Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TROCH GRIP PLATE 150MM

Facility

$10,525.50

Hospital Charge Code	270669264
Hospital Revenue Code	278
Min. Negotiated Rate	$1,578.83
Max. Negotiated Rate	$2,547.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,547.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,315.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,578.83

TROCH GRIP PLATE 150MM

Facility

$10,525.50

Hospital Charge Code	270669264
Hospital Revenue Code	278
Min. Negotiated Rate	$253.66
Max. Negotiated Rate	$5,262.75
Rate for Payer: Aetna Commercial	$3,999.69
Rate for Payer: Aetna Medicare Advantage	$3,157.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,684.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,684.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,684.00
Rate for Payer: Cigna Commercial	$5,262.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,547.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,315.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,578.83
Rate for Payer: UnitedHealthcare Community & State	$253.66
Rate for Payer: Wellpoint Medicaid Managed Care	$278.93

TROCH GRIP SM W/2, 2MM CABLETR

Facility

$10,020.00

Service Code	HCPCS C1713
Hospital Charge Code	270669261
Hospital Revenue Code	278
Min. Negotiated Rate	$241.48
Max. Negotiated Rate	$5,010.00
Rate for Payer: Aetna Commercial	$3,807.60
Rate for Payer: Aetna Medicare Advantage	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,555.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,555.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,555.10
Rate for Payer: Cigna Commercial	$5,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,424.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,204.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,503.00
Rate for Payer: UnitedHealthcare Community & State	$241.48
Rate for Payer: Wellpoint Medicaid Managed Care	$265.53

TROCH GRIP SM W/2, 2MM CABLETR

Facility

$10,020.00

Service Code	HCPCS C1713
Hospital Charge Code	270669261
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.00
Max. Negotiated Rate	$2,424.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,004.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,424.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,204.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,503.00

TROGLITAZONE TAB 200MG

Facility

$30.10

Hospital Charge Code	60628241
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.03
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

TROGLITAZONE TAB 200MG

Facility

$30.10

Hospital Charge Code	60628241
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

TROGLITAZONE TAB 400MG

Facility

$44.80

Hospital Charge Code	60628242
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$17.02
Rate for Payer: Aetna Medicare Advantage	$13.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.42
Rate for Payer: Cigna Commercial	$22.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.44
Rate for Payer: Oxford Commercial	$8.96
Rate for Payer: Qualcare PPO/HMO/WC	$6.72
Rate for Payer: UnitedHealthcare Commercial	$8.96
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

TROGLITAZONE TAB 400MG

Facility

$44.80

Hospital Charge Code	60628242
Hospital Revenue Code	250
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$6.72
Rate for Payer: Qualcare PPO/HMO/WC	$6.72

TROGLITAZONE TAB 400MG REZULIN

Facility

$26.90

Hospital Charge Code	6017990
Hospital Revenue Code	252
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$10.22
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$5.38
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

TROGLITAZONE TAB 400MG REZULIN

Facility

$26.90

Hospital Charge Code	6017990
Hospital Revenue Code	252
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

TROLAMINE SALIC CRM 10%

Facility

$33.65

Hospital Charge Code	60628460
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$12.79
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$6.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$6.73
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

TROLAMINE SALIC CRM 10%

Facility

$33.65

Hospital Charge Code	60628460
Hospital Revenue Code	250
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

TROLAMINE SALIC CRM 10% 60GM

Facility

$30.10

Hospital Charge Code	6005540
Hospital Revenue Code	251
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

TROLAMINE SALIC CRM 10% 60GM

Facility

$30.10

Hospital Charge Code	6005540
Hospital Revenue Code	251
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.03
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

TRONOLANE 1% CREAM

Facility

$4.00

Service Code	NDC 11868081401
Hospital Charge Code	60635736
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

TRONOLANE 1% CREAM

Facility

$4.00

Service Code	NDC 11868081401
Hospital Charge Code	60635736
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TROPCAMIDE 0.5%

Facility

$67.00

Service Code	NDC 17478010112
Hospital Charge Code	606390229
Hospital Revenue Code	250
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

TROPCAMIDE 0.5%

Facility

$67.00

Service Code	NDC 17478010112
Hospital Charge Code	606390229
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Oxford Commercial	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$13.40
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

TROPICAMIDE 1% OPHTH/15ML

Facility

$38.00

Hospital Charge Code	60634095
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

TROPICAMIDE 1% OPHTH/15ML

Facility

$38.00

Hospital Charge Code	60634095
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

TROPICAMIDE OPH 1% 15ML

Facility

$13.65

Hospital Charge Code	6005565
Hospital Revenue Code	251
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

TROPICAMIDE OPH 1% 15ML

Facility

$13.65

Hospital Charge Code	6005565
Hospital Revenue Code	251
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

TROPICAMIDE OPH .5% 15ML

Facility

$12.85

Hospital Charge Code	6005557
Hospital Revenue Code	251
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

TROPICAMIDE OPH .5% 15ML

Facility

$12.85

Hospital Charge Code	6005557
Hospital Revenue Code	251
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

TROPICAMIDE OPH SOL 1% 3ML

Facility

$168.04

Service Code	NDC 17478010212
Hospital Charge Code	60628068
Hospital Revenue Code	250
Min. Negotiated Rate	$25.21
Max. Negotiated Rate	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$25.21

Know your out-of-pocket cost for care.

All Charges