Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRYPSIN 1

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3035991A
Hospital Revenue Code	301
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$87.78

TRYPSIN 2

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3035991B
Hospital Revenue Code	301
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$87.78

TRYPSIN 2

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3035991B
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$292.58
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$292.58
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$15.51

TRYPSIN 3

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3035991C
Hospital Revenue Code	301
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$87.78

TRYPSIN 3

Facility

$585.17

Service Code	HCPCS 83519
Hospital Charge Code	3035991C
Hospital Revenue Code	301
Min. Negotiated Rate	$14.72
Max. Negotiated Rate	$292.58
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.42
Rate for Payer: Cigna Commercial	$292.58
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$15.51

TRYPSIN-BALSAM AEROSOL SPRAY

Facility

$131.25

Hospital Charge Code	60628461
Hospital Revenue Code	250
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

TRYPSIN-BALSAM AEROSOL SPRAY

Facility

$131.25

Hospital Charge Code	60628461
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.62
Rate for Payer: Aetna Commercial	$49.88
Rate for Payer: Aetna Medicare Advantage	$39.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.47
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.38
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$26.25
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

TRYPSIN,FECES,24HR,QUANT

Facility

$142.00

Service Code	HCPCS 84490
Hospital Charge Code	38472667
Hospital Revenue Code	301
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

TRYPSIN,FECES,24HR,QUANT

Facility

$142.00

Service Code	HCPCS 84490
Hospital Charge Code	38472667
Hospital Revenue Code	301
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$27.01
Rate for Payer: Aetna Medicare Advantage	$32.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.84
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$9.93
Rate for Payer: Clover Medicare Advantage	$9.43
Rate for Payer: EmblemHealth Commercial	$29.79
Rate for Payer: Humana Medicare Advantage	$10.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.93
Rate for Payer: Wellcare Medicare Advantage	$9.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

TRYPSIN;FECES,QUALITATIVE

Facility

$51.70

Service Code	HCPCS 84488
Hospital Charge Code	38477050
Hospital Revenue Code	301
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$19.86
Rate for Payer: Aetna Medicare Advantage	$23.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.35
Rate for Payer: Cigna Commercial	$25.85
Rate for Payer: Cigna Medicare Advantage	$7.30
Rate for Payer: Clover Medicare Advantage	$6.93
Rate for Payer: EmblemHealth Commercial	$21.90
Rate for Payer: Humana Medicare Advantage	$7.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.51
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.30
Rate for Payer: Wellcare Medicare Advantage	$7.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

TRYPSIN;FECES,QUALITATIVE

Facility

$51.70

Service Code	HCPCS 84488
Hospital Charge Code	38477050
Hospital Revenue Code	301
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$7.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.75

TRYPTASE

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900454
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TRYPTASE

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900454
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
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	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TRYPTASE

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3038116
Hospital Revenue Code	300
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

TRYPTASE

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3038116
Hospital Revenue Code	300
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$126.72
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$126.72
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.72

TRYPTASE TRYPTOPHAN***

Facility

$172.00

Hospital Charge Code	3032612
Hospital Revenue Code	309
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

TRYPTASE TRYPTOPHAN***

Facility

$172.00

Hospital Charge Code	3032612
Hospital Revenue Code	309
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.36
Rate for Payer: Aetna Medicare Advantage	$51.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.86
Rate for Payer: Cigna Commercial	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

TRYPTICASE KIT

Facility

$147.85

Hospital Charge Code	60628555
Hospital Revenue Code	250
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

TRYPTICASE KIT

Facility

$147.85

Hospital Charge Code	60628555
Hospital Revenue Code	250
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$56.18
Rate for Payer: Aetna Medicare Advantage	$44.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.70
Rate for Payer: Cigna Commercial	$73.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.35
Rate for Payer: Oxford Commercial	$29.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Commercial	$29.57
Rate for Payer: UnitedHealthcare Community & State	$3.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

TRYPTOPHAN

Facility

$115.90

Service Code	HCPCS 82131
Hospital Charge Code	39900455
Hospital Revenue Code	301
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$17.39
Rate for Payer: Qualcare PPO/HMO/WC	$17.39

TRYPTOPHAN

Facility

$115.90

Service Code	HCPCS 82131
Hospital Charge Code	39900455
Hospital Revenue Code	301
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.95
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: Cigna Medicare Advantage	$22.98
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.39
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Medicare Advantage	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

TRYPTOPHAN (SERUM)***

Facility

$58.00

Service Code	HCPCS 82131
Hospital Charge Code	3007713
Hospital Revenue Code	301
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

TRYPTOPHAN (SERUM)***

Facility

$58.00

Service Code	HCPCS 82131
Hospital Charge Code	3007713
Hospital Revenue Code	301
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.51
Rate for Payer: Aetna Medicare Advantage	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.95
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: Cigna Medicare Advantage	$22.98
Rate for Payer: Clover Medicare Advantage	$21.83
Rate for Payer: EmblemHealth Commercial	$68.94
Rate for Payer: Humana Medicare Advantage	$23.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.98
Rate for Payer: Wellcare Medicare Advantage	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

TRY VRTBRL BLLN 11Gx15 VBT1115

Facility

$5,750.00

Hospital Charge Code	270650185
Hospital Revenue Code	272
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,725.00
Rate for Payer: Oxford Commercial	$1,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$1,150.00
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

TRY VRTBRL BLLN 11Gx15 VBT1115

Facility

$5,750.00

Hospital Charge Code	270650185
Hospital Revenue Code	272
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

Know your out-of-pocket cost for care.

All Charges