Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRIPROL LQ 1.25MG PSEUD 30MG

Facility

$52.50

Hospital Charge Code	6010060
Hospital Revenue Code	251
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

TRIPROL LQ 1.25MG PSEUD 30MG

Facility

$52.50

Hospital Charge Code	6010060
Hospital Revenue Code	251
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

TRIPROL PSEUDOEPH 1.25 30MG 5M

Facility

$17.95

Hospital Charge Code	60627234
Hospital Revenue Code	251
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

TRIPROL PSEUDOEPH 1.25 30MG 5M

Facility

$17.95

Hospital Charge Code	60627234
Hospital Revenue Code	251
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$6.82
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.38
Rate for Payer: Oxford Commercial	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

TRIPROL PSEUDOEPH COD LQ 16 OZ

Facility

$309.15

Hospital Charge Code	6005532
Hospital Revenue Code	251
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$154.57
Rate for Payer: Aetna Commercial	$117.48
Rate for Payer: Aetna Medicare Advantage	$92.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.83
Rate for Payer: Cigna Commercial	$154.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.75
Rate for Payer: Oxford Commercial	$61.83
Rate for Payer: Qualcare PPO/HMO/WC	$46.37
Rate for Payer: UnitedHealthcare Commercial	$61.83
Rate for Payer: UnitedHealthcare Community & State	$7.45
Rate for Payer: Wellpoint Medicaid Managed Care	$8.19

TRIPROL PSEUDOEPH COD LQ 16 OZ

Facility

$309.15

Hospital Charge Code	6005532
Hospital Revenue Code	251
Min. Negotiated Rate	$46.37
Max. Negotiated Rate	$46.37
Rate for Payer: Qualcare PPO/HMO/WC	$46.37

TRIPROL PSEUDOEPH TAB 2.5-60MG

Facility

$2.45

Hospital Charge Code	60627473
Hospital Revenue Code	251
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TRIPROL PSEUDOEPH TAB 2.5-60MG

Facility

$2.45

Hospital Charge Code	60627473
Hospital Revenue Code	251
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

TRIPSLHACLUSACETSH56MMALPHA F

Facility

$4,734.70

Service Code	HCPCS C1776
Hospital Charge Code	270691176
Hospital Revenue Code	278
Min. Negotiated Rate	$114.11
Max. Negotiated Rate	$2,367.35
Rate for Payer: Aetna Commercial	$1,799.19
Rate for Payer: Aetna Medicare Advantage	$1,420.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.35
Rate for Payer: Cigna Commercial	$2,367.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.63
Rate for Payer: Qualcare PPO/HMO/WC	$710.21
Rate for Payer: UnitedHealthcare Community & State	$114.11
Rate for Payer: Wellpoint Medicaid Managed Care	$125.47

TRIPSLHACLUSACETSH56MMALPHA F

Facility

$4,734.70

Service Code	HCPCS C1776
Hospital Charge Code	270691176
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$1,145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.63
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

TRITANIUM CLUS HOLE SHELL 54MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270676576
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

TRITANIUM CLUS HOLE SHELL 54MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270676576
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRITANIUM CLUS HOLE SHELL 62MM

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671847
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

TRITANIUM CLUS HOLE SHELL 62MM

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671847
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

TRITOME TRIPLE EDGE

Facility

$2,725.00

Hospital Charge Code	270697199
Hospital Revenue Code	272
Min. Negotiated Rate	$408.75
Max. Negotiated Rate	$408.75
Rate for Payer: Qualcare PPO/HMO/WC	$408.75

TRITOME TRIPLE EDGE

Facility

$2,725.00

Hospital Charge Code	270697199
Hospital Revenue Code	272
Min. Negotiated Rate	$65.67
Max. Negotiated Rate	$1,362.50
Rate for Payer: Aetna Commercial	$1,035.50
Rate for Payer: Aetna Medicare Advantage	$817.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.88
Rate for Payer: Cigna Commercial	$1,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$817.50
Rate for Payer: Oxford Commercial	$545.00
Rate for Payer: Qualcare PPO/HMO/WC	$408.75
Rate for Payer: UnitedHealthcare Commercial	$545.00
Rate for Payer: UnitedHealthcare Community & State	$65.67
Rate for Payer: Wellpoint Medicaid Managed Care	$72.21

TRIVEX 100SV RESECTOR KIT

Facility

$613.00

Hospital Charge Code	270339009
Hospital Revenue Code	272
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$306.50
Rate for Payer: Aetna Commercial	$232.94
Rate for Payer: Aetna Medicare Advantage	$183.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.31
Rate for Payer: Cigna Commercial	$306.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.90
Rate for Payer: Oxford Commercial	$122.60
Rate for Payer: Qualcare PPO/HMO/WC	$91.95
Rate for Payer: UnitedHealthcare Commercial	$122.60
Rate for Payer: UnitedHealthcare Community & State	$14.77
Rate for Payer: Wellpoint Medicaid Managed Care	$16.24

TRIVEX 100SV RESECTOR KIT

Facility

$613.00

Hospital Charge Code	270339009
Hospital Revenue Code	272
Min. Negotiated Rate	$91.95
Max. Negotiated Rate	$91.95
Rate for Payer: Qualcare PPO/HMO/WC	$91.95

TRIVEX INFLOW TUBE SET

Facility

$178.00

Hospital Charge Code	270339010
Hospital Revenue Code	272
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$89.00
Rate for Payer: Aetna Commercial	$67.64
Rate for Payer: Aetna Medicare Advantage	$53.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.39
Rate for Payer: Cigna Commercial	$89.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.40
Rate for Payer: Oxford Commercial	$35.60
Rate for Payer: Qualcare PPO/HMO/WC	$26.70
Rate for Payer: UnitedHealthcare Commercial	$35.60
Rate for Payer: UnitedHealthcare Community & State	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

TRIVEX INFLOW TUBE SET

Facility

$178.00

Hospital Charge Code	270339010
Hospital Revenue Code	272
Min. Negotiated Rate	$26.70
Max. Negotiated Rate	$26.70
Rate for Payer: Qualcare PPO/HMO/WC	$26.70

TRI-VI-FLOR/0.25MG/1ML

Facility

$49.00

Hospital Charge Code	60634058
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

TRI-VI-FLOR/0.25MG/1ML

Facility

$49.00

Hospital Charge Code	60634058
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

TRI-VI-SOL/50ML

Facility

$43.00

Hospital Charge Code	60634059
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

TRI-VI-SOL/50ML

Facility

$43.00

Hospital Charge Code	60634059
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

TRIX3 TIB BER INRT PS SZ5 13MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697569
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.77
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

Know your out-of-pocket cost for care.

All Charges