Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TENSILON/10MG/1ML

Facility

$18.00

Hospital Charge Code	60633989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

TENSILON/10MG/1ML

Facility

$18.00

Hospital Charge Code	60633989
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

TENSIX DBM 10CC

Facility

$18,325.00

Service Code	HCPCS Q4146
Hospital Charge Code	270694926
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,434.65
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,434.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,031.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,748.75
Rate for Payer: UnitedHealthcare Community & State	$441.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$485.61

TENSIX DBM 10CC

Facility

$18,325.00

Service Code	HCPCS Q4146
Hospital Charge Code	270694926
Hospital Revenue Code	278
Min. Negotiated Rate	$2,748.75
Max. Negotiated Rate	$4,434.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,665.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,434.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,031.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,748.75

TENSIX DBM COMP 10CC

Facility

$18,325.00

Service Code	HCPCS C1713
Hospital Charge Code	270694902
Hospital Revenue Code	278
Min. Negotiated Rate	$2,748.75
Max. Negotiated Rate	$4,434.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,665.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,434.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,031.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,748.75

TENSIX DBM COMP 10CC

Facility

$18,325.00

Service Code	HCPCS C1713
Hospital Charge Code	270694902
Hospital Revenue Code	278
Min. Negotiated Rate	$441.63
Max. Negotiated Rate	$9,162.50
Rate for Payer: Aetna Commercial	$6,963.50
Rate for Payer: Aetna Medicare Advantage	$5,497.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,672.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,672.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,672.88
Rate for Payer: Cigna Commercial	$9,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,434.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,031.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,748.75
Rate for Payer: UnitedHealthcare Community & State	$441.63
Rate for Payer: Wellpoint Medicaid Managed Care	$485.61

TENT*******

Facility

$43.20

Hospital Charge Code	9500331
Hospital Revenue Code	279
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna Commercial	$16.42
Rate for Payer: Aetna Medicare Advantage	$12.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.02
Rate for Payer: Cigna Commercial	$21.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.96
Rate for Payer: Oxford Commercial	$8.64
Rate for Payer: Qualcare PPO/HMO/WC	$6.48
Rate for Payer: UnitedHealthcare Commercial	$8.64
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

TENT*******

Facility

$43.20

Hospital Charge Code	9500331
Hospital Revenue Code	279
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$6.48
Rate for Payer: Qualcare PPO/HMO/WC	$6.48

TENT CONTINUOUS***

Facility

$72.60

Service Code	HCPCS 94665
Hospital Charge Code	9500471
Hospital Revenue Code	419
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$27.59
Rate for Payer: Aetna Medicare Advantage	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.51
Rate for Payer: Cigna Commercial	$36.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.89
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$1.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

TENT CONTINUOUS***

Facility

$72.60

Service Code	HCPCS 94665
Hospital Charge Code	9500471
Hospital Revenue Code	419
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$10.89

TENT PRN***

Facility

$44.00

Service Code	HCPCS 94664
Hospital Charge Code	9500489
Hospital Revenue Code	419
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.06
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$1,550.00
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

TENT PRN***

Facility

$44.00

Service Code	HCPCS 94664
Hospital Charge Code	9500489
Hospital Revenue Code	419
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

TEQUIN 200MG/100ML PREMIX

Facility

$85.00

Hospital Charge Code	60635338
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

TEQUIN 200MG/100ML PREMIX

Facility

$85.00

Hospital Charge Code	60635338
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$17.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

TEQUIN 200MG/20ML VIAL

Facility

$79.00

Hospital Charge Code	60635290
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$39.50
Rate for Payer: Aetna Commercial	$30.02
Rate for Payer: Aetna Medicare Advantage	$23.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.14
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.12
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

TEQUIN 200MG/20ML VIAL

Facility

$79.00

Hospital Charge Code	60635290
Hospital Revenue Code	636
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$19.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.12
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

TEQUIN 200MG U/D TAB

Facility

$26.00

Hospital Charge Code	60635291
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

TEQUIN 200MG U/D TAB

Facility

$26.00

Hospital Charge Code	60635291
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$5.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

TEQUIN 400MG/200ML PREMIX

Facility

$107.00

Hospital Charge Code	60635339
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

TEQUIN 400MG/200ML PREMIX

Facility

$107.00

Hospital Charge Code	60635339
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

TEQUIN 400 MG INJ 40 ML

Facility

$135.00

Hospital Charge Code	60635287
Hospital Revenue Code	636
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

TEQUIN 400 MG INJ 40 ML

Facility

$135.00

Hospital Charge Code	60635287
Hospital Revenue Code	636
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

TEQUIN 400 MG TAB

Facility

$28.00

Hospital Charge Code	60635286
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

TEQUIN 400 MG TAB

Facility

$28.00

Hospital Charge Code	60635286
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

TERAZOSIN 1 MG CAP

Facility

$10.79

Service Code	NDC 51079093601
Hospital Charge Code	6027106
Hospital Revenue Code	251
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.62

Know your out-of-pocket cost for care.

All Charges