Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THROMBIN (BOVINE) 5000 U VIAL

Facility

$577.00

Service Code	NDC 60793021505
Hospital Charge Code	606390276
Hospital Revenue Code	250
Min. Negotiated Rate	$86.55
Max. Negotiated Rate	$86.55
Rate for Payer: Qualcare PPO/HMO/WC	$86.55

THROMBIN BOVINE TOPICAL 10,000

Facility

$106.90

Hospital Charge Code	6013270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$16.04

THROMBIN BOVINE TOPICAL 10,000

Facility

$106.90

Hospital Charge Code	6013270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.45
Rate for Payer: Aetna Commercial	$40.62
Rate for Payer: Aetna Medicare Advantage	$32.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.26
Rate for Payer: Cigna Commercial	$53.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.07
Rate for Payer: Oxford Commercial	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$16.04
Rate for Payer: UnitedHealthcare Commercial	$21.38
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.83

THROMBIN CLOTTING TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900183
Hospital Revenue Code	305
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.83
Rate for Payer: Cigna Commercial	$19.82
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

THROMBIN CLOTTING TIME

Facility

$63.25

Service Code	HCPCS 85670
Hospital Charge Code	3007820
Hospital Revenue Code	305
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.83
Rate for Payer: Cigna Commercial	$31.62
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

THROMBIN CLOTTING TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900183
Hospital Revenue Code	305
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.95

THROMBIN CLOTTING TIME

Facility

$63.25

Service Code	HCPCS 85670
Hospital Charge Code	3007820
Hospital Revenue Code	305
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$9.49
Rate for Payer: Qualcare PPO/HMO/WC	$9.49

THROMBIN JMI 5K SPRAY KIT

Facility

$588.60

Service Code	NDC 60793070505
Hospital Charge Code	60630116
Hospital Revenue Code	250
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna Commercial	$223.67
Rate for Payer: Aetna Medicare Advantage	$176.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.09
Rate for Payer: Cigna Commercial	$294.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.58
Rate for Payer: Oxford Commercial	$117.72
Rate for Payer: Qualcare PPO/HMO/WC	$88.29
Rate for Payer: UnitedHealthcare Commercial	$117.72
Rate for Payer: UnitedHealthcare Community & State	$14.19
Rate for Payer: Wellpoint Medicaid Managed Care	$15.60

THROMBIN JMI 5K SPRAY KIT

Facility

$588.60

Service Code	NDC 60793070505
Hospital Charge Code	60630116
Hospital Revenue Code	250
Min. Negotiated Rate	$88.29
Max. Negotiated Rate	$88.29
Rate for Payer: Qualcare PPO/HMO/WC	$88.29

THROMBIN RECOMB TPICAL 20000IU

Facility

$2,765.76

Service Code	NDC 43825070741
Hospital Charge Code	606390452
Hospital Revenue Code	250
Min. Negotiated Rate	$66.65
Max. Negotiated Rate	$1,382.88
Rate for Payer: Aetna Commercial	$1,050.99
Rate for Payer: Aetna Medicare Advantage	$829.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$705.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$705.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$705.27
Rate for Payer: Cigna Commercial	$1,382.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.73
Rate for Payer: Oxford Commercial	$553.15
Rate for Payer: Qualcare PPO/HMO/WC	$414.86
Rate for Payer: UnitedHealthcare Commercial	$553.15
Rate for Payer: UnitedHealthcare Community & State	$66.65
Rate for Payer: Wellpoint Medicaid Managed Care	$73.29

THROMBIN RECOMB TPICAL 20000IU

Facility

$2,765.76

Service Code	NDC 43825070741
Hospital Charge Code	606390452
Hospital Revenue Code	250
Min. Negotiated Rate	$414.86
Max. Negotiated Rate	$414.86
Rate for Payer: Qualcare PPO/HMO/WC	$414.86

THROMBIN TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900184
Hospital Revenue Code	305
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.83
Rate for Payer: Cigna Commercial	$19.82
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.89
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

THROMBIN TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900184
Hospital Revenue Code	305
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.95

THROMBIN TIME

Facility

$95.00

Service Code	HCPCS 85670
Hospital Charge Code	38478017
Hospital Revenue Code	305
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

THROMBIN TIME

Facility

$95.00

Service Code	HCPCS 85670
Hospital Charge Code	38478017
Hospital Revenue Code	305
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.83
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

THROMBIN TOPICAL 5000U

Facility

$176.00

Hospital Charge Code	60635488
Hospital Revenue Code	250
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$26.40
Rate for Payer: Qualcare PPO/HMO/WC	$26.40

THROMBIN TOPICAL 5000U

Facility

$176.00

Hospital Charge Code	60635488
Hospital Revenue Code	250
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$88.00
Rate for Payer: Aetna Commercial	$66.88
Rate for Payer: Aetna Medicare Advantage	$52.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.88
Rate for Payer: Cigna Commercial	$88.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.80
Rate for Payer: Oxford Commercial	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$26.40
Rate for Payer: UnitedHealthcare Commercial	$35.20
Rate for Payer: UnitedHealthcare Community & State	$4.24
Rate for Payer: Wellpoint Medicaid Managed Care	$4.66

THROMBIN TOPICAL KIT 10,000U

Facility

$343.70

Hospital Charge Code	60627529
Hospital Revenue Code	250
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$51.55
Rate for Payer: Qualcare PPO/HMO/WC	$51.55

THROMBIN TOPICAL KIT 10,000U

Facility

$343.70

Hospital Charge Code	60627529
Hospital Revenue Code	250
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$171.85
Rate for Payer: Aetna Commercial	$130.61
Rate for Payer: Aetna Medicare Advantage	$103.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.64
Rate for Payer: Cigna Commercial	$171.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.11
Rate for Payer: Oxford Commercial	$68.74
Rate for Payer: Qualcare PPO/HMO/WC	$51.55
Rate for Payer: UnitedHealthcare Commercial	$68.74
Rate for Payer: UnitedHealthcare Community & State	$8.28
Rate for Payer: Wellpoint Medicaid Managed Care	$9.11

THROMBIN TOPICAL KIT 20,000U

Facility

$2,275.66

Service Code	NDC 60793021720
Hospital Charge Code	60629270
Hospital Revenue Code	250
Min. Negotiated Rate	$341.35
Max. Negotiated Rate	$341.35
Rate for Payer: Qualcare PPO/HMO/WC	$341.35

THROMBIN TOPICAL KIT 20,000U

Facility

$2,275.66

Service Code	NDC 60793021720
Hospital Charge Code	60629270
Hospital Revenue Code	250
Min. Negotiated Rate	$54.84
Max. Negotiated Rate	$1,137.83
Rate for Payer: Aetna Commercial	$864.75
Rate for Payer: Aetna Medicare Advantage	$682.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$580.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$580.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$580.29
Rate for Payer: Cigna Commercial	$1,137.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.70
Rate for Payer: Oxford Commercial	$455.13
Rate for Payer: Qualcare PPO/HMO/WC	$341.35
Rate for Payer: UnitedHealthcare Commercial	$455.13
Rate for Payer: UnitedHealthcare Community & State	$54.84
Rate for Payer: Wellpoint Medicaid Managed Care	$60.30

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	411037214
Hospital Revenue Code	361
Min. Negotiated Rate	$138.89
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,728.88
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$864.44
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$138.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$152.72

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	366837214
Hospital Revenue Code	361
Min. Negotiated Rate	$864.44
Max. Negotiated Rate	$864.44
Rate for Payer: Qualcare PPO/HMO/WC	$864.44

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	366837214
Hospital Revenue Code	361
Min. Negotiated Rate	$138.89
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,728.88
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$864.44
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$138.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$152.72

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	411037214
Hospital Revenue Code	361
Min. Negotiated Rate	$864.44
Max. Negotiated Rate	$864.44
Rate for Payer: Qualcare PPO/HMO/WC	$864.44

Know your out-of-pocket cost for care.

All Charges