Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIAMTERENE CAP 100MG

Facility

$4.85

Hospital Charge Code	60627977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TRIAMTERENE CAP 100MG

Facility

$4.85

Hospital Charge Code	60627977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TRIAMTERENE CAP 50MG

Facility

$4.00

Hospital Charge Code	60627978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TRIAMTERENE CAP 50MG

Facility

$4.00

Hospital Charge Code	60627978
Hospital Revenue Code	250
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-HCTZ TAB 37.5-25MG

Facility

$4.85

Hospital Charge Code	60628833
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TRIAMTERENE-HCTZ TAB 37.5-25MG

Facility

$4.85

Hospital Charge Code	60628833
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TRIAMTERENE HCTZ TAB 75-50MG

Facility

$12.55

Hospital Charge Code	60627979
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Aetna Medicare Advantage	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.20
Rate for Payer: Cigna Commercial	$6.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.77
Rate for Payer: Oxford Commercial	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.51
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

TRIAMTERENE HCTZ TAB 75-50MG

Facility

$12.55

Hospital Charge Code	60627979
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

TRIATHALONCR FEM COMP#7 R-CEM

Facility

$7,846.20

Service Code	HCPCS C1789
Hospital Charge Code	270706037
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.93
Max. Negotiated Rate	$1,898.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,726.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.93

TRIATHALONCR FEM COMP#7 R-CEM

Facility

$7,846.20

Service Code	HCPCS C1789
Hospital Charge Code	270706037
Hospital Revenue Code	278
Min. Negotiated Rate	$189.09
Max. Negotiated Rate	$3,923.10
Rate for Payer: Aetna Commercial	$2,981.56
Rate for Payer: Aetna Medicare Advantage	$2,353.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.78
Rate for Payer: Cigna Commercial	$3,923.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,726.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.93
Rate for Payer: UnitedHealthcare Community & State	$189.09
Rate for Payer: Wellpoint Medicaid Managed Care	$207.92

TRIATHALON CRUCIATE RETAIN FEM

Facility

$7,846.20

Service Code	HCPCS C1789
Hospital Charge Code	270706038
Hospital Revenue Code	278
Min. Negotiated Rate	$189.09
Max. Negotiated Rate	$3,923.10
Rate for Payer: Aetna Commercial	$2,981.56
Rate for Payer: Aetna Medicare Advantage	$2,353.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.78
Rate for Payer: Cigna Commercial	$3,923.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,726.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.93
Rate for Payer: UnitedHealthcare Community & State	$189.09
Rate for Payer: Wellpoint Medicaid Managed Care	$207.92

TRIATHALON CRUCIATE RETAIN FEM

Facility

$7,846.20

Service Code	HCPCS C1789
Hospital Charge Code	270706038
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.93
Max. Negotiated Rate	$1,898.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,726.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.93

TRIATH CR FEM COMP BD SZ3 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270693337
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

TRIATH CR FEM COMP BD SZ3 RT

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270693337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATH CR FEM COMP B RT CR SZ2

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270693813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

TRIATH CR FEM COMP B RT CR SZ2

Facility

$10,529.50

Service Code	HCPCS C1776
Hospital Charge Code	270693813
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.75
Rate for Payer: Aetna Commercial	$4,001.21
Rate for Payer: Aetna Medicare Advantage	$3,158.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.02
Rate for Payer: Cigna Commercial	$5,264.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

TRIATH FEM DIST AUG RT SZ4 5MM

Facility

$7,780.50

Service Code	HCPCS C1776
Hospital Charge Code	270697478
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.08
Max. Negotiated Rate	$1,882.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,711.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.08

TRIATH FEM DIST AUG RT SZ4 5MM

Facility

$7,780.50

Service Code	HCPCS C1776
Hospital Charge Code	270697478
Hospital Revenue Code	278
Min. Negotiated Rate	$187.51
Max. Negotiated Rate	$3,890.25
Rate for Payer: Aetna Commercial	$2,956.59
Rate for Payer: Aetna Medicare Advantage	$2,334.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,984.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,984.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,984.03
Rate for Payer: Cigna Commercial	$3,890.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,711.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.08
Rate for Payer: UnitedHealthcare Community & State	$187.51
Rate for Payer: Wellpoint Medicaid Managed Care	$206.18

TRIATH FEM DIST AUG RTSZ5 10MM

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270697477
Hospital Revenue Code	278
Min. Negotiated Rate	$1,090.60
Max. Negotiated Rate	$22,626.50
Rate for Payer: Aetna Commercial	$17,196.14
Rate for Payer: Aetna Medicare Advantage	$13,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,539.51
Rate for Payer: Cigna Commercial	$22,626.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,955.66
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95
Rate for Payer: UnitedHealthcare Community & State	$1,090.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1,199.20

TRIATH FEM DIST AUG RTSZ5 10MM

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270697477
Hospital Revenue Code	278
Min. Negotiated Rate	$6,787.95
Max. Negotiated Rate	$10,951.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,955.66
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95

TRIATH FEMORAL COMP TS LT SZ2

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270699316
Hospital Revenue Code	278
Min. Negotiated Rate	$1,090.60
Max. Negotiated Rate	$22,626.50
Rate for Payer: Aetna Commercial	$17,196.14
Rate for Payer: Aetna Medicare Advantage	$13,575.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,539.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,539.51
Rate for Payer: Cigna Commercial	$22,626.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,955.66
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95
Rate for Payer: UnitedHealthcare Community & State	$1,090.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1,199.20

TRIATH FEMORAL COMP TS LT SZ2

Facility

$45,253.00

Service Code	HCPCS C1776
Hospital Charge Code	270699316
Hospital Revenue Code	278
Min. Negotiated Rate	$6,787.95
Max. Negotiated Rate	$10,951.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,050.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,951.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,955.66
Rate for Payer: Qualcare PPO/HMO/WC	$6,787.95

TRIATH FEM POST AUGMNT SZ5 5MM

Facility

$8,177.00

Service Code	HCPCS C1776
Hospital Charge Code	270697479
Hospital Revenue Code	278
Min. Negotiated Rate	$197.07
Max. Negotiated Rate	$4,088.50
Rate for Payer: Aetna Commercial	$3,107.26
Rate for Payer: Aetna Medicare Advantage	$2,453.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,085.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,085.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,085.14
Rate for Payer: Cigna Commercial	$4,088.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,798.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.55
Rate for Payer: UnitedHealthcare Community & State	$197.07
Rate for Payer: Wellpoint Medicaid Managed Care	$216.69

TRIATH FEM POST AUGMNT SZ5 5MM

Facility

$8,177.00

Service Code	HCPCS C1776
Hospital Charge Code	270697479
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.55
Max. Negotiated Rate	$1,978.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,798.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.55

TRIATH FEM STEM CMNT 12X100MM

Facility

$8,274.50

Service Code	HCPCS C1776
Hospital Charge Code	270697480
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.17
Max. Negotiated Rate	$2,002.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,654.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,002.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,820.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,241.17

Know your out-of-pocket cost for care.

All Charges