Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TNFA SCREW 75MM

Facility

$5,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270699727
Hospital Revenue Code	278
Min. Negotiated Rate	$878.25
Max. Negotiated Rate	$1,416.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,288.10
Rate for Payer: Qualcare PPO/HMO/WC	$878.25

TNK 50MG-TRANSPORT BOX

Facility

$17,131.00

Hospital Charge Code	60635395
Hospital Revenue Code	636
Min. Negotiated Rate	$2,569.65
Max. Negotiated Rate	$4,145.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,145.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,569.65

TNK 50MG-TRANSPORT BOX

Facility

$17,131.00

Hospital Charge Code	60635395
Hospital Revenue Code	636
Min. Negotiated Rate	$412.86
Max. Negotiated Rate	$8,565.50
Rate for Payer: Aetna Commercial	$6,509.78
Rate for Payer: Aetna Medicare Advantage	$5,139.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,368.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,368.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,368.40
Rate for Payer: Cigna Commercial	$8,565.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,145.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,569.65
Rate for Payer: UnitedHealthcare Community & State	$412.86
Rate for Payer: Wellpoint Medicaid Managed Care	$453.97

TNKASE KIT 50MG VIAL

Facility

$2,482.00

Hospital Charge Code	60635302
Hospital Revenue Code	636
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$600.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.64
Rate for Payer: Qualcare PPO/HMO/WC	$372.30

TNKASE KIT 50MG VIAL

Facility

$2,482.00

Hospital Charge Code	60635302
Hospital Revenue Code	636
Min. Negotiated Rate	$59.82
Max. Negotiated Rate	$1,241.00
Rate for Payer: Aetna Commercial	$943.16
Rate for Payer: Aetna Medicare Advantage	$744.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.91
Rate for Payer: Cigna Commercial	$1,241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.64
Rate for Payer: Qualcare PPO/HMO/WC	$372.30
Rate for Payer: UnitedHealthcare Community & State	$59.82
Rate for Payer: Wellpoint Medicaid Managed Care	$65.77

TOBACCO USE CESSATION >10MIN

Facility

$178.05

Service Code	HCPCS 99407
Hospital Charge Code	451199407
Hospital Revenue Code	942
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$1,202.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.67
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.41
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.71
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$4.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

TOBACCO USE CESSATION >10MIN

Facility

$178.05

Service Code	HCPCS 99407
Hospital Charge Code	451199407
Hospital Revenue Code	942
Min. Negotiated Rate	$26.71
Max. Negotiated Rate	$26.71
Rate for Payer: Qualcare PPO/HMO/WC	$26.71

TOBACCO USE CESSATION 3-10MIN

Facility

$178.05

Service Code	HCPCS 99406
Hospital Charge Code	451199406
Hospital Revenue Code	942
Min. Negotiated Rate	$26.71
Max. Negotiated Rate	$26.71
Rate for Payer: Qualcare PPO/HMO/WC	$26.71

TOBACCO USE CESSATION 3-10MIN

Facility

$178.05

Service Code	HCPCS 99406
Hospital Charge Code	451199406
Hospital Revenue Code	942
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$1,202.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.67
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.41
Rate for Payer: Oxford Commercial	$686.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.71
Rate for Payer: UnitedHealthcare Commercial	$1,202.00
Rate for Payer: UnitedHealthcare Community & State	$4.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

TOBRA GRAFT COLLECT

Facility

$5,000.00

Hospital Charge Code	270702382
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TOBRA GRAFT COLLECT

Facility

$5,000.00

Hospital Charge Code	270702382
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

TOBRAMYCIN

Facility

$169.00

Service Code	HCPCS 80200
Hospital Charge Code	38472650
Hospital Revenue Code	301
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.87
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.22
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: Cigna Medicare Advantage	$16.13
Rate for Payer: Clover Medicare Advantage	$15.32
Rate for Payer: EmblemHealth Commercial	$48.39
Rate for Payer: Humana Medicare Advantage	$16.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.13
Rate for Payer: Wellcare Medicare Advantage	$16.13
Rate for Payer: Wellpoint Medicaid Managed Care	$4.48

TOBRAMYCIN

Facility

$136.85

Service Code	HCPCS 80200
Hospital Charge Code	3004025
Hospital Revenue Code	301
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.87
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.22
Rate for Payer: Cigna Commercial	$68.42
Rate for Payer: Cigna Medicare Advantage	$16.13
Rate for Payer: Clover Medicare Advantage	$15.32
Rate for Payer: EmblemHealth Commercial	$48.39
Rate for Payer: Humana Medicare Advantage	$16.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.13
Rate for Payer: Wellcare Medicare Advantage	$16.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

