Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Tenecteplase 50mg inj

Facility

$28,404.46

Hospital Charge Code	606361032
Hospital Revenue Code	636
Min. Negotiated Rate	$4,260.67
Max. Negotiated Rate	$6,873.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,873.88
Rate for Payer: Qualcare PPO/HMO/WC	$4,260.67

Tenecteplase 50mg inj

Facility

$28,404.46

Hospital Charge Code	606361032
Hospital Revenue Code	636
Min. Negotiated Rate	$684.55
Max. Negotiated Rate	$14,202.23
Rate for Payer: Aetna Commercial	$10,793.69
Rate for Payer: Aetna Medicare Advantage	$8,521.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,243.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,243.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,243.14
Rate for Payer: Cigna Commercial	$14,202.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,873.88
Rate for Payer: Qualcare PPO/HMO/WC	$4,260.67
Rate for Payer: UnitedHealthcare Community & State	$684.55
Rate for Payer: Wellpoint Medicaid Managed Care	$752.72

TEN FUSE PIP ALLOGRAFT 2.0 X 1

Facility

$5,625.00

Hospital Charge Code	270665477
Hospital Revenue Code	270
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$843.75
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

TEN FUSE PIP ALLOGRAFT 2.0 X 1

Facility

$5,625.00

Hospital Charge Code	270665477
Hospital Revenue Code	270
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.50
Rate for Payer: Oxford Commercial	$1,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Commercial	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

TENIVAC 0.5ML PREFILLED SYRING

Facility

$192.76

Service Code	HCPCS 90714
Hospital Charge Code	606350971
Hospital Revenue Code	636
Min. Negotiated Rate	$28.91
Max. Negotiated Rate	$46.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.91

TENIVAC 0.5ML PREFILLED SYRING

Facility

$192.76

Service Code	HCPCS 90714
Hospital Charge Code	606350971
Hospital Revenue Code	636
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$96.38
Rate for Payer: Aetna Commercial	$73.25
Rate for Payer: Aetna Medicare Advantage	$57.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.15
Rate for Payer: Cigna Commercial	$96.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.91
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

TENIVAC EX

Facility

$192.76

Service Code	NDC 49281021515
Hospital Charge Code	606350971X
Hospital Revenue Code	259
Min. Negotiated Rate	$28.91
Max. Negotiated Rate	$28.91
Rate for Payer: Qualcare PPO/HMO/WC	$28.91

TENIVAC EX

Facility

$192.76

Service Code	NDC 49281021515
Hospital Charge Code	606350971X
Hospital Revenue Code	259
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$96.38
Rate for Payer: Aetna Commercial	$73.25
Rate for Payer: Aetna Medicare Advantage	$57.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.15
Rate for Payer: Cigna Commercial	$96.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.83
Rate for Payer: Oxford Commercial	$38.55
Rate for Payer: Qualcare PPO/HMO/WC	$28.91
Rate for Payer: UnitedHealthcare Commercial	$38.55
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

TENJET PERCUTANOUS SYSTEM

Facility

$4,250.00

Hospital Charge Code	270691836
Hospital Revenue Code	272
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,275.00
Rate for Payer: Oxford Commercial	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Commercial	$850.00
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

TENJET PERCUTANOUS SYSTEM

Facility

$4,250.00

Hospital Charge Code	270691836
Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$637.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

TEN-K/10MEQ/TAB

Facility

$3.00

Hospital Charge Code	60633983
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

TEN-K/10MEQ/TAB

Facility

$3.00

Hospital Charge Code	60633983
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TENLYSIS FL/EX TEND FA/W EA TN

Facility

$19,467.90

Service Code	HCPCS 25295
Hospital Charge Code	16000505
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

TENLYSIS FL/EX TEND FA/W EA TN

Facility

$19,467.90

Service Code	HCPCS 25295
Hospital Charge Code	16000505
Hospital Revenue Code	360
Min. Negotiated Rate	$469.18
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,840.37
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$469.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$515.90

