Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PILOCARPINE OPHT 2% 15ML

Facility

$675.43

Service Code	NDC 998020415
Hospital Charge Code	6004360
Hospital Revenue Code	251
Min. Negotiated Rate	$101.31
Max. Negotiated Rate	$101.31
Rate for Payer: Qualcare PPO/HMO/WC	$101.31

PILOCARPINE OPHT 2% 15ML

Facility

$675.43

Service Code	NDC 998020415
Hospital Charge Code	6004360
Hospital Revenue Code	251
Min. Negotiated Rate	$16.28
Max. Negotiated Rate	$337.71
Rate for Payer: Aetna Commercial	$256.66
Rate for Payer: Aetna Medicare Advantage	$202.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.23
Rate for Payer: Cigna Commercial	$337.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.63
Rate for Payer: Oxford Commercial	$135.09
Rate for Payer: Qualcare PPO/HMO/WC	$101.31
Rate for Payer: UnitedHealthcare Commercial	$135.09
Rate for Payer: UnitedHealthcare Community & State	$16.28
Rate for Payer: Wellpoint Medicaid Managed Care	$17.90

PILOCARPINE OPHT 2ML PRES-FREE

Facility

$53.80

Hospital Charge Code	6004378
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

PILOCARPINE OPHT 2ML PRES-FREE

Facility

$53.80

Hospital Charge Code	6004378
Hospital Revenue Code	251
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

PILOCARPINE OPHT 3% 15ML

Facility

$9.65

Hospital Charge Code	6004386
Hospital Revenue Code	251
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

PILOCARPINE OPHT 3% 15ML

Facility

$9.65

Hospital Charge Code	6004386
Hospital Revenue Code	251
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

PILOCARPINE OPHT 4% 15ML

Facility

$7.70

Hospital Charge Code	6004394
Hospital Revenue Code	251
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

PILOCARPINE OPHT 4% 15ML

Facility

$7.70

Hospital Charge Code	6004394
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

PILOCARPINE OPHT .5% 15ML

Facility

$9.65

Hospital Charge Code	6004345
Hospital Revenue Code	251
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

PILOCARPINE OPHT .5% 15ML

Facility

$9.65

Hospital Charge Code	6004345
Hospital Revenue Code	251
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

PILOCARPINE OPHT 6% 15ML

Facility

$10.45

Hospital Charge Code	6004402
Hospital Revenue Code	251
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

PILOCARPINE OPHT 6% 15ML

Facility

$10.45

Hospital Charge Code	6004402
Hospital Revenue Code	251
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

PILOCARPINE OPHT 8% 15ML

Facility

$185.00

Hospital Charge Code	6004410
Hospital Revenue Code	251
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.50
Rate for Payer: Oxford Commercial	$37.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$37.00
Rate for Payer: UnitedHealthcare Community & State	$4.46
Rate for Payer: Wellpoint Medicaid Managed Care	$4.90

PILOCARPINE OPHT 8% 15ML

Facility

$185.00

Hospital Charge Code	6004410
Hospital Revenue Code	251
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

PILOCARPINE SOL OPH 10%

Facility

$218.45

Hospital Charge Code	60628062
Hospital Revenue Code	250
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$109.22
Rate for Payer: Aetna Commercial	$83.01
Rate for Payer: Aetna Medicare Advantage	$65.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.70
Rate for Payer: Cigna Commercial	$109.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.53
Rate for Payer: Oxford Commercial	$43.69
Rate for Payer: Qualcare PPO/HMO/WC	$32.77
Rate for Payer: UnitedHealthcare Commercial	$43.69
Rate for Payer: UnitedHealthcare Community & State	$5.26
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

PILOCARPINE SOL OPH 10%

Facility

$218.45

Hospital Charge Code	60628062
Hospital Revenue Code	250
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

PILOCARPINE SOL OPH 10% 15ML

Facility

$192.65

Hospital Charge Code	6004428
Hospital Revenue Code	251
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$96.33
Rate for Payer: Aetna Commercial	$73.21
Rate for Payer: Aetna Medicare Advantage	$57.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.13
Rate for Payer: Cigna Commercial	$96.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.80
Rate for Payer: Oxford Commercial	$38.53
Rate for Payer: Qualcare PPO/HMO/WC	$28.90
Rate for Payer: UnitedHealthcare Commercial	$38.53
Rate for Payer: UnitedHealthcare Community & State	$4.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

PILOCARPINE SOL OPH 10% 15ML

Facility

$192.65

Hospital Charge Code	6004428
Hospital Revenue Code	251
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$28.90
Rate for Payer: Qualcare PPO/HMO/WC	$28.90

PILOCARPINE SOL OPH 2% 1ML

Facility

$14.75

Hospital Charge Code	60628061
Hospital Revenue Code	259
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$5.61
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$2.95
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

PILOCARPINE SOL OPH 2% 1ML

Facility

$14.75

Hospital Charge Code	60628061
Hospital Revenue Code	259
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

PILOCARPINE SOL OPH 4% 1ML

Facility

$24.85

Hospital Charge Code	60628063
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

PILOCARPINE SOL OPH 4% 1ML

Facility

$24.85

Hospital Charge Code	60628063
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

PILOT DRILL SHORT 2.0MM QUICK

Facility

$768.75

Hospital Charge Code	270669683
Hospital Revenue Code	272
Min. Negotiated Rate	$18.53
Max. Negotiated Rate	$384.38
Rate for Payer: Aetna Commercial	$292.12
Rate for Payer: Aetna Medicare Advantage	$230.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.03
Rate for Payer: Cigna Commercial	$384.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.62
Rate for Payer: Oxford Commercial	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$115.31
Rate for Payer: UnitedHealthcare Commercial	$153.75
Rate for Payer: UnitedHealthcare Community & State	$18.53
Rate for Payer: Wellpoint Medicaid Managed Care	$20.37

PILOT DRILL SHORT 2.0MM QUICK

Facility

$768.75

Hospital Charge Code	270669683
Hospital Revenue Code	272
Min. Negotiated Rate	$115.31
Max. Negotiated Rate	$115.31
Rate for Payer: Qualcare PPO/HMO/WC	$115.31

PIMECROLIMUS 1 % CRE

Facility

$124.00

Hospital Charge Code	60629254
Hospital Revenue Code	250
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

Know your out-of-pocket cost for care.

All Charges