Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TICAGRELOR 90MG TAB

Facility

$36.45

Service Code	NDC 186077739
Hospital Charge Code	60630216
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

TI CANN FRN 10MM GT400MM

Facility

$8,788.00

Service Code	HCPCS C1713
Hospital Charge Code	270688033
Hospital Revenue Code	278
Min. Negotiated Rate	$211.79
Max. Negotiated Rate	$4,394.00
Rate for Payer: Aetna Commercial	$3,339.44
Rate for Payer: Aetna Medicare Advantage	$2,636.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,757.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,240.94
Rate for Payer: Cigna Commercial	$4,394.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,126.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,933.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,318.20
Rate for Payer: UnitedHealthcare Community & State	$211.79
Rate for Payer: Wellpoint Medicaid Managed Care	$232.88

TI CANN FRN 10MM GT400MM

Facility

$8,788.00

Service Code	HCPCS C1713
Hospital Charge Code	270688033
Hospital Revenue Code	278
Min. Negotiated Rate	$1,318.20
Max. Negotiated Rate	$2,126.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,757.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,126.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,933.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,318.20

TICARCIL CLAV IVPB 3.1G/100ML

Facility

$105.00

Hospital Charge Code	60628878
Hospital Revenue Code	250
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

TICARCIL CLAV IVPB 3.1G/100ML

Facility

$105.00

Hospital Charge Code	60628878
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

TICARCIL CLAV IVPB3.1G/NS 50ML

Facility

$86.40

Hospital Charge Code	60627315
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$32.83
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.92
Rate for Payer: Oxford Commercial	$17.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$17.28
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

TICARCIL CLAV IVPB3.1G/NS 50ML

Facility

$86.40

Hospital Charge Code	60627315
Hospital Revenue Code	250
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

TICARCILLIN-CLAVULANATE3.1GINJ

Facility

$80.00

Hospital Charge Code	60629128
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

TICARCILLIN-CLAVULANATE3.1GINJ

Facility

$80.00

Hospital Charge Code	60629128
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

TICARCILLIN INJ 3GM

Facility

$109.45

Hospital Charge Code	6007108
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

TICARCILLIN INJ 3GM

Facility

$109.45

Hospital Charge Code	6007108
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

TICK ID

Facility

$59.00

Service Code	HCPCS 87208
Hospital Charge Code	3006848
Hospital Revenue Code	306
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

TICK ID

Facility

$59.00

Service Code	HCPCS 87208
Hospital Charge Code	3006848
Hospital Revenue Code	306
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

TICK IDENTIFICATION

Facility

$390.00

Service Code	HCPCS 87172
Hospital Charge Code	3006833
Hospital Revenue Code	309
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TICK IDENTIFICATION

Facility

$390.00

Service Code	HCPCS 87172
Hospital Charge Code	3006833
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TICK IDENTIFICATION

Facility

$29.35

Service Code	HCPCS 87168
Hospital Charge Code	39900274
Hospital Revenue Code	309
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.40

TICK IDENTIFICATION

Facility

$29.35

Service Code	HCPCS 87168
Hospital Charge Code	39900274
Hospital Revenue Code	309
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$14.68
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

TICK IDENTIFICATION

Facility

$106.00

Service Code	HCPCS 87168
Hospital Charge Code	38475095
Hospital Revenue Code	309
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

TICK IDENTIFICATION

Facility

$106.00

Service Code	HCPCS 87168
Hospital Charge Code	38475095
Hospital Revenue Code	309
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

TICLOPIDINE 250 MG TAB

Facility

$13.33

Service Code	NDC 57664032786
Hospital Charge Code	60628554
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

TICLOPIDINE 250 MG TAB

Facility

$13.33

Service Code	NDC 57664032786
Hospital Charge Code	60628554
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$5.07
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.00
Rate for Payer: Oxford Commercial	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$2.67
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

TICLOPIDINE HCL/250MG/UD

Facility

$5.00

Hospital Charge Code	60634666
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TICLOPIDINE HCL/250MG/UD

Facility

$5.00

Hospital Charge Code	60634666
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TICLOPIDINE HCL TAB 250MG

Facility

$13.45

Hospital Charge Code	6027072
Hospital Revenue Code	252
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

TICLOPIDINE HCL TAB 250MG

Facility

$13.45

Hospital Charge Code	6027072
Hospital Revenue Code	252
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.72
Rate for Payer: Aetna Commercial	$5.11
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.04
Rate for Payer: Oxford Commercial	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$2.69
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

Know your out-of-pocket cost for care.

All Charges