Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIP VITAL VUE DISP 8281-06

Facility

$856.85

Hospital Charge Code	270600270
Hospital Revenue Code	272
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$428.43
Rate for Payer: Aetna Commercial	$325.60
Rate for Payer: Aetna Medicare Advantage	$257.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.50
Rate for Payer: Cigna Commercial	$428.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.06
Rate for Payer: Oxford Commercial	$171.37
Rate for Payer: Qualcare PPO/HMO/WC	$128.53
Rate for Payer: UnitedHealthcare Commercial	$171.37
Rate for Payer: UnitedHealthcare Community & State	$20.65
Rate for Payer: Wellpoint Medicaid Managed Care	$22.71

TIRBOLOX INTERVERT BODY FUSION

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704564
Hospital Revenue Code	278
Min. Negotiated Rate	$373.55
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$5,890.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00
Rate for Payer: UnitedHealthcare Community & State	$373.55
Rate for Payer: Wellpoint Medicaid Managed Care	$410.75

TIRBOLOX INTERVERT BODY FUSION

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704564
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

TI ROD 70MM PREBENT LORDOTI

Facility

$4,580.00

Hospital Charge Code	270660949
Hospital Revenue Code	278
Min. Negotiated Rate	$687.00
Max. Negotiated Rate	$1,108.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,108.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,007.60
Rate for Payer: Qualcare PPO/HMO/WC	$687.00

TI ROD 70MM PREBENT LORDOTI

Facility

$4,580.00

Hospital Charge Code	270660949
Hospital Revenue Code	278
Min. Negotiated Rate	$110.38
Max. Negotiated Rate	$2,290.00
Rate for Payer: Aetna Commercial	$1,740.40
Rate for Payer: Aetna Medicare Advantage	$1,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,167.90
Rate for Payer: Cigna Commercial	$2,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,108.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,007.60
Rate for Payer: Qualcare PPO/HMO/WC	$687.00
Rate for Payer: UnitedHealthcare Community & State	$110.38
Rate for Payer: Wellpoint Medicaid Managed Care	$121.37

TIROFIBAN HCL INJ 12.5MG

Facility

$49.60

Hospital Charge Code	60628870
Hospital Revenue Code	636
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$24.80
Rate for Payer: Aetna Commercial	$18.85
Rate for Payer: Aetna Medicare Advantage	$14.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.65
Rate for Payer: Cigna Commercial	$24.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.44
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

TIROFIBAN HCL INJ 12.5MG

Facility

$49.60

Hospital Charge Code	60628870
Hospital Revenue Code	636
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.44

TI SET SCREW 8X17.5MM

Facility

$1,315.00

Hospital Charge Code	270656559
Hospital Revenue Code	278
Min. Negotiated Rate	$197.25
Max. Negotiated Rate	$318.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$263.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$289.30
Rate for Payer: Qualcare PPO/HMO/WC	$197.25

TI SET SCREW 8X17.5MM

Facility

$1,315.00

Hospital Charge Code	270656559
Hospital Revenue Code	278
Min. Negotiated Rate	$31.69
Max. Negotiated Rate	$657.50
Rate for Payer: Aetna Commercial	$499.70
Rate for Payer: Aetna Medicare Advantage	$394.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$335.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$335.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$263.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$335.32
Rate for Payer: Cigna Commercial	$657.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$289.30
Rate for Payer: Qualcare PPO/HMO/WC	$197.25
Rate for Payer: UnitedHealthcare Community & State	$31.69
Rate for Payer: Wellpoint Medicaid Managed Care	$34.85

TIS MATRX 9.6x19.3CM THIN

Facility

$27,445.00

Service Code	HCPCS Q4116
Hospital Charge Code	270675064
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$6,641.69
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,489.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,037.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75
Rate for Payer: UnitedHealthcare Community & State	$661.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$727.29

TIS MATRX 9.6x19.3CM THIN

Facility

$27,445.00

Service Code	HCPCS Q4116
Hospital Charge Code	270675064
Hospital Revenue Code	278
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$6,641.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,489.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,037.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

TIS MATRX 9.6x19.3CM TH/SQCMJW

Facility

$139.69

Hospital Charge Code	270675064W
Hospital Revenue Code	636
Min. Negotiated Rate	$20.95
Max. Negotiated Rate	$33.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.95

TIS MATRX 9.6x19.3CM TH/SQCMJW

Facility

$139.69

Hospital Charge Code	270675064W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$69.84
Rate for Payer: Aetna Commercial	$53.08
Rate for Payer: Aetna Medicare Advantage	$41.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.62
Rate for Payer: Cigna Commercial	$69.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.95
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.70

TI SPRL BLD 65MM F/T FEM NAILS

Facility

$2,563.85

Service Code	HCPCS C1713
Hospital Charge Code	270687937
Hospital Revenue Code	278
Min. Negotiated Rate	$61.79
Max. Negotiated Rate	$1,281.92
Rate for Payer: Aetna Commercial	$974.26
Rate for Payer: Aetna Medicare Advantage	$769.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$653.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$653.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$512.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$653.78
Rate for Payer: Cigna Commercial	$1,281.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$564.05
Rate for Payer: Qualcare PPO/HMO/WC	$384.58
Rate for Payer: UnitedHealthcare Community & State	$61.79
Rate for Payer: Wellpoint Medicaid Managed Care	$67.94

TI SPRL BLD 65MM F/T FEM NAILS

Facility

$2,563.85

Service Code	HCPCS C1713
Hospital Charge Code	270687937
Hospital Revenue Code	278
Min. Negotiated Rate	$384.58
Max. Negotiated Rate	$620.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$512.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$564.05
Rate for Payer: Qualcare PPO/HMO/WC	$384.58

