Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THIOTEPA VL 15MG

Facility

$585.60

Hospital Charge Code	6006795
Hospital Revenue Code	636
Min. Negotiated Rate	$14.11
Max. Negotiated Rate	$292.80
Rate for Payer: Aetna Commercial	$222.53
Rate for Payer: Aetna Medicare Advantage	$175.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.33
Rate for Payer: Cigna Commercial	$292.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.72
Rate for Payer: Qualcare PPO/HMO/WC	$87.84
Rate for Payer: UnitedHealthcare Community & State	$14.11
Rate for Payer: Wellpoint Medicaid Managed Care	$15.52

THIOTHIXENE 10 MG CAP

Facility

$34.24

Service Code	NDC 51079058920
Hospital Charge Code	6063943254
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

THIOTHIXENE 10 MG CAP

Facility

$5.65

Hospital Charge Code	60627828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

THIOTHIXENE 10 MG CAP

Facility

$5.65

Hospital Charge Code	60627828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

THIOTHIXENE 10 MG CAP

Facility

$34.24

Service Code	NDC 51079058920
Hospital Charge Code	6063943254
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.12
Rate for Payer: Aetna Commercial	$13.01
Rate for Payer: Aetna Medicare Advantage	$10.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.73
Rate for Payer: Cigna Commercial	$17.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.27
Rate for Payer: Oxford Commercial	$6.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$6.85
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.91

THIOTHIXENE 1 MG CAP

Facility

$4.00

Service Code	NDC 781222601
Hospital Charge Code	60627826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

THIOTHIXENE 1 MG CAP

Facility

$4.00

Service Code	NDC 781222601
Hospital Charge Code	60627826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

THIOTHIXENE 2 MG CAP

Facility

$16.01

Service Code	NDC 51079058720
Hospital Charge Code	60627827
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

THIOTHIXENE 2 MG CAP

Facility

$16.01

Service Code	NDC 51079058720
Hospital Charge Code	60627827
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.01
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.80
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

THIOTHIXENE 5 MG CAP

Facility

$15.95

Service Code	NDC 378300501
Hospital Charge Code	6063943255
Hospital Revenue Code	250
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$2.39
Rate for Payer: Qualcare PPO/HMO/WC	$2.39

THIOTHIXENE 5 MG CAP

Facility

$15.95

Service Code	NDC 378300501
Hospital Charge Code	6063943255
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.97
Rate for Payer: Aetna Commercial	$6.06
Rate for Payer: Aetna Medicare Advantage	$4.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.07
Rate for Payer: Cigna Commercial	$7.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.79
Rate for Payer: Oxford Commercial	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.39
Rate for Payer: UnitedHealthcare Commercial	$3.19
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

THIOTHIXENE 5 MG/ML ORAL CONC.

Facility

$326.45

Hospital Charge Code	60627829
Hospital Revenue Code	250
Min. Negotiated Rate	$48.97
Max. Negotiated Rate	$48.97
Rate for Payer: Qualcare PPO/HMO/WC	$48.97

THIOTHIXENE 5 MG/ML ORAL CONC.

Facility

$326.45

Hospital Charge Code	60627829
Hospital Revenue Code	250
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$163.22
Rate for Payer: Aetna Commercial	$124.05
Rate for Payer: Aetna Medicare Advantage	$97.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.24
Rate for Payer: Cigna Commercial	$163.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.94
Rate for Payer: Oxford Commercial	$65.29
Rate for Payer: Qualcare PPO/HMO/WC	$48.97
Rate for Payer: UnitedHealthcare Commercial	$65.29
Rate for Payer: UnitedHealthcare Community & State	$7.87
Rate for Payer: Wellpoint Medicaid Managed Care	$8.65

THIOTHIXENE CAP 10MG

Facility

$5.80

Hospital Charge Code	60627825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.20
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

THIOTHIXENE CAP 10MG

Facility

$5.80

Hospital Charge Code	60627825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

THIOTHIXENE INJ 5MG/ML 2ML

Facility

$37.00

Service Code	HCPCS J2330
Hospital Charge Code	6006092
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$14.06
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.10
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$7.40
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

THIOTHIXENE INJ 5MG/ML 2ML

Facility

$37.00

Service Code	HCPCS J2330
Hospital Charge Code	6006092
Hospital Revenue Code	250
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

THIOTHIXENE (NAVANE)

Facility

$324.00

Service Code	HCPCS 82542
Hospital Charge Code	38473123
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

THIOTHIXENE (NAVANE)

Facility

$324.00

Service Code	HCPCS 82542
Hospital Charge Code	38473123
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

THNA TI CANNULATED 235 MM

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270688448
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

THNA TI CANNULATED 235 MM

Facility

$9,653.15

Service Code	HCPCS C1713
Hospital Charge Code	270688448
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

THOMBO W/RFLX

Facility

$121.00

Hospital Charge Code	3035086G
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

THOMBO W/RFLX

Facility

$121.00

Hospital Charge Code	3035086G
Hospital Revenue Code	301
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$45.98
Rate for Payer: Aetna Medicare Advantage	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.86
Rate for Payer: Cigna Commercial	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

THORACENTESIS

Facility

$331.55

Service Code	HCPCS 32421
Hospital Charge Code	3400215
Hospital Revenue Code	761
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$165.78
Rate for Payer: Aetna Commercial	$125.99
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$165.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.47
Rate for Payer: Oxford Commercial	$66.31
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$66.31
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

THORACENTESIS

Facility

$331.55

Service Code	HCPCS 32421
Hospital Charge Code	3400215
Hospital Revenue Code	761
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

Know your out-of-pocket cost for care.

All Charges