TENODESIS BIO 7x23mm AR1570B

Facility

$1,463.25

Hospital Charge Code	270633796
Hospital Revenue Code	278
Min. Negotiated Rate	$219.49
Max. Negotiated Rate	$354.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$292.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$321.92
Rate for Payer: Qualcare PPO/HMO/WC	$219.49

TENODESIS BIO 7x23mm AR1570B

Facility

$1,463.25

Hospital Charge Code	270633796
Hospital Revenue Code	278
Min. Negotiated Rate	$35.26
Max. Negotiated Rate	$731.62
Rate for Payer: Aetna Commercial	$556.03
Rate for Payer: Aetna Medicare Advantage	$438.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$292.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.13
Rate for Payer: Cigna Commercial	$731.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$321.92
Rate for Payer: Qualcare PPO/HMO/WC	$219.49
Rate for Payer: UnitedHealthcare Community & State	$35.26
Rate for Payer: Wellpoint Medicaid Managed Care	$38.78

TENODESIS GRAFT SIZING KIT

Facility

$1,475.00

Hospital Charge Code	270694886
Hospital Revenue Code	279
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

TENODESIS GRAFT SIZING KIT

Facility

$1,475.00

Hospital Charge Code	270694886
Hospital Revenue Code	279
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.50
Rate for Payer: Oxford Commercial	$295.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$295.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

TENODESIS LG TENDON BICEPTSLT

Facility

$44,916.00

Service Code	HCPCS 23430
Hospital Charge Code	16000324
Hospital Revenue Code	360
Min. Negotiated Rate	$6,737.40
Max. Negotiated Rate	$6,737.40
Rate for Payer: Qualcare PPO/HMO/WC	$6,737.40

TENODESIS LG TENDON BICEPTSLT

Facility

$44,916.00

Service Code	HCPCS 23430
Hospital Charge Code	16000324
Hospital Revenue Code	360
Min. Negotiated Rate	$1,082.48
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,474.80
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,737.40
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,082.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,190.27

TENODESIS OF BICEPS TNDNAT EL

Facility

$44,916.00

Service Code	HCPCS 24340
Hospital Charge Code	16000614
Hospital Revenue Code	360
Min. Negotiated Rate	$1,082.48
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,474.80
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,737.40
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,082.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,190.27

TENODESIS OF BICEPS TNDNAT EL

Facility

$44,916.00

Service Code	HCPCS 24340
Hospital Charge Code	16000614
Hospital Revenue Code	360
Min. Negotiated Rate	$6,737.40
Max. Negotiated Rate	$6,737.40
Rate for Payer: Qualcare PPO/HMO/WC	$6,737.40

TENOFOVIR 25MG TABLET

Facility

$326.89

Service Code	NDC 61958230101
Hospital Charge Code	6063943395
Hospital Revenue Code	250
Min. Negotiated Rate	$49.03
Max. Negotiated Rate	$49.03
Rate for Payer: Qualcare PPO/HMO/WC	$49.03

TENOFOVIR 25MG TABLET

Facility

$326.89

Service Code	NDC 61958230101
Hospital Charge Code	6063943395
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$163.44
Rate for Payer: Aetna Commercial	$124.22
Rate for Payer: Aetna Medicare Advantage	$98.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.36
Rate for Payer: Cigna Commercial	$163.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.07
Rate for Payer: Oxford Commercial	$65.38
Rate for Payer: Qualcare PPO/HMO/WC	$49.03
Rate for Payer: UnitedHealthcare Commercial	$65.38
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$8.66

TENOFOVIR 300 MG TAB

Facility

$250.11

Service Code	NDC 61958040101
Hospital Charge Code	60629216
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.06
Rate for Payer: Aetna Commercial	$95.04
Rate for Payer: Aetna Medicare Advantage	$75.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.78
Rate for Payer: Cigna Commercial	$125.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.03
Rate for Payer: Oxford Commercial	$50.02
Rate for Payer: Qualcare PPO/HMO/WC	$37.52
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.63

Know your out-of-pocket cost for care.

All Charges