Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THORAZINE/10MG/5ML

Facility

$101.00

Hospital Charge Code	60634023
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

THORAZINE/10MG/5ML

Facility

$101.00

Hospital Charge Code	60634023
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

THORAZINE 50MG

Facility

$74.90

Hospital Charge Code	6008205
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$28.46
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.47
Rate for Payer: Oxford Commercial	$14.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$14.98
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

THORAZINE 50MG

Facility

$74.90

Hospital Charge Code	6008205
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

THORAZINE,SERUM

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473108
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
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	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

THORAZINE,SERUM

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473108
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

THORAZINE,URINE

Facility

$324.00

Service Code	HCPCS 80342
Hospital Charge Code	38473109
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

THORAZINE,URINE

Facility

$324.00

Service Code	HCPCS 80342
Hospital Charge Code	38473109
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

THOROCEAL STERILE UNIT

Facility

$271.26

Hospital Charge Code	270300905
Hospital Revenue Code	272
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$135.63
Rate for Payer: Aetna Commercial	$103.08
Rate for Payer: Aetna Medicare Advantage	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.17
Rate for Payer: Cigna Commercial	$135.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.38
Rate for Payer: Oxford Commercial	$54.25
Rate for Payer: Qualcare PPO/HMO/WC	$40.69
Rate for Payer: UnitedHealthcare Commercial	$54.25
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

THOROCEAL STERILE UNIT

Facility

$271.26

Hospital Charge Code	270300905
Hospital Revenue Code	272
Min. Negotiated Rate	$40.69
Max. Negotiated Rate	$40.69
Rate for Payer: Qualcare PPO/HMO/WC	$40.69

THOROCEAL STERILE UNIT *******

Facility

$224.00

Hospital Charge Code	8001232
Hospital Revenue Code	279
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Oxford Commercial	$44.80
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$44.80
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

THOROCEAL STERILE UNIT *******

Facility

$224.00

Hospital Charge Code	8001232
Hospital Revenue Code	279
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

THOROSEAL III AUTOTRANS 713192

Facility

$817.65

Hospital Charge Code	270606870
Hospital Revenue Code	270
Min. Negotiated Rate	$19.71
Max. Negotiated Rate	$408.82
Rate for Payer: Aetna Commercial	$310.71
Rate for Payer: Aetna Medicare Advantage	$245.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.50
Rate for Payer: Cigna Commercial	$408.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.29
Rate for Payer: Oxford Commercial	$163.53
Rate for Payer: Qualcare PPO/HMO/WC	$122.65
Rate for Payer: UnitedHealthcare Commercial	$163.53
Rate for Payer: UnitedHealthcare Community & State	$19.71
Rate for Payer: Wellpoint Medicaid Managed Care	$21.67

THOROSEAL III AUTOTRANS 713192

Facility

$817.65

Hospital Charge Code	270606870
Hospital Revenue Code	270
Min. Negotiated Rate	$122.65
Max. Negotiated Rate	$122.65
Rate for Payer: Qualcare PPO/HMO/WC	$122.65

THRD GUIDE PIN STE 3.2X 444MM

Facility

$600.00

Hospital Charge Code	270679178
Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

THRD GUIDE PIN STE 3.2X 444MM

Facility

$600.00

Hospital Charge Code	270679178
Hospital Revenue Code	272
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

THREAD BB TAK IMPLANT SYSTEM

Facility

$425.00

Service Code	HCPCS C1713
Hospital Charge Code	270682858
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

THREAD BB TAK IMPLANT SYSTEM

Facility

$425.00

Service Code	HCPCS C1713
Hospital Charge Code	270682858
Hospital Revenue Code	278
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

THREADED 1.1 K WIRE

Facility

$115.50

Service Code	HCPCS C1713
Hospital Charge Code	270701737
Hospital Revenue Code	278
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$27.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

THREADED 1.1 K WIRE

Facility

$115.50

Service Code	HCPCS C1713
Hospital Charge Code	270701737
Hospital Revenue Code	278
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Commercial	$43.89
Rate for Payer: Aetna Medicare Advantage	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.45
Rate for Payer: Cigna Commercial	$57.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$17.32
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.06

THREADED GUIDE PINS

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270698741
Hospital Revenue Code	278
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

THREADED GUIDE PINS

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270698741
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

THREADED PEG LOCKING 2.3X14

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664357
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

THREADED PEG LOCKING 2.3X14

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664357
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

THREADED POST W/NUT

Facility

$640.50

Hospital Charge Code	270656557
Hospital Revenue Code	271
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$320.25
Rate for Payer: Aetna Commercial	$243.39
Rate for Payer: Aetna Medicare Advantage	$192.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.33
Rate for Payer: Cigna Commercial	$320.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.15
Rate for Payer: Oxford Commercial	$128.10
Rate for Payer: Qualcare PPO/HMO/WC	$96.08
Rate for Payer: UnitedHealthcare Commercial	$128.10
Rate for Payer: UnitedHealthcare Community & State	$15.44
Rate for Payer: Wellpoint Medicaid Managed Care	$16.97

Know your out-of-pocket cost for care.

All Charges