Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$120.15
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,894.41
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
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
Rate for Payer: UnitedHealthcare Community & State	$120.15
Rate for Payer: Wellpoint Medicaid Managed Care	$132.11

TRIX3 TIB BER INST SZ 1 CS 9MM

Facility

$5,082.20

Service Code	HCPCS C1776
Hospital Charge Code	270697571
Hospital Revenue Code	278
Min. Negotiated Rate	$762.33
Max. Negotiated Rate	$1,229.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.08
Rate for Payer: Qualcare PPO/HMO/WC	$762.33

TRIX3 TIB BER INST SZ 1 CS 9MM

Facility

$5,082.20

Service Code	HCPCS C1776
Hospital Charge Code	270697571
Hospital Revenue Code	278
Min. Negotiated Rate	$122.48
Max. Negotiated Rate	$2,541.10
Rate for Payer: Aetna Commercial	$1,931.24
Rate for Payer: Aetna Medicare Advantage	$1,524.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,295.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,295.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,295.96
Rate for Payer: Cigna Commercial	$2,541.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.08
Rate for Payer: Qualcare PPO/HMO/WC	$762.33
Rate for Payer: UnitedHealthcare Community & State	$122.48
Rate for Payer: Wellpoint Medicaid Managed Care	$134.68

TRIZIVIR 150/300MG

Facility

$215.67

Service Code	NDC 49702021718
Hospital Charge Code	60635560
Hospital Revenue Code	250
Min. Negotiated Rate	$32.35
Max. Negotiated Rate	$32.35
Rate for Payer: Qualcare PPO/HMO/WC	$32.35

TRIZIVIR 150/300MG

Facility

$215.67

Service Code	NDC 49702021718
Hospital Charge Code	60635560
Hospital Revenue Code	250
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$107.83
Rate for Payer: Aetna Commercial	$81.95
Rate for Payer: Aetna Medicare Advantage	$64.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.00
Rate for Payer: Cigna Commercial	$107.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.70
Rate for Payer: Oxford Commercial	$43.13
Rate for Payer: Qualcare PPO/HMO/WC	$32.35
Rate for Payer: UnitedHealthcare Commercial	$43.13
Rate for Payer: UnitedHealthcare Community & State	$5.20
Rate for Payer: Wellpoint Medicaid Managed Care	$5.72

TRMT STERNOCLAV DISL W/MANIP

Facility

$2,251.00

Service Code	HCPCS 23525
Hospital Charge Code	5780030
Hospital Revenue Code	450
Min. Negotiated Rate	$337.65
Max. Negotiated Rate	$337.65
Rate for Payer: Qualcare PPO/HMO/WC	$337.65

TRMT STERNOCLAV DISL W/MANIP

Facility

$2,251.00

Service Code	HCPCS 23525
Hospital Charge Code	5780030
Hospital Revenue Code	450
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,057.82
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.65
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$59.65

TROCAR ******

Facility

$209.00

Hospital Charge Code	8002420
Hospital Revenue Code	279
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$31.35
Rate for Payer: Qualcare PPO/HMO/WC	$31.35

TROCAR ******

Facility

$209.00

Hospital Charge Code	8002420
Hospital Revenue Code	279
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$104.50
Rate for Payer: Aetna Commercial	$79.42
Rate for Payer: Aetna Medicare Advantage	$62.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.30
Rate for Payer: Cigna Commercial	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.70
Rate for Payer: Oxford Commercial	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.35
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Community & State	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

TROCAR 10/11MM GRN 511SD

Facility

$1,107.25

Hospital Charge Code	270608754
Hospital Revenue Code	272
Min. Negotiated Rate	$166.09
Max. Negotiated Rate	$166.09
Rate for Payer: Qualcare PPO/HMO/WC	$166.09

TROCAR 10/11MM GRN 511SD

Facility

$1,107.25

Hospital Charge Code	270608754
Hospital Revenue Code	272
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$553.62
Rate for Payer: Aetna Commercial	$420.75
Rate for Payer: Aetna Medicare Advantage	$332.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$282.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$282.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$282.35
Rate for Payer: Cigna Commercial	$553.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.18
Rate for Payer: Oxford Commercial	$221.45
Rate for Payer: Qualcare PPO/HMO/WC	$166.09
Rate for Payer: UnitedHealthcare Commercial	$221.45
Rate for Payer: UnitedHealthcare Community & State	$26.68
Rate for Payer: Wellpoint Medicaid Managed Care	$29.34

TROCAR 10/12MM LNG ML1012LD

Facility

$466.67

Hospital Charge Code	270600264
Hospital Revenue Code	272
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.00

TROCAR 10/12MM LNG ML1012LD

Facility

$466.67

Hospital Charge Code	270600264
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$233.34
Rate for Payer: Aetna Commercial	$177.33
Rate for Payer: Aetna Medicare Advantage	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.00
Rate for Payer: Cigna Commercial	$233.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.00
Rate for Payer: Oxford Commercial	$93.33
Rate for Payer: Qualcare PPO/HMO/WC	$70.00
Rate for Payer: UnitedHealthcare Commercial	$93.33
Rate for Payer: UnitedHealthcare Community & State	$11.25
Rate for Payer: Wellpoint Medicaid Managed Care	$12.37

