Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIATH TIBINSX3 TS TI SZ3 11MM

Facility

$5,542.30

Service Code	HCPCS C1776
Hospital Charge Code	270697488
Hospital Revenue Code	278
Min. Negotiated Rate	$831.35
Max. Negotiated Rate	$1,341.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,108.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,341.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,219.31
Rate for Payer: Qualcare PPO/HMO/WC	$831.35

TRIATH TIBINSX3 TS TI SZ3 11MM

Facility

$5,542.30

Service Code	HCPCS C1776
Hospital Charge Code	270697488
Hospital Revenue Code	278
Min. Negotiated Rate	$133.57
Max. Negotiated Rate	$2,771.15
Rate for Payer: Aetna Commercial	$2,106.07
Rate for Payer: Aetna Medicare Advantage	$1,662.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,413.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,413.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,108.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,413.29
Rate for Payer: Cigna Commercial	$2,771.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,341.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,219.31
Rate for Payer: Qualcare PPO/HMO/WC	$831.35
Rate for Payer: UnitedHealthcare Community & State	$133.57
Rate for Payer: Wellpoint Medicaid Managed Care	$146.87

TRIATH TRITAN BSPLT SZ2

Facility

$6,837.05

Service Code	HCPCS C1776
Hospital Charge Code	270693814
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.56
Max. Negotiated Rate	$1,654.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,504.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.56

TRIATH TRITAN BSPLT SZ2

Facility

$6,837.05

Service Code	HCPCS C1776
Hospital Charge Code	270693814
Hospital Revenue Code	278
Min. Negotiated Rate	$164.77
Max. Negotiated Rate	$3,418.53
Rate for Payer: Aetna Commercial	$2,598.08
Rate for Payer: Aetna Medicare Advantage	$2,051.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.45
Rate for Payer: Cigna Commercial	$3,418.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,504.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.56
Rate for Payer: UnitedHealthcare Community & State	$164.77
Rate for Payer: Wellpoint Medicaid Managed Care	$181.18

TRIATH X3 SYM PATELLA 8MM-CAP

Facility

$2,200.15

Service Code	HCPCS C1776
Hospital Charge Code	270692888
Hospital Revenue Code	278
Min. Negotiated Rate	$53.02
Max. Negotiated Rate	$1,100.08
Rate for Payer: Aetna Commercial	$836.06
Rate for Payer: Aetna Medicare Advantage	$660.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.04
Rate for Payer: Cigna Commercial	$1,100.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$484.03
Rate for Payer: Qualcare PPO/HMO/WC	$330.02
Rate for Payer: UnitedHealthcare Community & State	$53.02
Rate for Payer: Wellpoint Medicaid Managed Care	$58.30

TRIATH X3 SYM PATELLA 8MM-CAP

Facility

$2,200.15

Service Code	HCPCS C1776
Hospital Charge Code	270692888
Hospital Revenue Code	278
Min. Negotiated Rate	$330.02
Max. Negotiated Rate	$532.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$484.03
Rate for Payer: Qualcare PPO/HMO/WC	$330.02

TRIATH X3 TBI CS 11MM SZ2-CAP

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692887
Hospital Revenue Code	278
Min. Negotiated Rate	$122.48
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$122.48
Rate for Payer: Wellpoint Medicaid Managed Care	$134.68

TRIATH X3 TBI CS 11MM SZ2-CAP

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692887
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

TRIAVIL 2-10/TAB

Facility

$5.00

Hospital Charge Code	60634062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TRIAVIL 2-10/TAB

Facility

$5.00

Hospital Charge Code	60634062
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TRIAVIL 2-25

Facility

$3.00

Hospital Charge Code	60634679
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIAVIL 2-25

Facility

$3.00

Hospital Charge Code	60634679
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

TRIAVIL 2-25/UD

Facility

$3.00

Hospital Charge Code	60634680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIAVIL 2-25/UD

Facility

$3.00

Hospital Charge Code	60634680
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

TRIAVIL 4-10/TAB

Facility

$3.00

Hospital Charge Code	60634405
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

TRIAVIL 4-10/TAB

Facility

$3.00

Hospital Charge Code	60634405
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIAVIL 4-10/UD

Facility

$3.00

Hospital Charge Code	60634681
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIAVIL 4-10/UD

Facility

$3.00

Hospital Charge Code	60634681
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

TRIAVIL 4-25/TAB

Facility

$5.00

Hospital Charge Code	60634063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TRIAVIL 4-25/TAB

Facility

$5.00

Hospital Charge Code	60634063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TRIAVIL 4-50/TAB

Facility

$6.00

Hospital Charge Code	60634064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TRIAVIL 4-50/TAB

Facility

$6.00

Hospital Charge Code	60634064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TRIAZOLAM 0.125MG

Facility

$4.50

Hospital Charge Code	6011142
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

TRIAZOLAM 0.125MG

Facility

$4.50

Hospital Charge Code	6011142
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

TRIAZOLAM 0.25MG

Facility

$4.50

Hospital Charge Code	6011159
Hospital Revenue Code	251
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

Know your out-of-pocket cost for care.

All Charges