Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIFLUOPERAZINE TAB 10MG

Facility

$9.00

Hospital Charge Code	60627830
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TRIFLURIDINE SOL OPH 1%

Facility

$1,768.13

Service Code	NDC 61570003775
Hospital Charge Code	60628026
Hospital Revenue Code	250
Min. Negotiated Rate	$265.22
Max. Negotiated Rate	$265.22
Rate for Payer: Qualcare PPO/HMO/WC	$265.22

TRIFLURIDINE SOL OPH 1%

Facility

$1,768.13

Service Code	NDC 61570003775
Hospital Charge Code	60628026
Hospital Revenue Code	250
Min. Negotiated Rate	$42.61
Max. Negotiated Rate	$884.07
Rate for Payer: Aetna Commercial	$671.89
Rate for Payer: Aetna Medicare Advantage	$530.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.87
Rate for Payer: Cigna Commercial	$884.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.44
Rate for Payer: Oxford Commercial	$353.63
Rate for Payer: Qualcare PPO/HMO/WC	$265.22
Rate for Payer: UnitedHealthcare Commercial	$353.63
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

TRIFLURIDINE SOL OPH 1% 7.5ML

Facility

$317.45

Hospital Charge Code	6005508
Hospital Revenue Code	252
Min. Negotiated Rate	$47.62
Max. Negotiated Rate	$47.62
Rate for Payer: Qualcare PPO/HMO/WC	$47.62

TRIFLURIDINE SOL OPH 1% 7.5ML

Facility

$317.45

Hospital Charge Code	6005508
Hospital Revenue Code	252
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$158.72
Rate for Payer: Aetna Commercial	$120.63
Rate for Payer: Aetna Medicare Advantage	$95.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.95
Rate for Payer: Cigna Commercial	$158.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.23
Rate for Payer: Oxford Commercial	$63.49
Rate for Payer: Qualcare PPO/HMO/WC	$47.62
Rate for Payer: UnitedHealthcare Commercial	$63.49
Rate for Payer: UnitedHealthcare Community & State	$7.65
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

TRIGGER FLEX

Facility

$2,975.00

Hospital Charge Code	270674917
Hospital Revenue Code	272
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$1,130.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.50
Rate for Payer: Oxford Commercial	$595.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Commercial	$595.00
Rate for Payer: UnitedHealthcare Community & State	$71.70
Rate for Payer: Wellpoint Medicaid Managed Care	$78.84

TRIGGER FLEX

Facility

$2,475.00

Hospital Charge Code	270691475
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

TRIGGER FLEX

Facility

$2,475.00

Hospital Charge Code	270691475
Hospital Revenue Code	272
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.50
Rate for Payer: Oxford Commercial	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$495.00
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

TRIGGER FLEX

Facility

$2,975.00

Hospital Charge Code	270674917
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$446.25
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

TRIGGER POINT INJECTION****

Facility

$180.00

Service Code	HCPCS 20550
Hospital Charge Code	1001125
Hospital Revenue Code	361
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

TRIGGER POINT INJECTION****

Facility

$180.00

Service Code	HCPCS 20550
Hospital Charge Code	1001125
Hospital Revenue Code	361
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

TRIGLYCERIDE,PERICARDIAL FLUID

Facility

$390.00

Service Code	HCPCS 84478
Hospital Charge Code	3002610
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TRIGLYCERIDE,PERICARDIAL FLUID

Facility

$390.00

Service Code	HCPCS 84478
Hospital Charge Code	3002610
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TRIGLYCERIDE, PLEURAL FLUID

Facility

$77.65

Service Code	HCPCS 84478
Hospital Charge Code	3002611
Hospital Revenue Code	301
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

TRIGLYCERIDE, PLEURAL FLUID

Facility

$77.65

Service Code	HCPCS 84478
Hospital Charge Code	3002611
Hospital Revenue Code	301
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

TRIGLYCERIDES

Facility

$8.10

Service Code	HCPCS 84478CF
Hospital Charge Code	8200332RS
Hospital Revenue Code	301
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.22

TRIGLYCERIDES

Facility

$306.00

Service Code	HCPCS 84478
Hospital Charge Code	38472654
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$8.11

TRIGLYCERIDES

Facility

$8.10

Service Code	HCPCS 84478CF
Hospital Charge Code	8200332RS
Hospital Revenue Code	301
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna Medicare Advantage	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.07
Rate for Payer: Cigna Commercial	$4.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.43
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.22
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

TRIGLYCERIDES

Facility

$306.00

Service Code	HCPCS 84478
Hospital Charge Code	38472654
Hospital Revenue Code	301
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

TRIGLYCERIDES PERITONEAL

Facility

$39.50

Service Code	HCPCS 84478
Hospital Charge Code	39900144
Hospital Revenue Code	301
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$19.75
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.92
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

TRIGLYCERIDES PERITONEAL

Facility

$39.50

Service Code	HCPCS 84478
Hospital Charge Code	39900144
Hospital Revenue Code	301
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$5.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.92

TRIGLYCERIDES, SERUM

Facility

$667.59

Service Code	HCPCS 84478
Hospital Charge Code	3002615
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

TRIGLYCERIDES, SERUM

Facility

$667.59

Service Code	HCPCS 84478
Hospital Charge Code	3002615
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

TRIGLYCERIDES SERUM PANEL***

Facility

$6.00

Service Code	HCPCS 84478
Hospital Charge Code	3002615P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TRIGLYCERIDES SERUM PANEL***

Facility

$6.00

Service Code	HCPCS 84478
Hospital Charge Code	3002615P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

Know your out-of-pocket cost for care.

All Charges