Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIAMCINOLONE CRM .025%

Facility

$34.60

Hospital Charge Code	6005458
Hospital Revenue Code	251
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

TRIAMCINOLONE CRM .025%

Facility

$48.00

Hospital Charge Code	6005433
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

TRIAMCINOLONE CRM .025%

Facility

$48.00

Hospital Charge Code	6005433
Hospital Revenue Code	251
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

TRIAMCINOLONE CRM .5%

Facility

$181.15

Hospital Charge Code	6005466
Hospital Revenue Code	251
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$27.17
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

TRIAMCINOLONE CRM .5%

Facility

$181.15

Hospital Charge Code	6005466
Hospital Revenue Code	251
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$90.58
Rate for Payer: Aetna Commercial	$68.84
Rate for Payer: Aetna Medicare Advantage	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.19
Rate for Payer: Cigna Commercial	$90.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.34
Rate for Payer: Oxford Commercial	$36.23
Rate for Payer: Qualcare PPO/HMO/WC	$27.17
Rate for Payer: UnitedHealthcare Commercial	$36.23
Rate for Payer: UnitedHealthcare Community & State	$4.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

TRIAMCINOLONE DENTALPASTE 0.1%

Facility

$108.00

Service Code	NDC 64980032005
Hospital Charge Code	60628408
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.20

TRIAMCINOLONE DENTALPASTE 0.1%

Facility

$108.00

Service Code	NDC 64980032005
Hospital Charge Code	60628408
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$41.04
Rate for Payer: Aetna Medicare Advantage	$32.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.54
Rate for Payer: Cigna Commercial	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.40
Rate for Payer: Oxford Commercial	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$16.20
Rate for Payer: UnitedHealthcare Commercial	$21.60
Rate for Payer: UnitedHealthcare Community & State	$2.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.86

TRIAMCINOLONE INJ 50MG/5ML

Facility

$88.78

Service Code	HCPCS J3301
Hospital Charge Code	60628211
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.39
Rate for Payer: Aetna Commercial	$33.74
Rate for Payer: Aetna Medicare Advantage	$26.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.64
Rate for Payer: Cigna Commercial	$44.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.48
Rate for Payer: Qualcare PPO/HMO/WC	$13.32
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

TRIAMCINOLONE INJ 50MG/5ML

Facility

$88.78

Service Code	HCPCS J3301
Hospital Charge Code	60628211
Hospital Revenue Code	636
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$21.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.48
Rate for Payer: Qualcare PPO/HMO/WC	$13.32

TRIAMCINOLONE OINT 0.025%

Facility

$41.00

Service Code	NDC 45802005435
Hospital Charge Code	60628405
Hospital Revenue Code	250
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

TRIAMCINOLONE OINT 0.025%

Facility

$41.00

Service Code	NDC 45802005435
Hospital Charge Code	60628405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.50
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.30
Rate for Payer: Oxford Commercial	$8.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$8.20
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

TRIAMCINOLONE OINT 0.1% 15GM

Facility

$37.39

Service Code	NDC 168000615
Hospital Charge Code	60628406
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 OINT 0.1% 15GM

Facility

$37.39

Service Code	NDC 168000615
Hospital Charge Code	60628406
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$5.61
Rate for Payer: Qualcare PPO/HMO/WC	$5.61

TRIAMCINOLONE OINT .1%

Facility

$21.15

Hospital Charge Code	6005474
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

TRIAMCINOLONE OINT .1%

Facility

$21.15

Hospital Charge Code	6005474
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

TRIAMCINOLONE ORAL INH

Facility

$24.85

Hospital Charge Code	60628042
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

TRIAMCINOLONE ORAL INH

Facility

$24.85

Hospital Charge Code	60628042
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

TRIAMCNOLNE ACET INH 100MG/PFF

Facility

$109.45

Hospital Charge Code	6005425
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

TRIAMCNOLNE ACET INH 100MG/PFF

Facility

$109.45

Hospital Charge Code	6005425
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

TRIAMTERENE 37.5 MG/HCTZ 25MG

Facility

$4.00

Service Code	NDC 51079093501
Hospital Charge Code	6023410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TRIAMTERENE 37.5 MG/HCTZ 25MG

Facility

$4.00

Service Code	NDC 51079093501
Hospital Charge Code	6023410
Hospital Revenue Code	251
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

TRIAMTERENE 37.5 MG/HCTZ 25MG

Facility

$3.85

Hospital Charge Code	6023154
Hospital Revenue Code	251
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

TRIAMTERENE 37.5 MG/HCTZ 25MG

Facility

$3.85

Hospital Charge Code	6023154
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

TRIAMTERENE 50 MG CAP

Facility

$30.55

Service Code	NDC 59212000201
Hospital Charge Code	6063943256
Hospital Revenue Code	250
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$4.58
Rate for Payer: Qualcare PPO/HMO/WC	$4.58

TRIAMTERENE 50 MG CAP

Facility

$30.55

Service Code	NDC 59212000201
Hospital Charge Code	6063943256
Hospital Revenue Code	250
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.28
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.79
Rate for Payer: Cigna Commercial	$15.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.16
Rate for Payer: Oxford Commercial	$6.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.58
Rate for Payer: UnitedHealthcare Commercial	$6.11
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

Know your out-of-pocket cost for care.

All Charges