TISS CULT/NON-NEOPLASTIC LYMPH

Facility

$825.49

Service Code	HCPCS 88230
Hospital Charge Code	38477207
Hospital Revenue Code	311
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$420.49
Rate for Payer: Aetna Commercial	$316.85
Rate for Payer: Aetna Medicare Advantage	$377.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$116.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.49
Rate for Payer: Cigna Commercial	$412.75
Rate for Payer: Cigna Medicare Advantage	$116.49
Rate for Payer: Clover Medicare Advantage	$110.67
Rate for Payer: EmblemHealth Commercial	$349.47
Rate for Payer: Humana Medicare Advantage	$119.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$116.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.82
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$93.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$116.49
Rate for Payer: Wellcare Medicare Advantage	$116.49
Rate for Payer: Wellpoint Medicaid Managed Care	$21.88

TISS CULT/NON-NEOPLASTIC LYMPH

Facility

$825.49

Service Code	HCPCS 88230
Hospital Charge Code	38477207
Hospital Revenue Code	311
Min. Negotiated Rate	$123.82
Max. Negotiated Rate	$123.82
Rate for Payer: Qualcare PPO/HMO/WC	$123.82

TISSEAL FIBRIN SEALANT

Facility

$1,031.95

Hospital Charge Code	270660608
Hospital Revenue Code	272
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$515.98
Rate for Payer: Aetna Commercial	$392.14
Rate for Payer: Aetna Medicare Advantage	$309.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.15
Rate for Payer: Cigna Commercial	$515.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.58
Rate for Payer: Oxford Commercial	$206.39
Rate for Payer: Qualcare PPO/HMO/WC	$154.79
Rate for Payer: UnitedHealthcare Commercial	$206.39
Rate for Payer: UnitedHealthcare Community & State	$24.87
Rate for Payer: Wellpoint Medicaid Managed Care	$27.35

TISSEAL FIBRIN SEALANT

Facility

$1,031.95

Hospital Charge Code	270660608
Hospital Revenue Code	272
Min. Negotiated Rate	$154.79
Max. Negotiated Rate	$154.79
Rate for Payer: Qualcare PPO/HMO/WC	$154.79

TISSEEL 10ML FROZEN RTU

Facility

$957.85

Service Code	HCPCS C9250
Hospital Charge Code	270662412
Hospital Revenue Code	636
Min. Negotiated Rate	$143.68
Max. Negotiated Rate	$231.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.80
Rate for Payer: Qualcare PPO/HMO/WC	$143.68

TISSEEL 10ML FROZEN RTU

Facility

$2,350.65

Service Code	HCPCS C9250
Hospital Charge Code	270662413
Hospital Revenue Code	636
Min. Negotiated Rate	$56.65
Max. Negotiated Rate	$568.86
Rate for Payer: Aetna Commercial	$390.86
Rate for Payer: Aetna Medicare Advantage	$465.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$518.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$518.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$518.71
Rate for Payer: Cigna Medicare Advantage	$143.70
Rate for Payer: Clover Medicare Advantage	$136.51
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Humana Medicare Advantage	$148.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.86
Rate for Payer: Qualcare PPO/HMO/WC	$352.60
Rate for Payer: UnitedHealthcare Community & State	$56.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$62.29

TISSEEL 10ML FROZEN RTU

Facility

$2,350.65

Service Code	HCPCS C9250
Hospital Charge Code	270662413
Hospital Revenue Code	636
Min. Negotiated Rate	$352.60
Max. Negotiated Rate	$568.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.86
Rate for Payer: Qualcare PPO/HMO/WC	$352.60

TISSEEL 10ML FROZEN RTU

Facility

$957.85

Service Code	HCPCS C9250
Hospital Charge Code	270662412
Hospital Revenue Code	636
Min. Negotiated Rate	$23.08
Max. Negotiated Rate	$518.71
Rate for Payer: Aetna Commercial	$390.86
Rate for Payer: Aetna Medicare Advantage	$465.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$518.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$518.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$518.71
Rate for Payer: Cigna Medicare Advantage	$143.70
Rate for Payer: Clover Medicare Advantage	$136.51
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Humana Medicare Advantage	$148.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.80
Rate for Payer: Qualcare PPO/HMO/WC	$143.68
Rate for Payer: UnitedHealthcare Community & State	$23.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$25.38

TISSEEL 2ML FROZEN RTU

Facility

$571.45

Service Code	HCPCS C9250
Hospital Charge Code	270662411
Hospital Revenue Code	636
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$518.71
Rate for Payer: Aetna Commercial	$390.86
Rate for Payer: Aetna Medicare Advantage	$465.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$518.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$518.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$518.71
Rate for Payer: Cigna Medicare Advantage	$143.70
Rate for Payer: Clover Medicare Advantage	$136.51
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Humana Medicare Advantage	$148.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.29
Rate for Payer: Qualcare PPO/HMO/WC	$85.72
Rate for Payer: UnitedHealthcare Community & State	$13.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$15.14

TISSEEL 2ML FROZEN RTU

Facility

$571.45

Service Code	HCPCS C9250
Hospital Charge Code	270662411
Hospital Revenue Code	636
Min. Negotiated Rate	$85.72
Max. Negotiated Rate	$138.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.29
Rate for Payer: Qualcare PPO/HMO/WC	$85.72

Know your out-of-pocket cost for care.

All Charges