Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TEAR DRO GUIDE WIRE

Facility

$845.00

Service Code	HCPCS C1769
Hospital Charge Code	270657835
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.90
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

TEARS NATURAL EYE FORTE

Facility

$57.89

Service Code	NDC 65042623
Hospital Charge Code	606351021
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$22.00
Rate for Payer: Aetna Medicare Advantage	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.76
Rate for Payer: Cigna Commercial	$28.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.37
Rate for Payer: Oxford Commercial	$11.58
Rate for Payer: Qualcare PPO/HMO/WC	$8.68
Rate for Payer: UnitedHealthcare Commercial	$11.58
Rate for Payer: UnitedHealthcare Community & State	$1.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

TEARS NATURAL EYE FORTE

Facility

$62.02

Hospital Charge Code	606380013
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$31.01
Rate for Payer: Aetna Commercial	$23.57
Rate for Payer: Aetna Medicare Advantage	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.82
Rate for Payer: Cigna Commercial	$31.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Oxford Commercial	$12.40
Rate for Payer: Qualcare PPO/HMO/WC	$9.30
Rate for Payer: UnitedHealthcare Commercial	$12.40
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

TEARS NATURAL EYE FORTE

Facility

$57.89

Service Code	NDC 65042623
Hospital Charge Code	606351021
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.68

TEARS NATURAL EYE FORTE

Facility

$62.02

Hospital Charge Code	606380013
Hospital Revenue Code	250
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

TEDRAL/TAB

Facility

$3.00

Hospital Charge Code	60634399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEDRAL/TAB

Facility

$3.00

Hospital Charge Code	60634399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TEFLON BLOCK

Facility

$149.00

Hospital Charge Code	270335240
Hospital Revenue Code	272
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

TEFLON BLOCK

Facility

$149.00

Hospital Charge Code	270335240
Hospital Revenue Code	272
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$74.50
Rate for Payer: Aetna Commercial	$56.62
Rate for Payer: Aetna Medicare Advantage	$44.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.99
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.70
Rate for Payer: Oxford Commercial	$29.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$29.80
Rate for Payer: UnitedHealthcare Community & State	$3.59
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

TEFLON COATED GUIDE WIRE

Facility

$115.00

Hospital Charge Code	270330509
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.30
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

TEFLON COATED GUIDE WIRE

Facility

$115.00

Hospital Charge Code	270330509
Hospital Revenue Code	278
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.30
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Community & State	$2.77
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

TEFLON COATED STR. WIRE GUIDE

Facility

$211.00

Hospital Charge Code	270331705
Hospital Revenue Code	272
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$105.50
Rate for Payer: Aetna Commercial	$80.18
Rate for Payer: Aetna Medicare Advantage	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.80
Rate for Payer: Cigna Commercial	$105.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.30
Rate for Payer: Oxford Commercial	$42.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.65
Rate for Payer: UnitedHealthcare Commercial	$42.20
Rate for Payer: UnitedHealthcare Community & State	$5.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

TEFLON COATED STR. WIRE GUIDE

Facility

$211.00

Hospital Charge Code	270331705
Hospital Revenue Code	272
Min. Negotiated Rate	$31.65
Max. Negotiated Rate	$31.65
Rate for Payer: Qualcare PPO/HMO/WC	$31.65

TEGADERM 4 X 4 3/4

Facility

$125.50

Hospital Charge Code	270655053
Hospital Revenue Code	270
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$62.75
Rate for Payer: Aetna Commercial	$47.69
Rate for Payer: Aetna Medicare Advantage	$37.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.00
Rate for Payer: Cigna Commercial	$62.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.65
Rate for Payer: Oxford Commercial	$25.10
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Commercial	$25.10
Rate for Payer: UnitedHealthcare Community & State	$3.02
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

TEGADERM 4 X 4 3/4

Facility

$125.50

Hospital Charge Code	270655053
Hospital Revenue Code	270
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$18.82

TEGADERM FILM 3M 8X12

Facility

$8.89

Hospital Charge Code	270655592
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.45
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.27
Rate for Payer: Cigna Commercial	$4.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.67
Rate for Payer: Oxford Commercial	$1.78
Rate for Payer: Qualcare PPO/HMO/WC	$1.33
Rate for Payer: UnitedHealthcare Commercial	$1.78
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

TEGADERM FILM 3M 8X12

Facility

$8.89

Hospital Charge Code	270655592
Hospital Revenue Code	270
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

TEGADERM HP OV 1 7/8 X 2 3/8

Facility

$4.85

Hospital Charge Code	270350206
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TEGADERM HP OV 1 7/8 X 2 3/8

Facility

$4.85

Hospital Charge Code	270350206
Hospital Revenue Code	272
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TEGADERM HP OV 3 1/2 X 4******

Facility

$5.00

Hospital Charge Code	8003733
Hospital Revenue Code	272
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

TEGADERM HP OV 3 1/2 X 4******

Facility

$5.00

Hospital Charge Code	8003733
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TEGADERM HP OV 3 1/2X4

Facility

$12.85

Hospital Charge Code	270350207
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

TEGADERM HP OV 3 1/2X4

Facility

$12.85

Hospital Charge Code	270350207
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

TEGADERM HP OV 5 1/2 X 7*****

Facility

$12.00

Hospital Charge Code	8003741
Hospital Revenue Code	272
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

TEGADERM HP OV 5 1/2 X 7*****

Facility

$12.00

Hospital Charge Code	8003741
Hospital Revenue Code	272
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

Know your out-of-pocket cost for care.

All Charges