Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIMETHOBENZAMIDE 250 MG CAP

Facility

$4.85

Hospital Charge Code	60628153
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

TRIMETHOBENZAMIDE 250 MG CAP

Facility

$4.85

Hospital Charge Code	60628153
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TRIMETHOBENZAMIDE250MG UD

Facility

$3.00

Hospital Charge Code	60634026
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIMETHOBENZAMIDE250MG UD

Facility

$3.00

Hospital Charge Code	60634026
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

TRIMETHOBENZAMIDE 300 MG CAP

Facility

$21.51

Service Code	HCPCS Q0173
Hospital Charge Code	60629360
Hospital Revenue Code	636
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$5.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.21
Rate for Payer: Qualcare PPO/HMO/WC	$3.23

TRIMETHOBENZAMIDE 300 MG CAP

Facility

$21.51

Service Code	HCPCS Q0173
Hospital Charge Code	60629360
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.76
Rate for Payer: Aetna Commercial	$8.17
Rate for Payer: Aetna Medicare Advantage	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.49
Rate for Payer: Cigna Commercial	$10.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.21
Rate for Payer: Qualcare PPO/HMO/WC	$3.23
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

TRIMETHOBENZAMIDE CAP 100MG

Facility

$4.85

Hospital Charge Code	60628149
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

TRIMETHOBENZAMIDE CAP 100MG

Facility

$4.85

Hospital Charge Code	60628149
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

TRIMETHOBENZAMIDE INJ

Facility

$14.00

Service Code	HCPCS K0240
Hospital Charge Code	6006340
Hospital Revenue Code	259
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

TRIMETHOBENZAMIDE INJ

Facility

$14.00

Service Code	HCPCS K0240
Hospital Charge Code	6006340
Hospital Revenue Code	259
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

TRIMETHOBENZAMIDE INJ200MG/2ML

Facility

$47.64

Service Code	HCPCS J3250
Hospital Charge Code	60628152
Hospital Revenue Code	636
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$23.82
Rate for Payer: Aetna Commercial	$18.10
Rate for Payer: Aetna Medicare Advantage	$14.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.15
Rate for Payer: Cigna Commercial	$23.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.53
Rate for Payer: Qualcare PPO/HMO/WC	$7.15
Rate for Payer: UnitedHealthcare Community & State	$1.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

TRIMETHOBENZAMIDE INJ200MG/2ML

Facility

$47.64

Service Code	HCPCS J3250
Hospital Charge Code	60628152
Hospital Revenue Code	636
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.53
Rate for Payer: Qualcare PPO/HMO/WC	$7.15

TRIMETHOBENZAMIDE SUPP 200MG

Facility

$3.20

Hospital Charge Code	6022891
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

TRIMETHOBENZAMIDE SUPP 200MG

Facility

$3.20

Hospital Charge Code	6022883
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

TRIMETHOBENZAMIDE SUPP 200MG

Facility

$3.20

Hospital Charge Code	6022883
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TRIMETHOBENZAMIDE SUPP 200MG

Facility

$3.20

Hospital Charge Code	6022891
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TRIMETHOBENZAMIOC SUPP 100MG

Facility

$3.20

Hospital Charge Code	6023428
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

TRIMETHOBENZAMIOC SUPP 100MG

Facility

$3.20

Hospital Charge Code	6023428
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TRIMETHOPRIM/100MG/PO/TAB

Facility

$3.00

Hospital Charge Code	60634948
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TRIMETHOPRIM/100MG/PO/TAB

Facility

$3.00

Hospital Charge Code	60634948
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

TRIMETREXATE 25 MG INJ

Facility

$882.75

Hospital Charge Code	60629002
Hospital Revenue Code	636
Min. Negotiated Rate	$21.27
Max. Negotiated Rate	$441.38
Rate for Payer: Aetna Commercial	$335.44
Rate for Payer: Aetna Medicare Advantage	$264.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.10
Rate for Payer: Cigna Commercial	$441.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.63
Rate for Payer: Qualcare PPO/HMO/WC	$132.41
Rate for Payer: UnitedHealthcare Community & State	$21.27
Rate for Payer: Wellpoint Medicaid Managed Care	$23.39

TRIMETREXATE 25 MG INJ

Facility

$882.75

Hospital Charge Code	60629002
Hospital Revenue Code	636
Min. Negotiated Rate	$132.41
Max. Negotiated Rate	$213.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.63
Rate for Payer: Qualcare PPO/HMO/WC	$132.41

TRIM FIX NAIL 4X100MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705015
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$3,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,575.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

TRIM FIX NAIL 4X100MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705015
Hospital Revenue Code	278
Min. Negotiated Rate	$391.62
Max. Negotiated Rate	$8,125.00
Rate for Payer: Aetna Commercial	$6,175.00
Rate for Payer: Aetna Medicare Advantage	$4,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,143.75
Rate for Payer: Cigna Commercial	$8,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,575.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50
Rate for Payer: UnitedHealthcare Community & State	$391.62
Rate for Payer: Wellpoint Medicaid Managed Care	$430.62

TRIMING BLADES LONG

Facility

$43.10

Hospital Charge Code	270665508
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.55
Rate for Payer: Aetna Commercial	$16.38
Rate for Payer: Aetna Medicare Advantage	$12.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.99
Rate for Payer: Cigna Commercial	$21.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.93
Rate for Payer: Oxford Commercial	$8.62
Rate for Payer: Qualcare PPO/HMO/WC	$6.46
Rate for Payer: UnitedHealthcare Commercial	$8.62
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

Know your out-of-pocket cost for care.

All Charges