Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRAP SPUTUM****

Facility

$30.00

Hospital Charge Code	8001588
Hospital Revenue Code	279
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

TRAP WATER AIRLIFE***

Facility

$9.00

Hospital Charge Code	9501107
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TRAP WATER AIRLIFE***

Facility

$9.00

Hospital Charge Code	9501107
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

TRASTUZUMAB 10 mg

Facility

$742.16

Service Code	HCPCS J9355
Hospital Charge Code	60628881
Hospital Revenue Code	636
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$265.06
Rate for Payer: Aetna Commercial	$199.73
Rate for Payer: Aetna Medicare Advantage	$237.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$265.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$265.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$73.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$265.06
Rate for Payer: Cigna Medicare Advantage	$73.43
Rate for Payer: Clover Medicare Advantage	$69.76
Rate for Payer: EmblemHealth Commercial	$220.29
Rate for Payer: Humana Medicare Advantage	$75.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$73.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.60
Rate for Payer: Qualcare PPO/HMO/WC	$111.32
Rate for Payer: UnitedHealthcare Community & State	$17.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$73.43
Rate for Payer: Wellcare Medicare Advantage	$73.43
Rate for Payer: Wellpoint Medicaid Managed Care	$19.67

TRASTUZUMAB 10 mg

Facility

$742.16

Service Code	HCPCS J9355
Hospital Charge Code	60628881
Hospital Revenue Code	636
Min. Negotiated Rate	$111.32
Max. Negotiated Rate	$179.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.60
Rate for Payer: Qualcare PPO/HMO/WC	$111.32

TRASTUZUMAB-DKST 150MG

Facility

$4,018.86

Service Code	HCPCS Q5114
Hospital Charge Code	606390427
Hospital Revenue Code	636
Min. Negotiated Rate	$33.99
Max. Negotiated Rate	$972.56
Rate for Payer: Aetna Commercial	$97.32
Rate for Payer: Aetna Medicare Advantage	$115.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.16
Rate for Payer: Cigna Medicare Advantage	$35.78
Rate for Payer: Clover Medicare Advantage	$33.99
Rate for Payer: EmblemHealth Commercial	$107.34
Rate for Payer: Humana Medicare Advantage	$36.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$972.56
Rate for Payer: Qualcare PPO/HMO/WC	$602.83
Rate for Payer: UnitedHealthcare Community & State	$96.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.78
Rate for Payer: Wellcare Medicare Advantage	$35.78
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

TRASTUZUMAB-DKST 150MG

Facility

$4,018.86

Service Code	HCPCS Q5114
Hospital Charge Code	606390427
Hospital Revenue Code	636
Min. Negotiated Rate	$602.83
Max. Negotiated Rate	$972.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$972.56
Rate for Payer: Qualcare PPO/HMO/WC	$602.83

TRASTUZUMAB-DKST 420MG

Facility

$11,245.15

Service Code	HCPCS Q5114
Hospital Charge Code	606390426
Hospital Revenue Code	636
Min. Negotiated Rate	$1,686.77
Max. Negotiated Rate	$2,721.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,721.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,686.77

TRASTUZUMAB-DKST 420MG

Facility

$11,245.15

Service Code	HCPCS Q5114
Hospital Charge Code	606390426
Hospital Revenue Code	636
Min. Negotiated Rate	$33.99
Max. Negotiated Rate	$2,721.33
Rate for Payer: Aetna Commercial	$97.32
Rate for Payer: Aetna Medicare Advantage	$115.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.16
Rate for Payer: Cigna Medicare Advantage	$35.78
Rate for Payer: Clover Medicare Advantage	$33.99
Rate for Payer: EmblemHealth Commercial	$107.34
Rate for Payer: Humana Medicare Advantage	$36.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,721.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,686.77
Rate for Payer: UnitedHealthcare Community & State	$271.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.78
Rate for Payer: Wellcare Medicare Advantage	$35.78
Rate for Payer: Wellpoint Medicaid Managed Care	$298.00

TRAUMA ISTRUMENT FEE

Facility

$8,338.90

Hospital Charge Code	270698351
Hospital Revenue Code	279
Min. Negotiated Rate	$1,250.84
Max. Negotiated Rate	$1,250.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,250.84

TRAUMA ISTRUMENT FEE

Facility

$8,338.90

Hospital Charge Code	270698351
Hospital Revenue Code	279
Min. Negotiated Rate	$200.97
Max. Negotiated Rate	$4,169.45
Rate for Payer: Aetna Commercial	$3,168.78
Rate for Payer: Aetna Medicare Advantage	$2,501.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,126.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,126.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,126.42
Rate for Payer: Cigna Commercial	$4,169.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,501.67
Rate for Payer: Oxford Commercial	$1,667.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,250.84
Rate for Payer: UnitedHealthcare Commercial	$1,667.78
Rate for Payer: UnitedHealthcare Community & State	$200.97
Rate for Payer: Wellpoint Medicaid Managed Care	$220.98

TRAUMATIC INJURY WITH MCC

Facility

$54,967.07

Service Code	MSDRG 913
Min. Negotiated Rate	$16,736.77
Max. Negotiated Rate	$54,967.07
Rate for Payer: Aetna Commercial	$38,025.97
Rate for Payer: Aetna Medicare Advantage	$54,967.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34,658.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34,658.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,617.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34,658.89
Rate for Payer: Cigna Commercial	$30,589.90
Rate for Payer: Cigna Medicare Advantage	$17,617.65
Rate for Payer: Clover Medicare Advantage	$16,736.77
Rate for Payer: EmblemHealth Commercial	$52,852.95
Rate for Payer: Humana Medicare Advantage	$18,146.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,617.65
Rate for Payer: Oxford Commercial	$21,985.37
Rate for Payer: UnitedHealthcare Commercial	$38,552.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,617.65
Rate for Payer: Wellcare Medicare Advantage	$17,617.65

TRAUMATIC INJURY WITHOUT MCC

Facility

$30,754.93

Service Code	MSDRG 914
Min. Negotiated Rate	$9,364.48
Max. Negotiated Rate	$30,754.93
Rate for Payer: Aetna Commercial	$21,389.46
Rate for Payer: Aetna Medicare Advantage	$30,754.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,857.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,167.51
Rate for Payer: Cigna Commercial	$16,571.25
Rate for Payer: Cigna Medicare Advantage	$9,857.35
Rate for Payer: Clover Medicare Advantage	$9,364.48
Rate for Payer: EmblemHealth Commercial	$29,572.05
Rate for Payer: Humana Medicare Advantage	$10,153.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,857.35
Rate for Payer: Oxford Commercial	$11,909.98
Rate for Payer: UnitedHealthcare Commercial	$20,884.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,857.35
Rate for Payer: Wellcare Medicare Advantage	$9,857.35

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$44,239.48

Service Code	MSDRG 086
Min. Negotiated Rate	$13,470.35
Max. Negotiated Rate	$44,239.48
Rate for Payer: Aetna Medicare Advantage	$44,239.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,704.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,704.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,179.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,704.52
Rate for Payer: Cigna Commercial	$24,378.73
Rate for Payer: Cigna Medicare Advantage	$14,179.32
Rate for Payer: Clover Medicare Advantage	$13,470.35
Rate for Payer: EmblemHealth Commercial	$42,537.96
Rate for Payer: Humana Medicare Advantage	$14,604.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,179.32
Rate for Payer: Oxford Commercial	$17,521.31
Rate for Payer: UnitedHealthcare Commercial	$30,724.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,179.32
Rate for Payer: Wellcare Medicare Advantage	$14,179.32

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$47,248.62

Service Code	MSDRG 083
Min. Negotiated Rate	$14,386.60
Max. Negotiated Rate	$47,248.62
Rate for Payer: Aetna Medicare Advantage	$47,248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,634.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,634.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,143.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,634.96
Rate for Payer: Cigna Commercial	$26,121.00
Rate for Payer: Cigna Medicare Advantage	$15,143.79
Rate for Payer: Clover Medicare Advantage	$14,386.60
Rate for Payer: EmblemHealth Commercial	$45,431.37
Rate for Payer: Humana Medicare Advantage	$15,598.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,143.79
Rate for Payer: Oxford Commercial	$18,773.51
Rate for Payer: UnitedHealthcare Commercial	$32,919.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,143.79
Rate for Payer: Wellcare Medicare Advantage	$15,143.79

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$75,565.71

Service Code	MSDRG 085
Min. Negotiated Rate	$23,008.79
Max. Negotiated Rate	$75,565.71
Rate for Payer: Aetna Medicare Advantage	$75,565.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52,802.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52,802.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,219.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52,802.47
Rate for Payer: Cigna Commercial	$42,516.34
Rate for Payer: Cigna Medicare Advantage	$24,219.78
Rate for Payer: Clover Medicare Advantage	$23,008.79
Rate for Payer: EmblemHealth Commercial	$72,659.34
Rate for Payer: Humana Medicare Advantage	$24,946.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,219.78
Rate for Payer: Oxford Commercial	$30,557.06
Rate for Payer: UnitedHealthcare Commercial	$53,582.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,219.78
Rate for Payer: Wellcare Medicare Advantage	$24,219.78

