Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TISSEEL 4ML FROZEN PRIMA

Facility

$986.60

Service Code	HCPCS C9250
Hospital Charge Code	270687687
Hospital Revenue Code	636
Min. Negotiated Rate	$147.99
Max. Negotiated Rate	$238.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.76
Rate for Payer: Qualcare PPO/HMO/WC	$147.99

TISSEEL 4ML FROZEN PRIMA

Facility

$986.60

Service Code	HCPCS C9250
Hospital Charge Code	270687687
Hospital Revenue Code	636
Min. Negotiated Rate	$23.78
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	$238.76
Rate for Payer: Qualcare PPO/HMO/WC	$147.99
Rate for Payer: UnitedHealthcare Community & State	$23.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$26.14

TISSEEL FIBRIN SEALANT

Facility

$600.95

Service Code	HCPCS C9250
Hospital Charge Code	270653751
Hospital Revenue Code	636
Min. Negotiated Rate	$14.48
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	$145.43
Rate for Payer: Qualcare PPO/HMO/WC	$90.14
Rate for Payer: UnitedHealthcare Community & State	$14.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$15.93

TISSEEL FIBRIN SEALANT

Facility

$600.95

Service Code	HCPCS C9250
Hospital Charge Code	270653751
Hospital Revenue Code	636
Min. Negotiated Rate	$90.14
Max. Negotiated Rate	$145.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.43
Rate for Payer: Qualcare PPO/HMO/WC	$90.14

TISSEEL KIT 4ML

Facility

$516.64

Service Code	NDC 338840204
Hospital Charge Code	606361017
Hospital Revenue Code	250
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Qualcare PPO/HMO/WC	$77.50

TISSEEL KIT 4ML

Facility

$516.64

Service Code	NDC 338840204
Hospital Charge Code	606361017
Hospital Revenue Code	250
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$258.32
Rate for Payer: Aetna Commercial	$196.32
Rate for Payer: Aetna Medicare Advantage	$154.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.74
Rate for Payer: Cigna Commercial	$258.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.99
Rate for Payer: Oxford Commercial	$103.33
Rate for Payer: Qualcare PPO/HMO/WC	$77.50
Rate for Payer: UnitedHealthcare Commercial	$103.33
Rate for Payer: UnitedHealthcare Community & State	$12.45
Rate for Payer: Wellpoint Medicaid Managed Care	$13.69

TISSEEL VHSD FROZEN PRIMA 2ML

Facility

$606.25

Hospital Charge Code	270687686
Hospital Revenue Code	272
Min. Negotiated Rate	$90.94
Max. Negotiated Rate	$90.94
Rate for Payer: Qualcare PPO/HMO/WC	$90.94

TISSEEL VHSD FROZEN PRIMA 2ML

Facility

$606.25

Hospital Charge Code	270687686
Hospital Revenue Code	272
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$303.12
Rate for Payer: Aetna Commercial	$230.38
Rate for Payer: Aetna Medicare Advantage	$181.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.59
Rate for Payer: Cigna Commercial	$303.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.88
Rate for Payer: Oxford Commercial	$121.25
Rate for Payer: Qualcare PPO/HMO/WC	$90.94
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: UnitedHealthcare Community & State	$14.61
Rate for Payer: Wellpoint Medicaid Managed Care	$16.07

TISSEEL VHSD FROZEN PRIMA 8ML

Facility

$2,421.17

Service Code	HCPCS A4649
Hospital Charge Code	270687688
Hospital Revenue Code	272
Min. Negotiated Rate	$363.18
Max. Negotiated Rate	$363.18
Rate for Payer: Qualcare PPO/HMO/WC	$363.18

TISSEEL VHSD FROZEN PRIMA 8ML

Facility

$2,421.17

Service Code	HCPCS A4649
Hospital Charge Code	270687688
Hospital Revenue Code	272
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$1,210.59
Rate for Payer: Aetna Commercial	$920.04
Rate for Payer: Aetna Medicare Advantage	$726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$617.40
Rate for Payer: Cigna Commercial	$1,210.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.35
Rate for Payer: Oxford Commercial	$484.23
Rate for Payer: Qualcare PPO/HMO/WC	$363.18
Rate for Payer: UnitedHealthcare Commercial	$484.23
Rate for Payer: UnitedHealthcare Community & State	$58.35
Rate for Payer: Wellpoint Medicaid Managed Care	$64.16

TISS MATRX FIRM 20x25CM

Facility

$83,055.00

Hospital Charge Code	270661025
Hospital Revenue Code	636
Min. Negotiated Rate	$2,001.63
Max. Negotiated Rate	$41,527.50
Rate for Payer: Aetna Commercial	$31,560.90
Rate for Payer: Aetna Medicare Advantage	$24,916.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,179.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,179.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,179.03
Rate for Payer: Cigna Commercial	$41,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,099.31
Rate for Payer: Qualcare PPO/HMO/WC	$12,458.25
Rate for Payer: UnitedHealthcare Community & State	$2,001.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2,200.96

TISS MATRX FIRM 20x25CM

Facility

$83,055.00

Hospital Charge Code	270661025
Hospital Revenue Code	636
Min. Negotiated Rate	$12,458.25
Max. Negotiated Rate	$20,099.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,099.31
Rate for Payer: Qualcare PPO/HMO/WC	$12,458.25

TISS MATRX FIRM 20x25CM/SQCMJW

Facility

$166.11

Hospital Charge Code	270661025W
Hospital Revenue Code	636
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.92

TISS MATRX FIRM 20x25CM/SQCMJW

Facility

$166.11

Hospital Charge Code	270661025W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.06
Rate for Payer: Aetna Commercial	$63.12
Rate for Payer: Aetna Medicare Advantage	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.36
Rate for Payer: Cigna Commercial	$83.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.92
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

TISS THROMBOPLASTIN INH T

Facility

$51.80

Service Code	HCPCS 85705
Hospital Charge Code	39900185
Hospital Revenue Code	305
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$7.77
Rate for Payer: Qualcare PPO/HMO/WC	$7.77

TISS THROMBOPLASTIN INH T

Facility

$51.80

Service Code	HCPCS 85705
Hospital Charge Code	39900185
Hospital Revenue Code	305
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$26.19
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.76
Rate for Payer: Cigna Commercial	$25.90
Rate for Payer: Cigna Medicare Advantage	$9.63
Rate for Payer: Clover Medicare Advantage	$9.15
Rate for Payer: EmblemHealth Commercial	$28.89
Rate for Payer: Humana Medicare Advantage	$9.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.54
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.63
Rate for Payer: Wellcare Medicare Advantage	$9.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

TISS TRANSGLUTAMINASE IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39990009EX
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISS TRANSGLUTAMINASE IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39990009EX
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
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	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TISS TRANSGLUTAMINASE IGG I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

TISS TRANSGLUTAMINASE IGG I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009A
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.75
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.82
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

TISS TRANSGLUTAMINASE IGG II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

TISS TRANSGLUTAMINASE IGG II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.75
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.82
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

TISS TRNSGLTMNASE EA IG CLASS

Facility

$115.30

Service Code	HCPCS 86364
Hospital Charge Code	401186364B
Hospital Revenue Code	302
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$17.30

TISS TRNSGLTMNASE EA IG CLASS

Facility

$115.30

Service Code	HCPCS 86364
Hospital Charge Code	401186364B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$57.65
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.59
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.06

TISSU CANCELL CUBES 20c 450488

Facility

$1,500.00

Hospital Charge Code	270638783
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges