Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TETRACYCLINE OINT OPH 1% 3.5GM

Facility

$95.40

Hospital Charge Code	6005250
Hospital Revenue Code	251
Min. Negotiated Rate	$14.31
Max. Negotiated Rate	$14.31
Rate for Payer: Qualcare PPO/HMO/WC	$14.31

TETRAHYDROZOLN OPH .05% 15ML

Facility

$23.70

Hospital Charge Code	6005268
Hospital Revenue Code	251
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$11.85
Rate for Payer: Aetna Commercial	$9.01
Rate for Payer: Aetna Medicare Advantage	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.04
Rate for Payer: Cigna Commercial	$11.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.11
Rate for Payer: Oxford Commercial	$4.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.56
Rate for Payer: UnitedHealthcare Commercial	$4.74
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

TETRAHYDROZOLN OPH .05% 15ML

Facility

$23.70

Hospital Charge Code	6005268
Hospital Revenue Code	251
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$3.56
Rate for Payer: Qualcare PPO/HMO/WC	$3.56

TETRAHYDROZOLN OPH SOL 0.05%

Facility

$28.14

Service Code	NDC 74300000803
Hospital Charge Code	60628082
Hospital Revenue Code	250
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.22

TETRAHYDROZOLN OPH SOL 0.05%

Facility

$28.14

Service Code	NDC 74300000803
Hospital Charge Code	60628082
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.07
Rate for Payer: Aetna Commercial	$10.69
Rate for Payer: Aetna Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.18
Rate for Payer: Cigna Commercial	$14.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.44
Rate for Payer: Oxford Commercial	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.22
Rate for Payer: UnitedHealthcare Commercial	$5.63
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

TFCC FAST FIX KIT

Facility

$2,965.00

Hospital Charge Code	270675400
Hospital Revenue Code	272
Min. Negotiated Rate	$71.46
Max. Negotiated Rate	$1,482.50
Rate for Payer: Aetna Commercial	$1,126.70
Rate for Payer: Aetna Medicare Advantage	$889.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$756.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$756.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$756.08
Rate for Payer: Cigna Commercial	$1,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$889.50
Rate for Payer: Oxford Commercial	$593.00
Rate for Payer: Qualcare PPO/HMO/WC	$444.75
Rate for Payer: UnitedHealthcare Commercial	$593.00
Rate for Payer: UnitedHealthcare Community & State	$71.46
Rate for Payer: Wellpoint Medicaid Managed Care	$78.57

TFCC FAST FIX KIT

Facility

$2,965.00

Hospital Charge Code	270675400
Hospital Revenue Code	272
Min. Negotiated Rate	$444.75
Max. Negotiated Rate	$444.75
Rate for Payer: Qualcare PPO/HMO/WC	$444.75

TFNA 10MM 130D 320MM LT

Facility

$11,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270694883
Hospital Revenue Code	278
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

TFNA 10MM 130D 320MM LT

Facility

$11,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270694883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

TFNA 10MM130DEGTI CANN440MM LT

Facility

$9,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270693114
Hospital Revenue Code	278
Min. Negotiated Rate	$239.55
Max. Negotiated Rate	$4,970.00
Rate for Payer: Aetna Commercial	$3,777.20
Rate for Payer: Aetna Medicare Advantage	$2,982.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,534.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,534.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,534.70
Rate for Payer: Cigna Commercial	$4,970.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,405.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,186.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.00
Rate for Payer: UnitedHealthcare Community & State	$239.55
Rate for Payer: Wellpoint Medicaid Managed Care	$263.41

TFNA 10MM130DEGTI CANN440MM LT

Facility

$9,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270693114
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.00
Max. Negotiated Rate	$2,405.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,405.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,186.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.00

TFNA 11MM 130D TI 235MM RT

Facility

$22,045.00

Service Code	HCPCS C1776
Hospital Charge Code	270694976
Hospital Revenue Code	278
Min. Negotiated Rate	$531.28
Max. Negotiated Rate	$11,022.50
Rate for Payer: Aetna Commercial	$8,377.10
Rate for Payer: Aetna Medicare Advantage	$6,613.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,621.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,621.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,409.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,621.48
Rate for Payer: Cigna Commercial	$11,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,334.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,849.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,306.75
Rate for Payer: UnitedHealthcare Community & State	$531.28
Rate for Payer: Wellpoint Medicaid Managed Care	$584.19

TFNA 11MM 130D TI 235MM RT

Facility

$22,045.00

Service Code	HCPCS C1776
Hospital Charge Code	270694976
Hospital Revenue Code	278
Min. Negotiated Rate	$3,306.75
Max. Negotiated Rate	$5,334.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,409.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,334.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,849.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,306.75

TFNA 380MM LT 10MM/130 DEG TI

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270679686
Hospital Revenue Code	278
Min. Negotiated Rate	$232.64
Max. Negotiated Rate	$4,826.57
Rate for Payer: Aetna Commercial	$3,668.20
Rate for Payer: Aetna Medicare Advantage	$2,895.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,930.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,461.55
Rate for Payer: Cigna Commercial	$4,826.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,123.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,447.97
Rate for Payer: UnitedHealthcare Community & State	$232.64
Rate for Payer: Wellpoint Medicaid Managed Care	$255.81

