Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TBI TRIATHLON CS SZ 5 10MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697224
Hospital Revenue Code	278
Min. Negotiated Rate	$120.15
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,894.41
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.77
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$120.15
Rate for Payer: Wellpoint Medicaid Managed Care	$132.11

TBI TRIATHLON CS SZ 5 10MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697224
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.77
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TBI TRIATHLON CS SZ 8

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695714
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON CS SZ 8

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695714
Hospital Revenue Code	278
Min. Negotiated Rate	$122.48
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$122.48
Rate for Payer: Wellpoint Medicaid Managed Care	$134.68

TBI TRIATHLON SZ4 CS 14MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270698940
Hospital Revenue Code	278
Min. Negotiated Rate	$122.48
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$122.48
Rate for Payer: Wellpoint Medicaid Managed Care	$134.68

TBI TRIATHLON SZ4 CS 14MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270698940
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON X3 SZ 2 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695587
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TBI TRIATHLON X3 SZ 2 CS 9MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270695587
Hospital Revenue Code	278
Min. Negotiated Rate	$122.48
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$122.48
Rate for Payer: Wellpoint Medicaid Managed Care	$134.68

TBI TRIATHLON X3 SZ 4 CS 12MM

Facility

$5,082.40

Service Code	HCPCS C1776
Hospital Charge Code	270697368
Hospital Revenue Code	278
Min. Negotiated Rate	$762.36
Max. Negotiated Rate	$1,229.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.13
Rate for Payer: Qualcare PPO/HMO/WC	$762.36

TBI TRIATHLON X3 SZ 4 CS 12MM

Facility

$5,082.40

Service Code	HCPCS C1776
Hospital Charge Code	270697368
Hospital Revenue Code	278
Min. Negotiated Rate	$122.49
Max. Negotiated Rate	$2,541.20
Rate for Payer: Aetna Commercial	$1,931.31
Rate for Payer: Aetna Medicare Advantage	$1,524.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.01
Rate for Payer: Cigna Commercial	$2,541.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.13
Rate for Payer: Qualcare PPO/HMO/WC	$762.36
Rate for Payer: UnitedHealthcare Community & State	$122.49
Rate for Payer: Wellpoint Medicaid Managed Care	$134.68

TBI TRIATH PS X3 SZ2 11MM

Facility

$4,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270694194
Hospital Revenue Code	278
Min. Negotiated Rate	$117.61
Max. Negotiated Rate	$2,440.00
Rate for Payer: Aetna Commercial	$1,854.40
Rate for Payer: Aetna Medicare Advantage	$1,464.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.40
Rate for Payer: Cigna Commercial	$2,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,180.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,073.60
Rate for Payer: Qualcare PPO/HMO/WC	$732.00
Rate for Payer: UnitedHealthcare Community & State	$117.61
Rate for Payer: Wellpoint Medicaid Managed Care	$129.32

TBI TRIATH PS X3 SZ2 11MM

Facility

$4,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270694194
Hospital Revenue Code	278
Min. Negotiated Rate	$732.00
Max. Negotiated Rate	$1,180.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,180.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,073.60
Rate for Payer: Qualcare PPO/HMO/WC	$732.00

TBI TRIATH TS SZ6 11MM

Facility

$4,447.75

Service Code	HCPCS C1776
Hospital Charge Code	270694178
Hospital Revenue Code	278
Min. Negotiated Rate	$107.19
Max. Negotiated Rate	$2,223.88
Rate for Payer: Aetna Commercial	$1,690.14
Rate for Payer: Aetna Medicare Advantage	$1,334.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.18
Rate for Payer: Cigna Commercial	$2,223.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$978.50
Rate for Payer: Qualcare PPO/HMO/WC	$667.16
Rate for Payer: UnitedHealthcare Community & State	$107.19
Rate for Payer: Wellpoint Medicaid Managed Care	$117.87

TBI TRIATH TS SZ6 11MM

Facility

$4,447.75

Service Code	HCPCS C1776
Hospital Charge Code	270694178
Hospital Revenue Code	278
Min. Negotiated Rate	$667.16
Max. Negotiated Rate	$1,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$978.50
Rate for Payer: Qualcare PPO/HMO/WC	$667.16

TBI X3 PS TRIATHLON SZ4 11MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270694175
Hospital Revenue Code	278
Min. Negotiated Rate	$120.15
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,894.41
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.77
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$120.15
Rate for Payer: Wellpoint Medicaid Managed Care	$132.11

TBI X3 PS TRIATHLON SZ4 11MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270694175
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.77
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TBI X3 TRIATHLON CS SZ7 11MM

Facility

$5,082.55

Service Code	HCPCS C1776
Hospital Charge Code	270694174
Hospital Revenue Code	278
Min. Negotiated Rate	$122.49
Max. Negotiated Rate	$2,541.28
Rate for Payer: Aetna Commercial	$1,931.37
Rate for Payer: Aetna Medicare Advantage	$1,524.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.05
Rate for Payer: Cigna Commercial	$2,541.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.16
Rate for Payer: Qualcare PPO/HMO/WC	$762.38
Rate for Payer: UnitedHealthcare Community & State	$122.49
Rate for Payer: Wellpoint Medicaid Managed Care	$134.69

TBI X3 TRIATHLON CS SZ7 11MM

Facility

$5,082.55

Service Code	HCPCS C1776
Hospital Charge Code	270694174
Hospital Revenue Code	278
Min. Negotiated Rate	$762.38
Max. Negotiated Rate	$1,229.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.16
Rate for Payer: Qualcare PPO/HMO/WC	$762.38

T&B LYMPHOCYTE DIFFERENTIAL PR

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38473048
Hospital Revenue Code	311
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$223.48
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.41

T&B LYMPHOCYTE DIFFERENTIAL PR

Facility

$393.00

Service Code	HCPCS 88182
Hospital Charge Code	38473048
Hospital Revenue Code	311
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

*T&B LYMPHOCYTES DIFF PROFILE*

Facility

$89.00

Service Code	HCPCS 86355
Hospital Charge Code	3008706A
Hospital Revenue Code	305
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$136.19
Rate for Payer: Aetna Commercial	$102.63
Rate for Payer: Aetna Medicare Advantage	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$37.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.19
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: Cigna Medicare Advantage	$37.73
Rate for Payer: Clover Medicare Advantage	$35.84
Rate for Payer: EmblemHealth Commercial	$113.19
Rate for Payer: Humana Medicare Advantage	$38.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$37.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.73
Rate for Payer: Wellcare Medicare Advantage	$37.73
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

*T&B LYMPHOCYTES DIFF PROFILE*

Facility

$89.00

Service Code	HCPCS 86355
Hospital Charge Code	3008706A
Hospital Revenue Code	305
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

TBO-FILGRASTIM 300 MCG/0.5 ML

Facility

$2,008.93

Service Code	HCPCS J1447
Hospital Charge Code	606380015
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$486.16
Rate for Payer: Aetna Commercial	$0.68
Rate for Payer: Aetna Medicare Advantage	$0.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$0.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.90
Rate for Payer: Cigna Medicare Advantage	$0.25
Rate for Payer: Clover Medicare Advantage	$0.24
Rate for Payer: EmblemHealth Commercial	$0.75
Rate for Payer: Humana Medicare Advantage	$0.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.16
Rate for Payer: Qualcare PPO/HMO/WC	$301.34
Rate for Payer: UnitedHealthcare Community & State	$48.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.25
Rate for Payer: Wellcare Medicare Advantage	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$53.24

TBO-FILGRASTIM 300 MCG/0.5 ML

Facility

$2,008.93

Service Code	HCPCS J1447
Hospital Charge Code	606380015
Hospital Revenue Code	636
Min. Negotiated Rate	$301.34
Max. Negotiated Rate	$486.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.16
Rate for Payer: Qualcare PPO/HMO/WC	$301.34

TB TEST-QUANTIFERON/AG-GI RS

Facility

$438.95

Service Code	HCPCS 86480
Hospital Charge Code	38478078
Hospital Revenue Code	300
Min. Negotiated Rate	$65.84
Max. Negotiated Rate	$65.84
Rate for Payer: Qualcare PPO/HMO/WC	$65.84

Know your out-of-pocket cost for care.

All Charges