospital Revenue Code	278
Min. Negotiated Rate	$698.90
Max. Negotiated Rate	$14,500.00
Rate for Payer: Aetna Commercial	$11,020.00
Rate for Payer: Aetna Medicare Advantage	$8,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,395.00
Rate for Payer: Cigna Commercial	$14,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,380.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00
Rate for Payer: UnitedHealthcare Community & State	$698.90
Rate for Payer: Wellpoint Medicaid Managed Care	$768.50

TALUS SZ 5 ANKLE TOTAL

Facility

$29,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697284
Hospital Revenue Code	278
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$7,018.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,380.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00

TALUS TOTAL ANKLE SZ2 RT

Facility

$25,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677295
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

TALUS TOTAL ANKLE SZ2 RT

Facility

$25,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677295
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

TALUS TOTAL ANKLE SZ4 RT

Facility

$25,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678162
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

TALUS TOTAL ANKLE SZ4 RT

Facility

$25,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678162
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

Know your out-of-pocket cost for care.

All Charges