Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TREL-XPRESS 300C DMB

Facility

$4,465.00

Hospital Charge Code	270660818
Hospital Revenue Code	278
Min. Negotiated Rate	$669.75
Max. Negotiated Rate	$1,080.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$893.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,080.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$982.30
Rate for Payer: Qualcare PPO/HMO/WC	$669.75

TRENTAL/400MG/TAB

Facility

$3.00

Hospital Charge Code	60634055
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

TRENTAL/400MG/TAB

Facility

$3.00

Hospital Charge Code	60634056
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

TRENTAL/400MG/TAB

Facility

$3.00

Hospital Charge Code	60634056
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRENTAL/400MG/TAB

Facility

$3.00

Hospital Charge Code	60634055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TREPH11.5mIDx8 MRI NON99864015

Facility

$2,095.00

Hospital Charge Code	270638896
Hospital Revenue Code	272
Min. Negotiated Rate	$314.25
Max. Negotiated Rate	$314.25
Rate for Payer: Qualcare PPO/HMO/WC	$314.25

TREPH11.5mIDx8 MRI NON99864015

Facility

$2,095.00

Hospital Charge Code	270638896
Hospital Revenue Code	272
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$1,047.50
Rate for Payer: Aetna Commercial	$796.10
Rate for Payer: Aetna Medicare Advantage	$628.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.23
Rate for Payer: Cigna Commercial	$1,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.50
Rate for Payer: Oxford Commercial	$419.00
Rate for Payer: Qualcare PPO/HMO/WC	$314.25
Rate for Payer: UnitedHealthcare Commercial	$419.00
Rate for Payer: UnitedHealthcare Community & State	$50.49
Rate for Payer: Wellpoint Medicaid Managed Care	$55.52

TREPH13.5mIDx8 MRI NON99864019

Facility

$2,095.00

Hospital Charge Code	270638897
Hospital Revenue Code	272
Min. Negotiated Rate	$314.25
Max. Negotiated Rate	$314.25
Rate for Payer: Qualcare PPO/HMO/WC	$314.25

TREPH13.5mIDx8 MRI NON99864019

Facility

$2,095.00

Hospital Charge Code	270638897
Hospital Revenue Code	272
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$1,047.50
Rate for Payer: Aetna Commercial	$796.10
Rate for Payer: Aetna Medicare Advantage	$628.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.23
Rate for Payer: Cigna Commercial	$1,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.50
Rate for Payer: Oxford Commercial	$419.00
Rate for Payer: Qualcare PPO/HMO/WC	$314.25
Rate for Payer: UnitedHealthcare Commercial	$419.00
Rate for Payer: UnitedHealthcare Community & State	$50.49
Rate for Payer: Wellpoint Medicaid Managed Care	$55.52

TREPH14.5mIDx8 MRI NON99864021

Facility

$2,095.00

Hospital Charge Code	270638898
Hospital Revenue Code	272
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$1,047.50
Rate for Payer: Aetna Commercial	$796.10
Rate for Payer: Aetna Medicare Advantage	$628.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.23
Rate for Payer: Cigna Commercial	$1,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.50
Rate for Payer: Oxford Commercial	$419.00
Rate for Payer: Qualcare PPO/HMO/WC	$314.25
Rate for Payer: UnitedHealthcare Commercial	$419.00
Rate for Payer: UnitedHealthcare Community & State	$50.49
Rate for Payer: Wellpoint Medicaid Managed Care	$55.52

TREPH14.5mIDx8 MRI NON99864021

Facility

$2,095.00

Hospital Charge Code	270638898
Hospital Revenue Code	272
Min. Negotiated Rate	$314.25
Max. Negotiated Rate	$314.25
Rate for Payer: Qualcare PPO/HMO/WC	$314.25

TREPHINE 20.5MM

Facility

$2,350.00

Hospital Charge Code	270690278
Hospital Revenue Code	272
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$893.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.00
Rate for Payer: Oxford Commercial	$470.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Commercial	$470.00
Rate for Payer: UnitedHealthcare Community & State	$56.63
Rate for Payer: Wellpoint Medicaid Managed Care	$62.27

TREPHINE 20.5MM

Facility

$2,350.00

Hospital Charge Code	270690278
Hospital Revenue Code	272
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

TREPHINE 21.50 MM MRI

Facility

$2,350.00

Hospital Charge Code	270690280
Hospital Revenue Code	272
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

TREPHINE 21.50 MM MRI

Facility

$2,350.00

Hospital Charge Code	270690280
Hospital Revenue Code	272
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$893.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.00
Rate for Payer: Oxford Commercial	$470.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Commercial	$470.00
Rate for Payer: UnitedHealthcare Community & State	$56.63
Rate for Payer: Wellpoint Medicaid Managed Care	$62.27

TREPHINE 8.5MM

Facility

$1,483.75

Hospital Charge Code	270691602
Hospital Revenue Code	272
Min. Negotiated Rate	$222.56
Max. Negotiated Rate	$222.56
Rate for Payer: Qualcare PPO/HMO/WC	$222.56

TREPHINE 8.5MM

Facility

$1,483.75

Hospital Charge Code	270691602
Hospital Revenue Code	272
Min. Negotiated Rate	$35.76
Max. Negotiated Rate	$741.88
Rate for Payer: Aetna Commercial	$563.83
Rate for Payer: Aetna Medicare Advantage	$445.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$378.36
Rate for Payer: Cigna Commercial	$741.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$445.12
Rate for Payer: Oxford Commercial	$296.75
Rate for Payer: Qualcare PPO/HMO/WC	$222.56
Rate for Payer: UnitedHealthcare Commercial	$296.75
Rate for Payer: UnitedHealthcare Community & State	$35.76
Rate for Payer: Wellpoint Medicaid Managed Care	$39.32

TREPHINE BLADES

Facility

$300.00

Hospital Charge Code	270332558
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

TREPHINE BLADES

Facility

$300.00

Hospital Charge Code	270332558
Hospital Revenue Code	272
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

TREPHINE MRI 11.5MM ID N/S

Facility

$2,550.00

Hospital Charge Code	270675771
Hospital Revenue Code	272
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$1,275.00
Rate for Payer: Aetna Commercial	$969.00
Rate for Payer: Aetna Medicare Advantage	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.25
Rate for Payer: Cigna Commercial	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$765.00
Rate for Payer: Oxford Commercial	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$382.50
Rate for Payer: UnitedHealthcare Commercial	$510.00
Rate for Payer: UnitedHealthcare Community & State	$61.45
Rate for Payer: Wellpoint Medicaid Managed Care	$67.58

TREPHINE MRI 11.5MM ID N/S

Facility

$2,550.00

Hospital Charge Code	270675771
Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$382.50
Rate for Payer: Qualcare PPO/HMO/WC	$382.50

TREPHINE MRI 11MM ID N/S

Facility

$2,550.00

Hospital Charge Code	270675770
Hospital Revenue Code	272
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$1,275.00
Rate for Payer: Aetna Commercial	$969.00
Rate for Payer: Aetna Medicare Advantage	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.25
Rate for Payer: Cigna Commercial	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$765.00
Rate for Payer: Oxford Commercial	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$382.50
Rate for Payer: UnitedHealthcare Commercial	$510.00
Rate for Payer: UnitedHealthcare Community & State	$61.45
Rate for Payer: Wellpoint Medicaid Managed Care	$67.58

TREPHINE MRI 11MM ID N/S

Facility

$2,550.00

Hospital Charge Code	270675770
Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$382.50
Rate for Payer: Qualcare PPO/HMO/WC	$382.50

TREPHINE MRI 21 MM

Facility

$2,350.00

Hospital Charge Code	270690279
Hospital Revenue Code	272
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$352.50
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

TREPHINE MRI 21 MM

Facility

$2,350.00

Hospital Charge Code	270690279
Hospital Revenue Code	272
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$893.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.00
Rate for Payer: Oxford Commercial	$470.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Commercial	$470.00
Rate for Payer: UnitedHealthcare Community & State	$56.63
Rate for Payer: Wellpoint Medicaid Managed Care	$62.27

Know your out-of-pocket cost for care.

All Charges