Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Trailblazer Angle .035 x 90

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676N
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

Trailblazer Angle .035 x 90

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676S
Hospital Revenue Code	278
Min. Negotiated Rate	$127.25
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$127.25
Rate for Payer: Wellpoint Medicaid Managed Care	$139.92

Trailblazer Angle .035 x 90

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676S
Hospital Revenue Code	278
Min. Negotiated Rate	$792.00
Max. Negotiated Rate	$1,277.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$792.00

Trailblazer Angle .035 x 90

Facility

$5,280.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676N
Hospital Revenue Code	278
Min. Negotiated Rate	$127.25
Max. Negotiated Rate	$2,640.00
Rate for Payer: Aetna Commercial	$2,006.40
Rate for Payer: Aetna Medicare Advantage	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,056.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.40
Rate for Payer: Cigna Commercial	$2,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,161.60
Rate for Payer: Qualcare PPO/HMO/WC	$792.00
Rate for Payer: UnitedHealthcare Community & State	$127.25
Rate for Payer: Wellpoint Medicaid Managed Care	$139.92

TRAMADOL 50MG

Facility

$3.00

Hospital Charge Code	60635624
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TRAMADOL 50MG

Facility

$3.00

Hospital Charge Code	60635624
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRAMADOL 50 MG TAB

Facility

$5.36

Service Code	NDC 51079099120
Hospital Charge Code	60627720
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

TRAMADOL 50 MG TAB

Facility

$5.36

Service Code	NDC 51079099120
Hospital Charge Code	60627720
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

TRAMADOL SCREENW REF/CONF URIN

Facility

$399.05

Service Code	HCPCS 80307
Hospital Charge Code	39708045
Hospital Revenue Code	306
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$224.31
Rate for Payer: Aetna Commercial	$169.02
Rate for Payer: Aetna Medicare Advantage	$201.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.31
Rate for Payer: Cigna Commercial	$199.53
Rate for Payer: Cigna Medicare Advantage	$62.14
Rate for Payer: Clover Medicare Advantage	$59.03
Rate for Payer: EmblemHealth Commercial	$186.42
Rate for Payer: Humana Medicare Advantage	$64.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$62.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.72
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.86
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$49.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.14
Rate for Payer: Wellcare Medicare Advantage	$62.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.57

TRAMADOL SCREENW REF/CONF URIN

Facility

$399.05

Service Code	HCPCS 80307
Hospital Charge Code	39708045
Hospital Revenue Code	306
Min. Negotiated Rate	$59.86
Max. Negotiated Rate	$59.86
Rate for Payer: Qualcare PPO/HMO/WC	$59.86

TRANDATE/100MG/TAB

Facility

$3.00

Hospital Charge Code	60634403
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRANDATE/100MG/TAB

Facility

$3.00

Hospital Charge Code	60634403
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TRANDATE/5MG/1ML

Facility

$183.00

Hospital Charge Code	60634047
Hospital Revenue Code	250
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$91.50
Rate for Payer: Aetna Commercial	$69.54
Rate for Payer: Aetna Medicare Advantage	$54.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.66
Rate for Payer: Cigna Commercial	$91.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.90
Rate for Payer: Oxford Commercial	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$27.45
Rate for Payer: UnitedHealthcare Commercial	$36.60
Rate for Payer: UnitedHealthcare Community & State	$4.41
Rate for Payer: Wellpoint Medicaid Managed Care	$4.85

TRANDATE/5MG/1ML

Facility

$183.00

Hospital Charge Code	60634047
Hospital Revenue Code	250
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$27.45
Rate for Payer: Qualcare PPO/HMO/WC	$27.45

TRANEXAMIC ACID

Facility

$16.75

Service Code	NDC 517096010
Hospital Charge Code	606380005
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.51

TRANEXAMIC ACID

Facility

$16.75

Service Code	NDC 517096010
Hospital Charge Code	606380005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.38
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: Aetna Medicare Advantage	$5.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.27
Rate for Payer: Cigna Commercial	$8.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.03
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.51
Rate for Payer: UnitedHealthcare Commercial	$3.35
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

TRANEXAMIC ACID 1000MG/100ML

Facility

$169.18

Service Code	NDC 51754010803
Hospital Charge Code	606390297
Hospital Revenue Code	250
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$84.59
Rate for Payer: Aetna Commercial	$64.29
Rate for Payer: Aetna Medicare Advantage	$50.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.14
Rate for Payer: Cigna Commercial	$84.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.75
Rate for Payer: Oxford Commercial	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$25.38
Rate for Payer: UnitedHealthcare Commercial	$33.84
Rate for Payer: UnitedHealthcare Community & State	$4.08
Rate for Payer: Wellpoint Medicaid Managed Care	$4.48

TRANEXAMIC ACID 1000MG/100ML

Facility

$169.18

Service Code	NDC 51754010803
Hospital Charge Code	606390297
Hospital Revenue Code	250
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$25.38
Rate for Payer: Qualcare PPO/HMO/WC	$25.38

TRAN OR AVULSE OTH SPINAL NRV

Facility

$16,437.00

Service Code	HCPCS 64772
Hospital Charge Code	16000656
Hospital Revenue Code	360
Min. Negotiated Rate	$2,465.55
Max. Negotiated Rate	$2,465.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55

TRAN OR AVULSE OTH SPINAL NRV

Facility

$16,437.00

Service Code	HCPCS 64772
Hospital Charge Code	16000656
Hospital Revenue Code	360
Min. Negotiated Rate	$396.13
Max. Negotiated Rate	$8,374.11
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,374.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,374.11
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,931.10
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,465.55
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$396.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$435.58

TRANS ARTHER BRACHI-BI

Facility

$26,293.00

Service Code	HCPCS 0237T50
Hospital Charge Code	7411257
Hospital Revenue Code	361
Min. Negotiated Rate	$3,943.95
Max. Negotiated Rate	$3,943.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,943.95

TRANS ARTHER BRACHI-BI

Facility

$26,293.00

Service Code	HCPCS 0237T50
Hospital Charge Code	7411257
Hospital Revenue Code	361
Min. Negotiated Rate	$633.66
Max. Negotiated Rate	$13,146.50
Rate for Payer: Aetna Commercial	$9,991.34
Rate for Payer: Aetna Medicare Advantage	$7,887.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,704.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,704.72
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	$6,704.72
Rate for Payer: Cigna Commercial	$13,146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,887.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,943.95
Rate for Payer: UnitedHealthcare Community & State	$633.66
Rate for Payer: Wellpoint Medicaid Managed Care	$696.76

TRANS ARTHER BRACHI-LT

Facility

$26,293.00

Service Code	HCPCS 0237TLT
Hospital Charge Code	7411259
Hospital Revenue Code	361
Min. Negotiated Rate	$3,943.95
Max. Negotiated Rate	$3,943.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,943.95

TRANS ARTHER BRACHI-LT

Facility

$26,293.00

Service Code	HCPCS 0237TLT
Hospital Charge Code	7411259
Hospital Revenue Code	361
Min. Negotiated Rate	$633.66
Max. Negotiated Rate	$13,146.50
Rate for Payer: Aetna Commercial	$9,991.34
Rate for Payer: Aetna Medicare Advantage	$7,887.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,704.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,704.72
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	$6,704.72
Rate for Payer: Cigna Commercial	$13,146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,887.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,943.95
Rate for Payer: UnitedHealthcare Community & State	$633.66
Rate for Payer: Wellpoint Medicaid Managed Care	$696.76

TRANS ARTHER BRACHI-RT

Facility

$26,293.00

Service Code	HCPCS 0237TRT
Hospital Charge Code	7411261
Hospital Revenue Code	361
Min. Negotiated Rate	$633.66
Max. Negotiated Rate	$13,146.50
Rate for Payer: Aetna Commercial	$9,991.34
Rate for Payer: Aetna Medicare Advantage	$7,887.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,704.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,704.72
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	$6,704.72
Rate for Payer: Cigna Commercial	$13,146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,887.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,943.95
Rate for Payer: UnitedHealthcare Community & State	$633.66
Rate for Payer: Wellpoint Medicaid Managed Care	$696.76

Know your out-of-pocket cost for care.

All Charges