Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIZANIDINE 4 MG TAB

Facility

$11.79

Service Code	NDC 904641861
Hospital Charge Code	60629865
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

TIZANIDINE (ZANAFLEX) 2MG CAP

Facility

$14.27

Service Code	NDC 378072219
Hospital Charge Code	60630191
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$2.14
Rate for Payer: Qualcare PPO/HMO/WC	$2.14

TIZANIDINE (ZANAFLEX) 2MG CAP

Facility

$14.27

Service Code	NDC 378072219
Hospital Charge Code	60630191
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.13
Rate for Payer: Aetna Commercial	$5.42
Rate for Payer: Aetna Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.64
Rate for Payer: Cigna Commercial	$7.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.28
Rate for Payer: Oxford Commercial	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.14
Rate for Payer: UnitedHealthcare Commercial	$2.85
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

TL201 THALLIUM MCI

Facility

$55.00

Hospital Charge Code	74117075
Hospital Revenue Code	343
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

TL201 THALLIUM MCI

Facility

$55.00

Hospital Charge Code	74117075
Hospital Revenue Code	343
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

TL201 THALLIUM MCI

Facility

$55.00

Service Code	HCPCS A9505
Hospital Charge Code	5309025
Hospital Revenue Code	343
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$59.80
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

TL201 THALLIUM MCI

Facility

$55.00

Hospital Charge Code	74116075
Hospital Revenue Code	343
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

TL201 THALLIUM MCI

Facility

$55.00

Hospital Charge Code	74116075
Hospital Revenue Code	343
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

TL201 THALLIUM MCI

Facility

$55.00

Service Code	HCPCS A9505
Hospital Charge Code	74115075
Hospital Revenue Code	343
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$59.80
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

TL201 THALLIUM MCI

Facility

$55.00

Service Code	HCPCS A9505
Hospital Charge Code	74115075
Hospital Revenue Code	343
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

TL201 THALLIUM MCI

Facility

$55.00

Service Code	HCPCS A9505
Hospital Charge Code	5309025
Hospital Revenue Code	343
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

TL ANGIOPLASTY TIBIOPERONEAL

Facility

$9,403.75

Hospital Charge Code	5600055
Hospital Revenue Code	323
Min. Negotiated Rate	$226.63
Max. Negotiated Rate	$4,701.88
Rate for Payer: Aetna Commercial	$3,573.43
Rate for Payer: Aetna Medicare Advantage	$2,821.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.96
Rate for Payer: Cigna Commercial	$4,701.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,821.12
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.56
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$226.63
Rate for Payer: Wellpoint Medicaid Managed Care	$249.20

TL ANGIOPLASTY TIBIOPERONEAL

Facility

$9,403.75

Hospital Charge Code	5600055
Hospital Revenue Code	323
Min. Negotiated Rate	$1,410.56
Max. Negotiated Rate	$1,410.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.56

TLH UTERUS 250 G OR LESS

Facility

$43,334.60

Service Code	HCPCS 58570
Hospital Charge Code	1600000716
Hospital Revenue Code	360
Min. Negotiated Rate	$6,500.19
Max. Negotiated Rate	$6,500.19
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.19

TLH UTERUS 250 G OR LESS

Facility

$43,334.60

Service Code	HCPCS 58570
Hospital Charge Code	1600000716
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.36
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,000.38
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.19
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,044.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1,148.37

TLH W/T/O 250 G OR LESS

Facility

$43,334.60

Service Code	HCPCS 58571
Hospital Charge Code	16000763
Hospital Revenue Code	360
Min. Negotiated Rate	$1,044.36
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,000.38
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.19
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,044.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1,148.37

TLH W/T/O 250 G OR LESS

Facility

$43,334.60

Service Code	HCPCS 58571
Hospital Charge Code	16000763
Hospital Revenue Code	360
Min. Negotiated Rate	$6,500.19
Max. Negotiated Rate	$6,500.19
Rate for Payer: Qualcare PPO/HMO/WC	$6,500.19

TLH W/T/O UTERUS OVER 250 G

Facility

$30,381.68

Service Code	HCPCS 58573
Hospital Charge Code	16000764
Hospital Revenue Code	360
Min. Negotiated Rate	$4,557.25
Max. Negotiated Rate	$4,557.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,557.25

TLH W/T/O UTERUS OVER 250 G

Facility

$30,381.68

Service Code	HCPCS 58573
Hospital Charge Code	16000764
Hospital Revenue Code	360
Min. Negotiated Rate	$732.20
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,114.50
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,557.25
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$732.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$805.11

TLIF, 10X25, L

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704015
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

TLIF, 10X25, L

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704015
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

TLIF PEEK CORENT 8X9X30MM 8 DE

Facility

$33,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270682867
Hospital Revenue Code	278
Min. Negotiated Rate	$5,079.00
Max. Negotiated Rate	$8,194.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,194.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,449.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,079.00

TLIF PEEK CORENT 8X9X30MM 8 DE

Facility

$33,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270682867
Hospital Revenue Code	278
Min. Negotiated Rate	$816.03
Max. Negotiated Rate	$16,930.00
Rate for Payer: Aetna Commercial	$12,866.80
Rate for Payer: Aetna Medicare Advantage	$10,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,634.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,634.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,634.30
Rate for Payer: Cigna Commercial	$16,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,194.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,449.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,079.00
Rate for Payer: UnitedHealthcare Community & State	$816.03
Rate for Payer: Wellpoint Medicaid Managed Care	$897.29

T.L.S. DRAIN

Facility

$186.00

Hospital Charge Code	270331695
Hospital Revenue Code	278
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

T.L.S. DRAIN

Facility

$186.00

Hospital Charge Code	270331695
Hospital Revenue Code	278
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

Know your out-of-pocket cost for care.

All Charges