Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIAL LEAD LINEAR ST 70CM

Facility

$5,000.00

Service Code	HCPCS C1778
Hospital Charge Code	270673085
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TRIAL LEAD LINEAR ST 70CM

Facility

$5,000.00

Service Code	HCPCS C1778
Hospital Charge Code	270673085
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

TRIAL SIMULATOR

Facility

$1,100.00

Hospital Charge Code	270703576
Hospital Revenue Code	270
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.00
Rate for Payer: Oxford Commercial	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Commercial	$220.00
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

TRIAL SIMULATOR

Facility

$1,100.00

Hospital Charge Code	270703576
Hospital Revenue Code	270
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

TRIAMCINOLONE 0.5% 15GM

Facility

$67.74

Service Code	NDC 45802006535
Hospital Charge Code	6063943313
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$10.16

TRIAMCINOLONE 0.5% 15GM

Facility

$67.74

Service Code	NDC 45802006535
Hospital Charge Code	6063943313
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$33.87
Rate for Payer: Aetna Commercial	$25.74
Rate for Payer: Aetna Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.27
Rate for Payer: Cigna Commercial	$33.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.32
Rate for Payer: Oxford Commercial	$13.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.16
Rate for Payer: UnitedHealthcare Commercial	$13.55
Rate for Payer: UnitedHealthcare Community & State	$1.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

TRIAMCINOLONE 55MCG/SPRAY 25ML

Facility

$222.75

Hospital Charge Code	60629214
Hospital Revenue Code	250
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Commercial	$84.64
Rate for Payer: Aetna Medicare Advantage	$66.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.80
Rate for Payer: Cigna Commercial	$111.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.83
Rate for Payer: Oxford Commercial	$44.55
Rate for Payer: Qualcare PPO/HMO/WC	$33.41
Rate for Payer: UnitedHealthcare Commercial	$44.55
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.90

TRIAMCINOLONE 55MCG/SPRAY 25ML

Facility

$222.75

Hospital Charge Code	60629214
Hospital Revenue Code	250
Min. Negotiated Rate	$33.41
Max. Negotiated Rate	$33.41
Rate for Payer: Qualcare PPO/HMO/WC	$33.41

TRIAMCINOLONE ACET .025%80GM

Facility

$67.74

Service Code	NDC 45802005436
Hospital Charge Code	606390494
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$33.87
Rate for Payer: Aetna Commercial	$25.74
Rate for Payer: Aetna Medicare Advantage	$20.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.27
Rate for Payer: Cigna Commercial	$33.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.32
Rate for Payer: Oxford Commercial	$13.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.16
Rate for Payer: UnitedHealthcare Commercial	$13.55
Rate for Payer: UnitedHealthcare Community & State	$1.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

TRIAMCINOLONE ACET .025%80GM

Facility

$67.74

Service Code	NDC 45802005436
Hospital Charge Code	606390494
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$10.16
Rate for Payer: Qualcare PPO/HMO/WC	$10.16

TRIAMCINOLONE ACET INJ 40MG/ML

Facility

$68.74

Service Code	HCPCS J3301
Hospital Charge Code	6005409
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.37
Rate for Payer: Aetna Commercial	$26.12
Rate for Payer: Aetna Medicare Advantage	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.53
Rate for Payer: Cigna Commercial	$34.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Qualcare PPO/HMO/WC	$10.31
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

TRIAMCINOLONE ACET INJ 40MG/ML

Facility

$68.74

Service Code	HCPCS J3301
Hospital Charge Code	6005409
Hospital Revenue Code	636
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$16.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.64
Rate for Payer: Qualcare PPO/HMO/WC	$10.31

TRIAMCINOLONE ACET INJ 80MG/ML

Facility

$52.50

Hospital Charge Code	6005417
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

TRIAMCINOLONE ACET INJ 80MG/ML

Facility

$52.50

Hospital Charge Code	6005417
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

TRIAMCINOLONE ACETONIDE

Facility

$13.00

Hospital Charge Code	60634060
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

TRIAMCINOLONE ACETONIDE

Facility

$37.39

Service Code	NDC 168000415
Hospital Charge Code	60634061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.70
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare Advantage	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.53
Rate for Payer: Cigna Commercial	$18.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.22
Rate for Payer: Oxford Commercial	$7.48
Rate for Payer: Qualcare PPO/HMO/WC	$5.61
Rate for Payer: UnitedHealthcare Commercial	$7.48
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

TRIAMCINOLONE ACETONIDE

Facility

$37.39

Service Code	NDC 168000415
Hospital Charge Code	60634061
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$5.61
Rate for Payer: Qualcare PPO/HMO/WC	$5.61

TRIAMCINOLONE ACETONIDE

Facility

$13.00

Hospital Charge Code	60634060
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

TRIAMCINOLONE ACETONIDE 0.25%

Facility

$29.82

Service Code	NDC 45802006335
Hospital Charge Code	6063943306
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.91
Rate for Payer: Aetna Commercial	$11.33
Rate for Payer: Aetna Medicare Advantage	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.60
Rate for Payer: Cigna Commercial	$14.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.95
Rate for Payer: Oxford Commercial	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$4.47
Rate for Payer: UnitedHealthcare Commercial	$5.96
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

TRIAMCINOLONE ACETONIDE 0.25%

Facility

$29.82

Service Code	NDC 45802006335
Hospital Charge Code	6063943306
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$4.47

TRIAMCINOLONE AEROSOL 63G

Facility

$252.00

Hospital Charge Code	60628887
Hospital Revenue Code	250
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$37.80

TRIAMCINOLONE AEROSOL 63G

Facility

$252.00

Hospital Charge Code	60628887
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$95.76
Rate for Payer: Aetna Medicare Advantage	$75.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.26
Rate for Payer: Cigna Commercial	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.60
Rate for Payer: Oxford Commercial	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$37.80
Rate for Payer: UnitedHealthcare Commercial	$50.40
Rate for Payer: UnitedHealthcare Community & State	$6.07
Rate for Payer: Wellpoint Medicaid Managed Care	$6.68

TRIAMCINOLONE CRM 0.025% 15GM

Facility

$11.25

Hospital Charge Code	60628403
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

TRIAMCINOLONE CRM 0.025% 15GM

Facility

$11.25

Hospital Charge Code	60628403
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

TRIAMCINOLONE CRM .025%

Facility

$34.60

Hospital Charge Code	6005458
Hospital Revenue Code	251
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

Know your out-of-pocket cost for care.

All Charges