Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TELETX ISODOSE PLAN INTERMED-T

Facility

$219.75

Service Code	HCPCS 77310TC
Hospital Charge Code	85000495
Hospital Revenue Code	333
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$83.50
Rate for Payer: Aetna Medicare Advantage	$65.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.04
Rate for Payer: Cigna Commercial	$109.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.92
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.96
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$5.82

TELETX ISODOSE PLAN SIMPLE-GL

Facility

$711.65

Service Code	HCPCS 77305
Hospital Charge Code	85000475
Hospital Revenue Code	333
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$270.43
Rate for Payer: Aetna Medicare Advantage	$213.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.47
Rate for Payer: Cigna Commercial	$355.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.50
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.75
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$17.15
Rate for Payer: Wellpoint Medicaid Managed Care	$18.86

TELETX ISODOSE PLAN SIMPLE-GL

Facility

$711.65

Service Code	HCPCS 77305
Hospital Charge Code	85000475
Hospital Revenue Code	333
Min. Negotiated Rate	$106.75
Max. Negotiated Rate	$106.75
Rate for Payer: Qualcare PPO/HMO/WC	$106.75

TELETX ISODOSE PLAN SIMPLE-PC

Facility

$186.20

Service Code	HCPCS 7730526
Hospital Charge Code	85000485
Hospital Revenue Code	333
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$70.76
Rate for Payer: Aetna Medicare Advantage	$55.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.48
Rate for Payer: Cigna Commercial	$93.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.86
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.93
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

TELETX ISODOSE PLAN SIMPLE-PC

Facility

$186.20

Service Code	HCPCS 7730526
Hospital Charge Code	85000485
Hospital Revenue Code	333
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$27.93
Rate for Payer: Qualcare PPO/HMO/WC	$27.93

TELETX ISODOSE PLAN SIMPLE-TC

Facility

$165.25

Service Code	HCPCS 77305TC
Hospital Charge Code	85000480
Hospital Revenue Code	333
Min. Negotiated Rate	$24.79
Max. Negotiated Rate	$24.79
Rate for Payer: Qualcare PPO/HMO/WC	$24.79

TELETX ISODOSE PLAN SIMPLE-TC

Facility

$165.25

Service Code	HCPCS 77305TC
Hospital Charge Code	85000480
Hospital Revenue Code	333
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$62.80
Rate for Payer: Aetna Medicare Advantage	$49.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.14
Rate for Payer: Cigna Commercial	$82.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.58
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.79
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.38

TELFA 2 X 2 PER ***********

Facility

$9.00

Hospital Charge Code	8001745
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

TELFA 2 X 2 PER ***********

Facility

$9.00

Hospital Charge Code	8001745
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TELFA 2 X 3

Facility

$2.45

Hospital Charge Code	270350035
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

TELFA 2 X 3

Facility

$2.45

Hospital Charge Code	270350035
Hospital Revenue Code	272
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

TELFA 3X4 EA

Facility

$5.00

Hospital Charge Code	270350045
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TELFA 3X4 EA

Facility

$5.00

Hospital Charge Code	270350045
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TELFA 3 X 4 PER *************

Facility

$9.00

Hospital Charge Code	8001752
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

TELFA 3 X 4 PER *************

Facility

$9.00

Hospital Charge Code	8001752
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

TELFA 3 X 8 PER ************

Facility

$11.00

Hospital Charge Code	8001760
Hospital Revenue Code	279
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

TELFA 3 X 8 PER ************

Facility

$11.00

Hospital Charge Code	8001760
Hospital Revenue Code	279
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

TELMISARTAN 40 MG TAB

Facility

$9.55

Hospital Charge Code	60629883
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$3.63
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$1.91
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.91
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

TELMISARTAN 40 MG TAB

Facility

$9.55

Hospital Charge Code	60629883
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

TELMISARTAN 80 MG TAB

Facility

$9.25

Hospital Charge Code	60629882
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.39

TELMISARTAN 80 MG TAB

Facility

$9.25

Hospital Charge Code	60629882
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.62
Rate for Payer: Aetna Commercial	$3.52
Rate for Payer: Aetna Medicare Advantage	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.36
Rate for Payer: Cigna Commercial	$4.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.77
Rate for Payer: Oxford Commercial	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.39
Rate for Payer: UnitedHealthcare Commercial	$1.85
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

TEMARIL/5MG/CAP

Facility

$6.00

Hospital Charge Code	60633977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

TEMARIL/5MG/CAP

Facility

$6.00

Hospital Charge Code	60633977
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

TEMAZEPAM 15MG

Facility

$1.95

Hospital Charge Code	6021166
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

TEMAZEPAM 15MG

Facility

$1.95

Hospital Charge Code	6021166
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

Know your out-of-pocket cost for care.

All Charges