TROCAR 10/12MM LNG PURP 512XD

Facility

$1,225.65

Hospital Charge Code	272608756
Hospital Revenue Code	272
Min. Negotiated Rate	$29.54
Max. Negotiated Rate	$612.83
Rate for Payer: Aetna Commercial	$465.75
Rate for Payer: Aetna Medicare Advantage	$367.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.54
Rate for Payer: Cigna Commercial	$612.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.69
Rate for Payer: Oxford Commercial	$245.13
Rate for Payer: Qualcare PPO/HMO/WC	$183.85
Rate for Payer: UnitedHealthcare Commercial	$245.13
Rate for Payer: UnitedHealthcare Community & State	$29.54
Rate for Payer: Wellpoint Medicaid Managed Care	$32.48

TROCAR 10/12MM LNG PURP 512XD

Facility

$1,225.65

Hospital Charge Code	272608756
Hospital Revenue Code	272
Min. Negotiated Rate	$183.85
Max. Negotiated Rate	$183.85
Rate for Payer: Qualcare PPO/HMO/WC	$183.85

TROCAR 10/12MM LNG PURP 512XD

Facility

$250.15

Hospital Charge Code	270608756
Hospital Revenue Code	272
Min. Negotiated Rate	$37.52
Max. Negotiated Rate	$37.52
Rate for Payer: Qualcare PPO/HMO/WC	$37.52

TROCAR 10/12MM LNG PURP 512XD

Facility

$250.15

Hospital Charge Code	270608756
Hospital Revenue Code	272
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.08
Rate for Payer: Aetna Commercial	$95.06
Rate for Payer: Aetna Medicare Advantage	$75.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.79
Rate for Payer: Cigna Commercial	$125.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.05
Rate for Payer: Oxford Commercial	$50.03
Rate for Payer: Qualcare PPO/HMO/WC	$37.52
Rate for Payer: UnitedHealthcare Commercial	$50.03
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.63

TROCAR 10/12MM ML1012D

Facility

$820.00

Hospital Charge Code	270600263
Hospital Revenue Code	272
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$311.60
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.00
Rate for Payer: Oxford Commercial	$164.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Commercial	$164.00
Rate for Payer: UnitedHealthcare Community & State	$19.76
Rate for Payer: Wellpoint Medicaid Managed Care	$21.73

TROCAR 10/12MM ML1012D

Facility

$820.00

Hospital Charge Code	270600263
Hospital Revenue Code	272
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

TROCAR 10/12MM PURP 512SD

Facility

$215.07

Hospital Charge Code	270608755
Hospital Revenue Code	272
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.53
Rate for Payer: Aetna Commercial	$81.73
Rate for Payer: Aetna Medicare Advantage	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.84
Rate for Payer: Cigna Commercial	$107.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.52
Rate for Payer: Oxford Commercial	$43.01
Rate for Payer: Qualcare PPO/HMO/WC	$32.26
Rate for Payer: UnitedHealthcare Commercial	$43.01
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

TROCAR 10/12MM PURP 512SD

Facility

$215.07

Hospital Charge Code	270608755
Hospital Revenue Code	272
Min. Negotiated Rate	$32.26
Max. Negotiated Rate	$32.26
Rate for Payer: Qualcare PPO/HMO/WC	$32.26

TROCAR 10MM

Facility

$146.00

Hospital Charge Code	270338715
Hospital Revenue Code	272
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$55.48
Rate for Payer: Aetna Medicare Advantage	$43.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.23
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.80
Rate for Payer: Oxford Commercial	$29.20
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$29.20
Rate for Payer: UnitedHealthcare Community & State	$3.52
Rate for Payer: Wellpoint Medicaid Managed Care	$3.87

TROCAR 10MM

Facility

$146.00

Hospital Charge Code	270338715
Hospital Revenue Code	272
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

TROCAR 10MM BLUNT TIP SGL

Facility

$967.07

Hospital Charge Code	270622305
Hospital Revenue Code	272
Min. Negotiated Rate	$23.31
Max. Negotiated Rate	$483.54
Rate for Payer: Aetna Commercial	$367.49
Rate for Payer: Aetna Medicare Advantage	$290.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.60
Rate for Payer: Cigna Commercial	$483.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.12
Rate for Payer: Oxford Commercial	$193.41
Rate for Payer: Qualcare PPO/HMO/WC	$145.06
Rate for Payer: UnitedHealthcare Commercial	$193.41
Rate for Payer: UnitedHealthcare Community & State	$23.31
Rate for Payer: Wellpoint Medicaid Managed Care	$25.63

TROCAR 10MM BLUNT TIP SGL

Facility

$967.07

Hospital Charge Code	270622305
Hospital Revenue Code	272
Min. Negotiated Rate	$145.06
Max. Negotiated Rate	$145.06
Rate for Payer: Qualcare PPO/HMO/WC	$145.06

Know your out-of-pocket cost for care.

All Charges