Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TEGRETOL/200MG/TAB

Facility

$4.00

Hospital Charge Code	60633971
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 CITRUS-VANILLA

Facility

$4.00

Service Code	NDC 60432012916
Hospital Charge Code	60633976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TEGRETOL CITRUS-VANILLA

Facility

$4.00

Service Code	NDC 60432012916
Hospital Charge Code	60633976
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 XR 100 BULK

Facility

$7.44

Service Code	NDC 78051005
Hospital Charge Code	60635257
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.72
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.49
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

TEGRETOL XR 100 BULK

Facility

$7.44

Service Code	NDC 78051005
Hospital Charge Code	60635257
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

TEGRETOL XR 200 U/D

Facility

$13.94

Service Code	NDC 51672412401
Hospital Charge Code	60635258
Hospital Revenue Code	250
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.09

TEGRETOL XR 200 U/D

Facility

$13.94

Service Code	NDC 51672412401
Hospital Charge Code	60635258
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.97
Rate for Payer: Aetna Commercial	$5.30
Rate for Payer: Aetna Medicare Advantage	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.55
Rate for Payer: Cigna Commercial	$6.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.18
Rate for Payer: Oxford Commercial	$2.79
Rate for Payer: Qualcare PPO/HMO/WC	$2.09
Rate for Payer: UnitedHealthcare Commercial	$2.79
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

TEGRETOL XR 400MG

Facility

$7.00

Hospital Charge Code	60635137
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

TEGRETOL XR 400MG

Facility

$7.00

Hospital Charge Code	60635137
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

TEGRETOL XR 400 U/D

Facility

$6.00

Hospital Charge Code	60635259
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TEGRETOL XR 400 U/D

Facility

$6.00

Hospital Charge Code	60635259
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TEICHOIC ACID AB

Facility

$82.35

Service Code	HCPCS 86331
Hospital Charge Code	39900213
Hospital Revenue Code	302
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$12.35
Rate for Payer: Qualcare PPO/HMO/WC	$12.35

TEICHOIC ACID AB

Facility

$82.35

Service Code	HCPCS 86331
Hospital Charge Code	39900213
Hospital Revenue Code	302
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$41.17
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.18

TEICHOIC ACID AB

Facility

$131.25

Service Code	HCPCS 86329
Hospital Charge Code	3006749
Hospital Revenue Code	302
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.22
Rate for Payer: Aetna Medicare Advantage	$45.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.72
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: Cigna Medicare Advantage	$14.05
Rate for Payer: Clover Medicare Advantage	$13.35
Rate for Payer: EmblemHealth Commercial	$42.15
Rate for Payer: Humana Medicare Advantage	$14.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.05
Rate for Payer: Wellcare Medicare Advantage	$14.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

TEICHOIC ACID AB

Facility

$131.25

Service Code	HCPCS 86329
Hospital Charge Code	3006749
Hospital Revenue Code	302
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

TEICHOIC ACID ANTIBODIES

Facility

$293.00

Service Code	HCPCS 86331
Hospital Charge Code	38472613
Hospital Revenue Code	302
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

TEICHOIC ACID ANTIBODIES

Facility

$293.00

Service Code	HCPCS 86331
Hospital Charge Code	38472613
Hospital Revenue Code	302
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

TEICHOIC ACID TITER

Facility

$96.50

Service Code	HCPCS 86329
Hospital Charge Code	39900212
Hospital Revenue Code	302
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$14.47
Rate for Payer: Qualcare PPO/HMO/WC	$14.47

TEICHOIC ACID TITER

Facility

$96.50

Service Code	HCPCS 86329
Hospital Charge Code	39900212
Hospital Revenue Code	302
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.22
Rate for Payer: Aetna Medicare Advantage	$45.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.72
Rate for Payer: Cigna Commercial	$48.25
Rate for Payer: Cigna Medicare Advantage	$14.05
Rate for Payer: Clover Medicare Advantage	$13.35
Rate for Payer: EmblemHealth Commercial	$42.15
Rate for Payer: Humana Medicare Advantage	$14.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.95
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.47
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.05
Rate for Payer: Wellcare Medicare Advantage	$14.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

TEICHOIC ACID W/TITER RFX

Facility

$390.00

Service Code	HCPCS 86331
Hospital Charge Code	39900410
Hospital Revenue Code	302
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
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	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TEICHOIC ACID W/TITER RFX

Facility

$390.00

Service Code	HCPCS 86331
Hospital Charge Code	39900410
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TELEHEALTH FACILITY FEE

Facility

$133.25

Service Code	HCPCS Q3014
Hospital Charge Code	4850Q3014
Hospital Revenue Code	780
Min. Negotiated Rate	$19.99
Max. Negotiated Rate	$19.99
Rate for Payer: Qualcare PPO/HMO/WC	$19.99

TELEHEALTH FACILITY FEE

Facility

$133.25

Service Code	HCPCS Q3014
Hospital Charge Code	4850Q3014
Hospital Revenue Code	780
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$66.62
Rate for Payer: Aetna Commercial	$50.63
Rate for Payer: Aetna Medicare Advantage	$39.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.98
Rate for Payer: Cigna Commercial	$66.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.98
Rate for Payer: Oxford Commercial	$26.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.99
Rate for Payer: UnitedHealthcare Commercial	$26.65
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.53

TELEHEALTH FACILITY FEE

Facility

$133.25

Service Code	HCPCS Q3014
Hospital Charge Code	4855Q3014
Hospital Revenue Code	780
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$66.62
Rate for Payer: Aetna Commercial	$50.63
Rate for Payer: Aetna Medicare Advantage	$39.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.98
Rate for Payer: Cigna Commercial	$66.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.98
Rate for Payer: Oxford Commercial	$26.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.99
Rate for Payer: UnitedHealthcare Commercial	$26.65
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.53

TELEHEALTH FACILITY FEE

Facility

$133.25

Service Code	HCPCS Q3014
Hospital Charge Code	4855Q3014
Hospital Revenue Code	780
Min. Negotiated Rate	$19.99
Max. Negotiated Rate	$19.99
Rate for Payer: Qualcare PPO/HMO/WC	$19.99

Know your out-of-pocket cost for care.

All Charges