Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRANSTELEPHONIC PCMKR CHK SGL

Facility

$106.90

Service Code	HCPCS 93293
Hospital Charge Code	5300135
Hospital Revenue Code	921
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.07
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.04
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.83

TRANSTELEPHONIC PCMKR CHK SGL

Facility

$106.90

Service Code	HCPCS 93293
Hospital Charge Code	5300135
Hospital Revenue Code	921
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$16.04

TRANSTELEPHONIC PCMKR MON DUAL

Facility

$128.65

Service Code	HCPCS 93293
Hospital Charge Code	5300116
Hospital Revenue Code	921
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$19.30
Rate for Payer: Qualcare PPO/HMO/WC	$19.30

TRANSTELEPHONIC PCMKR MON DUAL

Facility

$128.65

Service Code	HCPCS 93293
Hospital Charge Code	5300116
Hospital Revenue Code	921
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$6,760.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.59
Rate for Payer: Oxford Commercial	$4,459.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.30
Rate for Payer: UnitedHealthcare Commercial	$6,760.00
Rate for Payer: UnitedHealthcare Community & State	$3.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

TRANSUR ELECTR RESECT OF PROST

Facility

$34,504.00

Service Code	HCPCS 52601
Hospital Charge Code	1600000259
Hospital Revenue Code	360
Min. Negotiated Rate	$5,175.60
Max. Negotiated Rate	$5,175.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,175.60

TRANSUR ELECTR RESECT OF PROST

Facility

$34,504.00

Service Code	HCPCS 52601
Hospital Charge Code	1600000259
Hospital Revenue Code	360
Min. Negotiated Rate	$831.55
Max. Negotiated Rate	$22,993.64
Rate for Payer: Aetna Commercial	$17,326.29
Rate for Payer: Aetna Medicare Advantage	$20,638.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,369.96
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	$22,993.64
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: Cigna Medicare Advantage	$6,369.96
Rate for Payer: Clover Medicare Advantage	$6,051.46
Rate for Payer: EmblemHealth Commercial	$19,109.88
Rate for Payer: Humana Medicare Advantage	$6,561.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,369.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,351.20
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,175.60
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$831.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,369.96
Rate for Payer: Wellcare Medicare Advantage	$6,369.96
Rate for Payer: Wellpoint Medicaid Managed Care	$914.36

TRANSUR ELECTR RESECT OF PROST

Facility

$34,504.00

Service Code	HCPCS 52601
Hospital Charge Code	1600000271
Hospital Revenue Code	360
Min. Negotiated Rate	$5,175.60
Max. Negotiated Rate	$5,175.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,175.60

TRANSUR ELECTR RESECT OF PROST

Facility

$34,504.00

Service Code	HCPCS 52601
Hospital Charge Code	1600000271
Hospital Revenue Code	360
Min. Negotiated Rate	$831.55
Max. Negotiated Rate	$22,993.64
Rate for Payer: Aetna Commercial	$17,326.29
Rate for Payer: Aetna Medicare Advantage	$20,638.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,993.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,369.96
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	$22,993.64
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: Cigna Medicare Advantage	$6,369.96
Rate for Payer: Clover Medicare Advantage	$6,051.46
Rate for Payer: EmblemHealth Commercial	$19,109.88
Rate for Payer: Humana Medicare Advantage	$6,561.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,369.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,351.20
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,175.60
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$831.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,369.96
Rate for Payer: Wellcare Medicare Advantage	$6,369.96
Rate for Payer: Wellpoint Medicaid Managed Care	$914.36

TRANSURETHRAL PROCEDURES WITH CC

Facility

$52,297.28

Service Code	MSDRG 669
Min. Negotiated Rate	$15,923.85
Max. Negotiated Rate	$52,297.28
Rate for Payer: Aetna Commercial	$36,191.53
Rate for Payer: Aetna Medicare Advantage	$52,297.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,589.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,589.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,761.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,589.33
Rate for Payer: Cigna Commercial	$29,044.13
Rate for Payer: Cigna Medicare Advantage	$16,761.95
Rate for Payer: Clover Medicare Advantage	$15,923.85
Rate for Payer: EmblemHealth Commercial	$50,285.85
Rate for Payer: Humana Medicare Advantage	$17,264.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,761.95
Rate for Payer: Oxford Commercial	$20,874.40
Rate for Payer: UnitedHealthcare Commercial	$36,603.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,761.95
Rate for Payer: Wellcare Medicare Advantage	$16,761.95

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$96,513.30

Service Code	MSDRG 668
Min. Negotiated Rate	$29,387.06
Max. Negotiated Rate	$96,513.30
Rate for Payer: Aetna Commercial	$66,572.96
Rate for Payer: Aetna Medicare Advantage	$96,513.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65,596.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65,596.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30,933.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65,596.02
Rate for Payer: Cigna Commercial	$54,644.88
Rate for Payer: Cigna Medicare Advantage	$30,933.75
Rate for Payer: Clover Medicare Advantage	$29,387.06
Rate for Payer: EmblemHealth Commercial	$92,801.25
Rate for Payer: Humana Medicare Advantage	$31,861.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30,933.75
Rate for Payer: Oxford Commercial	$39,274.00
Rate for Payer: UnitedHealthcare Commercial	$68,868.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$30,933.75
Rate for Payer: Wellcare Medicare Advantage	$30,933.75

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$33,722.05

Service Code	MSDRG 670
Min. Negotiated Rate	$10,267.93
Max. Negotiated Rate	$33,722.05
Rate for Payer: Aetna Commercial	$23,428.21
Rate for Payer: Aetna Medicare Advantage	$33,722.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,330.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,330.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,808.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,330.56
Rate for Payer: Cigna Commercial	$18,289.19
Rate for Payer: Cigna Medicare Advantage	$10,808.35
Rate for Payer: Clover Medicare Advantage	$10,267.93
Rate for Payer: EmblemHealth Commercial	$32,425.05
Rate for Payer: Humana Medicare Advantage	$11,132.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,808.35
Rate for Payer: Oxford Commercial	$13,144.68
Rate for Payer: UnitedHealthcare Commercial	$23,049.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,808.35
Rate for Payer: Wellcare Medicare Advantage	$10,808.35

TRANSURETHRAL PROSTATECTOMY

Facility

$20,122.20

Service Code	APR-DRG 4823
Min. Negotiated Rate	$19,727.65
Max. Negotiated Rate	$20,122.20
Rate for Payer: UnitedHealthcare Community & State	$19,727.65
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,122.20
Rate for Payer: Wellpoint Medicaid Managed Care	$19,727.65

TRANSURETHRAL PROSTATECTOMY

Facility

$11,051.23

Service Code	APR-DRG 4822
Min. Negotiated Rate	$10,834.54
Max. Negotiated Rate	$11,051.23
Rate for Payer: UnitedHealthcare Community & State	$10,834.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,051.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10,834.54

TRANSURETHRAL PROSTATECTOMY

Facility

$8,926.77

Service Code	APR-DRG 4821
Min. Negotiated Rate	$8,751.74
Max. Negotiated Rate	$8,926.77
Rate for Payer: UnitedHealthcare Community & State	$8,751.74
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,926.77
Rate for Payer: Wellpoint Medicaid Managed Care	$8,751.74

TRANSURETHRAL PROSTATECTOMY

Facility

$33,816.18

Service Code	APR-DRG 4824
Min. Negotiated Rate	$33,153.12
Max. Negotiated Rate	$33,816.18
Rate for Payer: UnitedHealthcare Community & State	$33,153.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$33,816.18
Rate for Payer: Wellpoint Medicaid Managed Care	$33,153.12

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$50,726.49

Service Code	MSDRG 713
Min. Negotiated Rate	$15,445.57
Max. Negotiated Rate	$50,726.49
Rate for Payer: Aetna Commercial	$35,112.19
Rate for Payer: Aetna Medicare Advantage	$50,726.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,728.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,728.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,258.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,728.45
Rate for Payer: Cigna Commercial	$28,134.63
Rate for Payer: Cigna Medicare Advantage	$16,258.49
Rate for Payer: Clover Medicare Advantage	$15,445.57
Rate for Payer: EmblemHealth Commercial	$48,775.47
Rate for Payer: Humana Medicare Advantage	$16,746.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,258.49
Rate for Payer: Oxford Commercial	$20,220.73
Rate for Payer: UnitedHealthcare Commercial	$35,457.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,258.49
Rate for Payer: Wellcare Medicare Advantage	$16,258.49

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$36,311.00

Service Code	MSDRG 714
Min. Negotiated Rate	$11,056.23
Max. Negotiated Rate	$36,311.00
Rate for Payer: Aetna Commercial	$25,207.11
Rate for Payer: Aetna Medicare Advantage	$36,311.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,330.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,330.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,638.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,330.56
Rate for Payer: Cigna Commercial	$19,788.18
Rate for Payer: Cigna Medicare Advantage	$11,638.14
Rate for Payer: Clover Medicare Advantage	$11,056.23
Rate for Payer: EmblemHealth Commercial	$34,914.42
Rate for Payer: Humana Medicare Advantage	$11,987.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,638.14
Rate for Payer: Oxford Commercial	$14,222.03
Rate for Payer: UnitedHealthcare Commercial	$24,938.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,638.14
Rate for Payer: Wellcare Medicare Advantage	$11,638.14

TRANSURETHRAL RSCTN BLDDR NECK

Facility

$23,841.70

Service Code	HCPCS 52500
Hospital Charge Code	1600000310
Hospital Revenue Code	360
Min. Negotiated Rate	$574.58
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,152.51
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$574.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$631.81

TRANSURETHRAL RSCTN BLDDR NECK

Facility

$23,841.70

Service Code	HCPCS 52500
Hospital Charge Code	1600000310
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

TRANSVAGINAL

Facility

$6,700.00

Service Code	HCPCS 76830
Hospital Charge Code	94061177
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

TRANSVAGINAL

Facility

$6,700.00

Service Code	HCPCS 76830
Hospital Charge Code	94061177
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

TRANSVAGINAL US, OBSTETRIC

Facility

$2,298.80

Service Code	HCPCS 76817
Hospital Charge Code	83653080
Hospital Revenue Code	402
Min. Negotiated Rate	$55.40
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$689.64
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.82
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$55.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$60.92

TRANSVAGINAL US, OBSTETRIC

Facility

$2,298.80

Service Code	HCPCS 76817
Hospital Charge Code	83653080
Hospital Revenue Code	402
Min. Negotiated Rate	$344.82
Max. Negotiated Rate	$344.82
Rate for Payer: Qualcare PPO/HMO/WC	$344.82

TRANXENE T-TAB/15MG/TAB

Facility

$6.00

Hospital Charge Code	60634053
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TRANXENE T-TAB/15MG/TAB

Facility

$6.00

Hospital Charge Code	60634053
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

Know your out-of-pocket cost for care.

All Charges