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$76,008.44

Service Code	MSDRG 082
Min. Negotiated Rate	$23,143.60
Max. Negotiated Rate	$76,008.44
Rate for Payer: Aetna Medicare Advantage	$76,008.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53,035.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53,035.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,361.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53,035.08
Rate for Payer: Cigna Commercial	$42,772.72
Rate for Payer: Cigna Medicare Advantage	$24,361.68
Rate for Payer: Clover Medicare Advantage	$23,143.60
Rate for Payer: EmblemHealth Commercial	$73,085.04
Rate for Payer: Humana Medicare Advantage	$25,092.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,361.68
Rate for Payer: Oxford Commercial	$30,741.32
Rate for Payer: UnitedHealthcare Commercial	$53,905.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,361.68
Rate for Payer: Wellcare Medicare Advantage	$24,361.68

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$31,698.67

Service Code	MSDRG 087
Min. Negotiated Rate	$9,651.84
Max. Negotiated Rate	$31,698.67
Rate for Payer: Aetna Medicare Advantage	$31,698.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,702.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,702.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,159.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,702.29
Rate for Payer: Cigna Commercial	$17,117.70
Rate for Payer: Cigna Medicare Advantage	$10,159.83
Rate for Payer: Clover Medicare Advantage	$9,651.84
Rate for Payer: EmblemHealth Commercial	$30,479.49
Rate for Payer: Humana Medicare Advantage	$10,464.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,159.83
Rate for Payer: Oxford Commercial	$12,302.72
Rate for Payer: UnitedHealthcare Commercial	$21,573.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,159.83
Rate for Payer: Wellcare Medicare Advantage	$10,159.83

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$33,027.13

Service Code	MSDRG 084
Min. Negotiated Rate	$10,056.34
Max. Negotiated Rate	$33,027.13
Rate for Payer: Aetna Medicare Advantage	$33,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,400.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,400.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,585.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,400.12
Rate for Payer: Cigna Commercial	$17,886.84
Rate for Payer: Cigna Medicare Advantage	$10,585.62
Rate for Payer: Clover Medicare Advantage	$10,056.34
Rate for Payer: EmblemHealth Commercial	$31,756.86
Rate for Payer: Humana Medicare Advantage	$10,903.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,585.62
Rate for Payer: Oxford Commercial	$12,855.51
Rate for Payer: UnitedHealthcare Commercial	$22,542.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,585.62
Rate for Payer: Wellcare Medicare Advantage	$10,585.62

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$49,714.77

Service Code	MSDRG 604
Min. Negotiated Rate	$15,137.51
Max. Negotiated Rate	$49,714.77
Rate for Payer: Aetna Commercial	$34,417.05
Rate for Payer: Aetna Medicare Advantage	$49,714.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,124.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,124.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,934.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,124.11
Rate for Payer: Cigna Commercial	$27,548.88
Rate for Payer: Cigna Medicare Advantage	$15,934.22
Rate for Payer: Clover Medicare Advantage	$15,137.51
Rate for Payer: EmblemHealth Commercial	$47,802.66
Rate for Payer: Humana Medicare Advantage	$16,412.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,934.22
Rate for Payer: Oxford Commercial	$19,799.74
Rate for Payer: UnitedHealthcare Commercial	$34,719.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,934.22
Rate for Payer: Wellcare Medicare Advantage	$15,934.22

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$31,740.70

Service Code	MSDRG 605
Min. Negotiated Rate	$9,664.64
Max. Negotiated Rate	$31,740.70
Rate for Payer: Aetna Commercial	$22,066.78
Rate for Payer: Aetna Medicare Advantage	$31,740.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,167.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,173.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,167.51
Rate for Payer: Cigna Commercial	$17,142.02
Rate for Payer: Cigna Medicare Advantage	$10,173.30
Rate for Payer: Clover Medicare Advantage	$9,664.64
Rate for Payer: EmblemHealth Commercial	$30,519.90
Rate for Payer: Humana Medicare Advantage	$10,478.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,173.30
Rate for Payer: Oxford Commercial	$12,320.20
Rate for Payer: UnitedHealthcare Commercial	$21,603.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,173.30
Rate for Payer: Wellcare Medicare Advantage	$10,173.30

TRAVASE OINTMENT

Facility

$101.00

Hospital Charge Code	60634529
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

TRAVASE OINTMENT

Facility

$101.00

Hospital Charge Code	60634529
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

TRAVASOL 1000 (GLASS) *******

Facility

$18.00

Hospital Charge Code	7000243
Hospital Revenue Code	258
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

TRAVASOL 1000 (GLASS) *******

Facility

$18.00

Hospital Charge Code	7000243
Hospital Revenue Code	258
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

Know your out-of-pocket cost for care.

All Charges