Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TEGADERM OCCLUSIVE 4 X 6

Facility

$125.05

Hospital Charge Code	270649961
Hospital Revenue Code	272
Min. Negotiated Rate	$18.76
Max. Negotiated Rate	$18.76
Rate for Payer: Qualcare PPO/HMO/WC	$18.76

TEGADERM OCCLUSIVE 4 X 6

Facility

$125.05

Hospital Charge Code	270649961
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.52
Rate for Payer: Aetna Commercial	$47.52
Rate for Payer: Aetna Medicare Advantage	$37.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.89
Rate for Payer: Cigna Commercial	$62.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.52
Rate for Payer: Oxford Commercial	$25.01
Rate for Payer: Qualcare PPO/HMO/WC	$18.76
Rate for Payer: UnitedHealthcare Commercial	$25.01
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

TEGADERM TRANSP 6X8

Facility

$6.04

Hospital Charge Code	270650240S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.91

TEGADERM TRANSP 6X8

Facility

$6.04

Hospital Charge Code	270650240S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.30
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TEGADERM TRANSPAREMT 4X4 1626W

Facility

$3.09

Hospital Charge Code	270649122
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.46

TEGADERM TRANSPAREMT 4X4 1626W

Facility

$3.09

Hospital Charge Code	270649122
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna Commercial	$1.17
Rate for Payer: Aetna Medicare Advantage	$0.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.79
Rate for Payer: Cigna Commercial	$1.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.93
Rate for Payer: Oxford Commercial	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.46
Rate for Payer: UnitedHealthcare Commercial	$0.62
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TEGADERM TRANSPARENT 8X12

Facility

$9.75

Hospital Charge Code	270649123
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

TEGADERM TRANSPARENT 8X12

Facility

$9.75

Hospital Charge Code	270649123
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.88
Rate for Payer: Aetna Commercial	$3.71
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Commercial	$1.95
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

TEGASEROD 2 MG TAB UD

Facility

$18.75

Hospital Charge Code	60629849
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.38
Rate for Payer: Aetna Commercial	$7.12
Rate for Payer: Aetna Medicare Advantage	$5.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.78
Rate for Payer: Cigna Commercial	$9.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.62
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.81
Rate for Payer: UnitedHealthcare Commercial	$3.75
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

TEGASEROD 2 MG TAB UD

Facility

$18.75

Hospital Charge Code	60629849
Hospital Revenue Code	250
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.81

TEGASEROD 6 MG TAB

Facility

$12.85

Hospital Charge Code	60629262
Hospital Revenue Code	250
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

TEGASEROD 6 MG TAB

Facility

$12.85

Hospital Charge Code	60629262
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

TEGASORB 2 3/4 X 3 1/2

Facility

$32.00

Hospital Charge Code	270350217
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

TEGASORB 2 3/4 X 3 1/2

Facility

$32.00

Hospital Charge Code	270350217
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

TEGASORB 4 X 4 3/4

Facility

$44.85

Hospital Charge Code	270350218
Hospital Revenue Code	272
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.43
Rate for Payer: Aetna Commercial	$17.04
Rate for Payer: Aetna Medicare Advantage	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.44
Rate for Payer: Cigna Commercial	$22.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.46
Rate for Payer: Oxford Commercial	$8.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.73
Rate for Payer: UnitedHealthcare Commercial	$8.97
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

TEGASORB 4 X 4 3/4

Facility

$44.85

Hospital Charge Code	270350218
Hospital Revenue Code	272
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$6.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.73

TEGRETOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633974
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

TEGRETOL/100MG/TAB

Facility

$3.00

Hospital Charge Code	60633975
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEGRETOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633974
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TEGRETOL/100MG/TAB

Facility

$3.00

Hospital Charge Code	60633975
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TEGRETOL/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633973
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEGRETOL/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633973
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TEGRETOL/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633972
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

TEGRETOL/200MG/TAB

Facility

$4.00

Hospital Charge Code	60633971
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TEGRETOL/200MG/TAB

Facility

$3.00

Hospital Charge Code	60633972
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges