Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRICOR,160MG,TAB

Facility

$4.00

Hospital Charge Code	60635458
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TRICOR,160MG,TAB

Facility

$4.00

Hospital Charge Code	60635458
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

TRICOR 48 MG TAB

Facility

$4.65

Hospital Charge Code	60629828
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.33
Rate for Payer: Aetna Commercial	$1.77
Rate for Payer: Aetna Medicare Advantage	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.19
Rate for Payer: Cigna Commercial	$2.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.40
Rate for Payer: Oxford Commercial	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$0.93
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

TRICOR 48 MG TAB

Facility

$4.65

Hospital Charge Code	60629828
Hospital Revenue Code	251
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

TRICOR,54MG,TAB

Facility

$2.00

Hospital Charge Code	60635457
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

TRICOR,54MG,TAB

Facility

$2.00

Hospital Charge Code	60635457
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

TRI CRU RETAIN FEM SZ 1 LT CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697570
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

TRI CRU RETAIN FEM SZ 1 LT CR

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270697570
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

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	3039018
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	3039018
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	38430018
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	39990218
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	38430018
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

TRICYCLIC & CYCLICALS 6/MORE

Facility

$190.45

Service Code	HCPCS 80337
Hospital Charge Code	39990218
Hospital Revenue Code	301
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

TRIDENT 0 DEG INSERT 40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697216
Hospital Revenue Code	278
Min. Negotiated Rate	$106.87
Max. Negotiated Rate	$2,217.12
Rate for Payer: Aetna Commercial	$1,685.02
Rate for Payer: Aetna Medicare Advantage	$1,330.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,130.73
Rate for Payer: Cigna Commercial	$2,217.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$975.53
Rate for Payer: Qualcare PPO/HMO/WC	$665.14
Rate for Payer: UnitedHealthcare Community & State	$106.87
Rate for Payer: Wellpoint Medicaid Managed Care	$117.51

TRIDENT 0 DEG INSERT 40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697216
Hospital Revenue Code	278
Min. Negotiated Rate	$665.14
Max. Negotiated Rate	$1,073.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$975.53
Rate for Payer: Qualcare PPO/HMO/WC	$665.14

TRIDENT 10 X 3 INSERT 36MM ID

Facility

$5,146.35

Service Code	HCPCS C1776
Hospital Charge Code	270681085
Hospital Revenue Code	278
Min. Negotiated Rate	$771.95
Max. Negotiated Rate	$1,245.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,132.20
Rate for Payer: Qualcare PPO/HMO/WC	$771.95

TRIDENT 10 X 3 INSERT 36MM ID

Facility

$5,146.35

Service Code	HCPCS C1776
Hospital Charge Code	270681085
Hospital Revenue Code	278
Min. Negotiated Rate	$124.03
Max. Negotiated Rate	$2,573.18
Rate for Payer: Aetna Commercial	$1,955.61
Rate for Payer: Aetna Medicare Advantage	$1,543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,312.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,312.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,312.32
Rate for Payer: Cigna Commercial	$2,573.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,132.20
Rate for Payer: Qualcare PPO/HMO/WC	$771.95
Rate for Payer: UnitedHealthcare Community & State	$124.03
Rate for Payer: Wellpoint Medicaid Managed Care	$136.38

TRIDENT 10X3 INSERT 36MM ID

Facility

$4,203.25

Service Code	HCPCS C1776
Hospital Charge Code	270692857
Hospital Revenue Code	278
Min. Negotiated Rate	$630.49
Max. Negotiated Rate	$1,017.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$924.72
Rate for Payer: Qualcare PPO/HMO/WC	$630.49

TRIDENT 10X3 INSERT 36MM ID

Facility

$4,203.25

Service Code	HCPCS C1776
Hospital Charge Code	270692857
Hospital Revenue Code	278
Min. Negotiated Rate	$101.30
Max. Negotiated Rate	$2,101.62
Rate for Payer: Aetna Commercial	$1,597.23
Rate for Payer: Aetna Medicare Advantage	$1,260.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.83
Rate for Payer: Cigna Commercial	$2,101.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$924.72
Rate for Payer: Qualcare PPO/HMO/WC	$630.49
Rate for Payer: UnitedHealthcare Community & State	$101.30
Rate for Payer: Wellpoint Medicaid Managed Care	$111.39

TRIDENT II TI CLUST ACET SHELL

Facility

$6,562.50

Service Code	HCPCS C1776
Hospital Charge Code	270686576
Hospital Revenue Code	278
Min. Negotiated Rate	$158.16
Max. Negotiated Rate	$3,281.25
Rate for Payer: Aetna Commercial	$2,493.75
Rate for Payer: Aetna Medicare Advantage	$1,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,673.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,673.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,673.44
Rate for Payer: Cigna Commercial	$3,281.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,443.75
Rate for Payer: Qualcare PPO/HMO/WC	$984.38
Rate for Payer: UnitedHealthcare Community & State	$158.16
Rate for Payer: Wellpoint Medicaid Managed Care	$173.91

TRIDENT II TI CLUST ACET SHELL

Facility

$6,562.50

Service Code	HCPCS C1776
Hospital Charge Code	270686576
Hospital Revenue Code	278
Min. Negotiated Rate	$984.38
Max. Negotiated Rate	$1,588.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,443.75
Rate for Payer: Qualcare PPO/HMO/WC	$984.38

TRIDENT II TRITANIUM CLUSTERHO

Facility

$20,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270684555
Hospital Revenue Code	278
Min. Negotiated Rate	$3,047.25
Max. Negotiated Rate	$4,916.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,063.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,916.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,047.25

TRIDENT II TRITANIUM CLUSTERHO

Facility

$20,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270684555
Hospital Revenue Code	278
Min. Negotiated Rate	$489.59
Max. Negotiated Rate	$10,157.50
Rate for Payer: Aetna Commercial	$7,719.70
Rate for Payer: Aetna Medicare Advantage	$6,094.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,180.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,180.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,180.32
Rate for Payer: Cigna Commercial	$10,157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,916.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,047.25
Rate for Payer: UnitedHealthcare Community & State	$489.59
Rate for Payer: Wellpoint Medicaid Managed Care	$538.35

TRIDENT II TRITAN SOLIDBK 56F

Facility

$5,888.55

Service Code	HCPCS C1776
Hospital Charge Code	270699331
Hospital Revenue Code	278
Min. Negotiated Rate	$883.28
Max. Negotiated Rate	$1,425.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.48
Rate for Payer: Qualcare PPO/HMO/WC	$883.28

Know your out-of-pocket cost for care.

All Charges