TOBRAMYCIN

Facility

$169.00

Service Code	HCPCS 80200
Hospital Charge Code	38472650
Hospital Revenue Code	301
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

TOBRAMYCIN

Facility

$136.85

Service Code	HCPCS 80200
Hospital Charge Code	3004025
Hospital Revenue Code	301
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.53

TOBRAMYCIN 0.3%/DEX OPTH SUSP

Facility

$374.43

Hospital Charge Code	606350910
Hospital Revenue Code	250
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$56.16
Rate for Payer: Qualcare PPO/HMO/WC	$56.16

TOBRAMYCIN 0.3%/DEX OPTH SUSP

Facility

$374.43

Hospital Charge Code	606350910
Hospital Revenue Code	250
Min. Negotiated Rate	$9.02
Max. Negotiated Rate	$187.22
Rate for Payer: Aetna Commercial	$142.28
Rate for Payer: Aetna Medicare Advantage	$112.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.48
Rate for Payer: Cigna Commercial	$187.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.33
Rate for Payer: Oxford Commercial	$74.89
Rate for Payer: Qualcare PPO/HMO/WC	$56.16
Rate for Payer: UnitedHealthcare Commercial	$74.89
Rate for Payer: UnitedHealthcare Community & State	$9.02
Rate for Payer: Wellpoint Medicaid Managed Care	$9.92

TOBRAMYCIN DEXTHSN OPH OINT

Facility

$1,499.46

Service Code	NDC 78087601
Hospital Charge Code	60628024
Hospital Revenue Code	250
Min. Negotiated Rate	$36.14
Max. Negotiated Rate	$749.73
Rate for Payer: Aetna Commercial	$569.79
Rate for Payer: Aetna Medicare Advantage	$449.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.36
Rate for Payer: Cigna Commercial	$749.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$449.84
Rate for Payer: Oxford Commercial	$299.89
Rate for Payer: Qualcare PPO/HMO/WC	$224.92
Rate for Payer: UnitedHealthcare Commercial	$299.89
Rate for Payer: UnitedHealthcare Community & State	$36.14
Rate for Payer: Wellpoint Medicaid Managed Care	$39.74

TOBRAMYCIN DEXTHSN OPH OINT

Facility

$1,499.46

Service Code	NDC 78087601
Hospital Charge Code	60628024
Hospital Revenue Code	250
Min. Negotiated Rate	$224.92
Max. Negotiated Rate	$224.92
Rate for Payer: Qualcare PPO/HMO/WC	$224.92

TOBRAMYCIN DEXTHSN OPH SSP

Facility

$566.42

Service Code	NDC 78095340
Hospital Charge Code	60628025
Hospital Revenue Code	250
Min. Negotiated Rate	$84.96
Max. Negotiated Rate	$84.96
Rate for Payer: Qualcare PPO/HMO/WC	$84.96

TOBRAMYCIN DEXTHSN OPH SSP

Facility

$566.42

Service Code	NDC 78095340
Hospital Charge Code	60628025
Hospital Revenue Code	250
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$283.21
Rate for Payer: Aetna Commercial	$215.24
Rate for Payer: Aetna Medicare Advantage	$169.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.44
Rate for Payer: Cigna Commercial	$283.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.93
Rate for Payer: Oxford Commercial	$113.28
Rate for Payer: Qualcare PPO/HMO/WC	$84.96
Rate for Payer: UnitedHealthcare Commercial	$113.28
Rate for Payer: UnitedHealthcare Community & State	$13.65
Rate for Payer: Wellpoint Medicaid Managed Care	$15.01

TOBRAMYCIN DEXTHSN OPT SOL 5ML

Facility

$174.75

Hospital Charge Code	6007421
Hospital Revenue Code	251
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

TOBRAMYCIN DEXTHSN OPT SOL 5ML

Facility

$174.75

Hospital Charge Code	6007421
Hospital Revenue Code	251
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.38
Rate for Payer: Aetna Commercial	$66.41
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Oxford Commercial	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$34.95
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

TOBRAMYCIN OPH DROPS

Facility

$174.75

Hospital Charge Code	6005367
Hospital Revenue Code	251
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.38
Rate for Payer: Aetna Commercial	$66.41
Rate for Payer: Aetna Medicare Advantage	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.56
Rate for Payer: Cigna Commercial	$87.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Oxford Commercial	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Commercial	$34.95
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

TOBRAMYCIN OPH DROPS

Facility

$174.75

Hospital Charge Code	6005367
Hospital Revenue Code	251
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$26.21
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

Know your out-of-pocket cost for care.

All Charges