TFNA 380MM LT 10MM/130 DEG TI

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270679686
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.97
Max. Negotiated Rate	$2,336.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,930.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,123.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,447.97

TFNA CANN 10MM/130/360

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270677487
Hospital Revenue Code	278
Min. Negotiated Rate	$232.64
Max. Negotiated Rate	$4,826.57
Rate for Payer: Aetna Commercial	$3,668.20
Rate for Payer: Aetna Medicare Advantage	$2,895.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,930.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,461.55
Rate for Payer: Cigna Commercial	$4,826.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,123.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,447.97
Rate for Payer: UnitedHealthcare Community & State	$232.64
Rate for Payer: Wellpoint Medicaid Managed Care	$255.81

TFNA CANN 10MM/130/360

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270677487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.97
Max. Negotiated Rate	$2,336.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,930.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,336.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,123.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,447.97

TFNA CANN 11MM 130D 235MM LT

Facility

$22,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270700152
Hospital Revenue Code	278
Min. Negotiated Rate	$3,306.75
Max. Negotiated Rate	$5,334.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,409.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,334.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,849.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,306.75

TFNA CANN 11MM 130D 235MM LT

Facility

$22,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270700152
Hospital Revenue Code	278
Min. Negotiated Rate	$531.28
Max. Negotiated Rate	$11,022.50
Rate for Payer: Aetna Commercial	$8,377.10
Rate for Payer: Aetna Medicare Advantage	$6,613.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,621.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,621.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,409.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,621.48
Rate for Payer: Cigna Commercial	$11,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,334.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,849.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,306.75
Rate for Payer: UnitedHealthcare Community & State	$531.28
Rate for Payer: Wellpoint Medicaid Managed Care	$584.19

TFNA CANNULA 11/125 340 RT

Facility

$10,969.10

Service Code	HCPCS C1713
Hospital Charge Code	270693038
Hospital Revenue Code	278
Min. Negotiated Rate	$1,645.37
Max. Negotiated Rate	$2,654.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,193.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,654.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,413.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,645.37

TFNA CANNULA 11/125 340 RT

Facility

$10,969.10

Service Code	HCPCS C1713
Hospital Charge Code	270693038
Hospital Revenue Code	278
Min. Negotiated Rate	$264.36
Max. Negotiated Rate	$5,484.55
Rate for Payer: Aetna Commercial	$4,168.26
Rate for Payer: Aetna Medicare Advantage	$3,290.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,797.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,797.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,193.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,797.12
Rate for Payer: Cigna Commercial	$5,484.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,654.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,413.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,645.37
Rate for Payer: UnitedHealthcare Community & State	$264.36
Rate for Payer: Wellpoint Medicaid Managed Care	$290.68

TFN-ADVNAIL12MM130DTICANN170MM

Facility

$7,576.05

Service Code	HCPCS C1713
Hospital Charge Code	270692572
Hospital Revenue Code	278
Min. Negotiated Rate	$182.58
Max. Negotiated Rate	$3,788.03
Rate for Payer: Aetna Commercial	$2,878.90
Rate for Payer: Aetna Medicare Advantage	$2,272.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,931.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,931.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,515.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,931.89
Rate for Payer: Cigna Commercial	$3,788.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,833.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,666.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.41
Rate for Payer: UnitedHealthcare Community & State	$182.58
Rate for Payer: Wellpoint Medicaid Managed Care	$200.77

TFN-ADVNAIL12MM130DTICANN170MM

Facility

$7,576.05

Service Code	HCPCS C1713
Hospital Charge Code	270692572
Hospital Revenue Code	278
Min. Negotiated Rate	$1,136.41
Max. Negotiated Rate	$1,833.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,515.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,833.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,666.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,136.41

TFNA FENESTRATED HELICAL 95MM

Facility

$3,389.60

Service Code	HCPCS C1713
Hospital Charge Code	270681754
Hospital Revenue Code	278
Min. Negotiated Rate	$81.69
Max. Negotiated Rate	$1,694.80
Rate for Payer: Aetna Commercial	$1,288.05
Rate for Payer: Aetna Medicare Advantage	$1,016.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$677.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.35
Rate for Payer: Cigna Commercial	$1,694.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$820.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$745.71
Rate for Payer: Qualcare PPO/HMO/WC	$508.44
Rate for Payer: UnitedHealthcare Community & State	$81.69
Rate for Payer: Wellpoint Medicaid Managed Care	$89.82

TFNA FENESTRATED HELICAL 95MM

Facility

$3,389.60

Service Code	HCPCS C1713
Hospital Charge Code	270681754
Hospital Revenue Code	278
Min. Negotiated Rate	$508.44
Max. Negotiated Rate	$820.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$677.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$820.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$745.71
Rate for Payer: Qualcare PPO/HMO/WC	$508.44

Know your out-of-pocket cost for care.

All Charges