Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TOFRANIL/50MG/TAB

Facility

$4.00

Hospital Charge Code	60634036
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

TOFRANIL/50MG/TAB

Facility

$4.00

Hospital Charge Code	60634038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

TOFRANIL PM 75MG

Facility

$5.00

Hospital Charge Code	60635142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TOFRANIL PM 75MG

Facility

$5.00

Hospital Charge Code	60635142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TOGGELOC W/ZIPLOOP ELBOW SYS W

Facility

$8,085.00

Hospital Charge Code	270662948
Hospital Revenue Code	278
Min. Negotiated Rate	$194.85
Max. Negotiated Rate	$4,042.50
Rate for Payer: Aetna Commercial	$3,072.30
Rate for Payer: Aetna Medicare Advantage	$2,425.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,061.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,061.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,617.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,061.68
Rate for Payer: Cigna Commercial	$4,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,212.75
Rate for Payer: UnitedHealthcare Community & State	$194.85
Rate for Payer: Wellpoint Medicaid Managed Care	$214.25

TOGGELOC W/ZIPLOOP ELBOW SYS W

Facility

$8,085.00

Hospital Charge Code	270662948
Hospital Revenue Code	278
Min. Negotiated Rate	$1,212.75
Max. Negotiated Rate	$1,956.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,617.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,212.75

TOGGLEL ELBOW IMPLANT SYSTEM

Facility

$7,375.00

Hospital Charge Code	270662680
Hospital Revenue Code	278
Min. Negotiated Rate	$177.74
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,802.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,622.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25
Rate for Payer: UnitedHealthcare Community & State	$177.74
Rate for Payer: Wellpoint Medicaid Managed Care	$195.44

TOGGLEL ELBOW IMPLANT SYSTEM

Facility

$7,375.00

Hospital Charge Code	270662680
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,622.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

TOILET TISSUE 500 SHEET APM35

Facility

$2.03

Hospital Charge Code	270637411
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

TOILET TISSUE 500 SHEET APM35

Facility

$2.03

Hospital Charge Code	270637411
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.01
Rate for Payer: Aetna Commercial	$0.77
Rate for Payer: Aetna Medicare Advantage	$0.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.52
Rate for Payer: Cigna Commercial	$1.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.61
Rate for Payer: Oxford Commercial	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.41
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

TOKEN SYNK WIRELESS

Facility

$225.00

Hospital Charge Code	270676529
Hospital Revenue Code	272
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

TOKEN SYNK WIRELESS

Facility

$225.00

Hospital Charge Code	270676529
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

TOLAZAMIDE 100 MG TAB

Facility

$4.00

Hospital Charge Code	60628237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TOLAZAMIDE 100 MG TAB

Facility

$4.00

Hospital Charge Code	60628237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

TOLAZAMIDE 250 MG TAB

Facility

$5.65

Hospital Charge Code	60628238
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

TOLAZAMIDE 250 MG TAB

Facility

$5.65

Hospital Charge Code	60628238
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

TOLAZOLINE INJ 25MG/1ML 4ML

Facility

$106.90

Hospital Charge Code	60627663
Hospital Revenue Code	250
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$16.04

TOLAZOLINE INJ 25MG/1ML 4ML

Facility

$106.90

Hospital Charge Code	60627663
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.45
Rate for Payer: Aetna Commercial	$40.62
Rate for Payer: Aetna Medicare Advantage	$32.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.26
Rate for Payer: Cigna Commercial	$53.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.07
Rate for Payer: Oxford Commercial	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$16.04
Rate for Payer: UnitedHealthcare Commercial	$21.38
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.83

TOLBUTAMIDE 500 MG TAB

Facility

$2.45

Hospital Charge Code	60628239
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TOLBUTAMIDE 500 MG TAB

Facility

$2.45

Hospital Charge Code	60628239
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

TOLCAPONE 100 MG TAB

Facility

$20.85

Hospital Charge Code	60628768
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.25
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$4.17
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

TOLCAPONE 100 MG TAB

Facility

$20.85

Hospital Charge Code	60628768
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

TOLECTIN 600/600MG/TAB

Facility

$6.00

Hospital Charge Code	60634039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TOLECTIN 600/600MG/TAB

Facility

$6.00

Hospital Charge Code	60634039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TOLECTIN DS/400MG/CAP

Facility

$3.00

Hospital Charge Code	60634402
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges