Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TOBRAMYCIN OPH ITV 2MG/ML

Facility

$61.45

Hospital Charge Code	6005359
Hospital Revenue Code	251
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$9.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.22

TOBRAMYCIN OPH ITV 2MG/ML

Facility

$61.45

Hospital Charge Code	6005359
Hospital Revenue Code	251
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$30.73
Rate for Payer: Aetna Commercial	$23.35
Rate for Payer: Aetna Medicare Advantage	$18.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.67
Rate for Payer: Cigna Commercial	$30.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.43
Rate for Payer: Oxford Commercial	$12.29
Rate for Payer: Qualcare PPO/HMO/WC	$9.22
Rate for Payer: UnitedHealthcare Commercial	$12.29
Rate for Payer: UnitedHealthcare Community & State	$1.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

TOBRAMYCIN OPH OINT 0.3% 3.5GM

Facility

$41.60

Hospital Charge Code	6005334
Hospital Revenue Code	251
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

TOBRAMYCIN OPH OINT 0.3% 3.5GM

Facility

$41.60

Hospital Charge Code	6005334
Hospital Revenue Code	251
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

TOBRAMYCIN OPH SOL .3% 5ML

Facility

$53.80

Hospital Charge Code	6005342
Hospital Revenue Code	251
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

TOBRAMYCIN OPH SOL .3% 5ML

Facility

$53.80

Hospital Charge Code	6005342
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

TOBRAMYCIN OPTH OINT

Facility

$604.61

Service Code	NDC 65064435
Hospital Charge Code	60628022
Hospital Revenue Code	250
Min. Negotiated Rate	$90.69
Max. Negotiated Rate	$90.69
Rate for Payer: Qualcare PPO/HMO/WC	$90.69

TOBRAMYCIN OPTH OINT

Facility

$604.61

Service Code	NDC 65064435
Hospital Charge Code	60628022
Hospital Revenue Code	250
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$302.31
Rate for Payer: Aetna Commercial	$229.75
Rate for Payer: Aetna Medicare Advantage	$181.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.18
Rate for Payer: Cigna Commercial	$302.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.38
Rate for Payer: Oxford Commercial	$120.92
Rate for Payer: Qualcare PPO/HMO/WC	$90.69
Rate for Payer: UnitedHealthcare Commercial	$120.92
Rate for Payer: UnitedHealthcare Community & State	$14.57
Rate for Payer: Wellpoint Medicaid Managed Care	$16.02

TOBRAMYCIN OPTH SOL 0.3% 5ML

Facility

$98.42

Service Code	NDC 24208029005
Hospital Charge Code	60628023
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$14.76
Rate for Payer: Qualcare PPO/HMO/WC	$14.76

TOBRAMYCIN OPTH SOL 0.3% 5ML

Facility

$98.42

Service Code	NDC 24208029005
Hospital Charge Code	60628023
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$49.21
Rate for Payer: Aetna Commercial	$37.40
Rate for Payer: Aetna Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.10
Rate for Payer: Cigna Commercial	$49.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.53
Rate for Payer: Oxford Commercial	$19.68
Rate for Payer: Qualcare PPO/HMO/WC	$14.76
Rate for Payer: UnitedHealthcare Commercial	$19.68
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.61

TOBRAMYCIN VL 1.2GM

Facility

$489.60

Hospital Charge Code	6010540
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$244.80
Rate for Payer: Aetna Commercial	$186.05
Rate for Payer: Aetna Medicare Advantage	$146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.85
Rate for Payer: Cigna Commercial	$244.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.88
Rate for Payer: Oxford Commercial	$97.92
Rate for Payer: Qualcare PPO/HMO/WC	$73.44
Rate for Payer: UnitedHealthcare Commercial	$97.92
Rate for Payer: UnitedHealthcare Community & State	$11.80
Rate for Payer: Wellpoint Medicaid Managed Care	$12.97

TOBRAMYCIN VL 1.2GM

Facility

$489.60

Hospital Charge Code	6010540
Hospital Revenue Code	250
Min. Negotiated Rate	$73.44
Max. Negotiated Rate	$73.44
Rate for Payer: Qualcare PPO/HMO/WC	$73.44

TOBREX 0.3% OPHTH/5ML

Facility

$97.00

Hospital Charge Code	60634035
Hospital Revenue Code	250
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

TOBREX 0.3% OPHTH/5ML

Facility

$97.00

Hospital Charge Code	60634035
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.10
Rate for Payer: Oxford Commercial	$19.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$19.40
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

TOCAINIDE TAB 400MG

Facility

$10.45

Hospital Charge Code	60627612
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

TOCAINIDE TAB 400MG

Facility

$10.45

Hospital Charge Code	60627612
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

TOCAINIDE (TONOCARD)

Facility

$291.00

Service Code	HCPCS 80299
Hospital Charge Code	38473122
Hospital Revenue Code	301
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

TOCAINIDE (TONOCARD)

Facility

$291.00

Service Code	HCPCS 80299
Hospital Charge Code	38473122
Hospital Revenue Code	301
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

TOCOPHEROL CAP 1000U

Facility

$3.20

Hospital Charge Code	60628725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TOCOPHEROL CAP 1000U

Facility

$3.20

Hospital Charge Code	60628725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

TODDLER MASK

Facility

$39.00

Hospital Charge Code	270332339
Hospital Revenue Code	272
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

TODDLER MASK

Facility

$39.00

Hospital Charge Code	270332339
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

TOE ARTIC COMP 15MM 2.5X4.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270696339
Hospital Revenue Code	278
Min. Negotiated Rate	$362.22
Max. Negotiated Rate	$7,515.00
Rate for Payer: Aetna Commercial	$5,711.40
Rate for Payer: Aetna Medicare Advantage	$4,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,832.65
Rate for Payer: Cigna Commercial	$7,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,306.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50
Rate for Payer: UnitedHealthcare Community & State	$362.22
Rate for Payer: Wellpoint Medicaid Managed Care	$398.30

TOE ARTIC COMP 15MM 2.5X4.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270696339
Hospital Revenue Code	278
Min. Negotiated Rate	$2,254.50
Max. Negotiated Rate	$3,637.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,306.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50

TOE FLEX HINGE W/GR G426-0010

Facility

$2,681.65

Hospital Charge Code	270611667
Hospital Revenue Code	278
Min. Negotiated Rate	$402.25
Max. Negotiated Rate	$648.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$589.96
Rate for Payer: Qualcare PPO/HMO/WC	$402.25

Know your out-of-pocket cost for care.

All Charges