Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TEMAZEPAM 15 MG CAP

Facility

$4.76

Service Code	NDC 51079041821
Hospital Charge Code	60627851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$1.81
Rate for Payer: Aetna Medicare Advantage	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.21
Rate for Payer: Cigna Commercial	$2.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.43
Rate for Payer: Oxford Commercial	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.71
Rate for Payer: UnitedHealthcare Commercial	$0.95
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TEMAZEPAM 15 MG CAP

Facility

$4.76

Service Code	NDC 51079041821
Hospital Charge Code	60627851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.71

TEMAZEPAM/15MG/CAP

Facility

$3.00

Hospital Charge Code	60633979
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEMAZEPAM/15MG/CAP

Facility

$3.00

Hospital Charge Code	60633979
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

TEMAZEPAM/30MG/CAP

Facility

$5.56

Service Code	NDC 51079041920
Hospital Charge Code	60633978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna Commercial	$2.11
Rate for Payer: Aetna Medicare Advantage	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.42
Rate for Payer: Cigna Commercial	$2.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.67
Rate for Payer: Oxford Commercial	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$1.11
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

TEMAZEPAM/30MG/CAP

Facility

$5.56

Service Code	NDC 51079041920
Hospital Charge Code	60633978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

TEMAZEPAM/30MG/CAP

Facility

$3.00

Hospital Charge Code	60633980
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

TEMAZEPAM/30MG/CAP

Facility

$3.00

Hospital Charge Code	60633980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

TEMAZEPAM 7.5 MG CAP

Facility

$49.70

Hospital Charge Code	60629846
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$24.85
Rate for Payer: Aetna Commercial	$18.89
Rate for Payer: Aetna Medicare Advantage	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.67
Rate for Payer: Cigna Commercial	$24.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.91
Rate for Payer: Oxford Commercial	$9.94
Rate for Payer: Qualcare PPO/HMO/WC	$7.46
Rate for Payer: UnitedHealthcare Commercial	$9.94
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

TEMAZEPAM 7.5 MG CAP

Facility

$49.70

Hospital Charge Code	60629846
Hospital Revenue Code	250
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$7.46
Rate for Payer: Qualcare PPO/HMO/WC	$7.46

TEMAZEPAM (RESTORIL)

Facility

$324.00

Service Code	HCPCS 80346
Hospital Charge Code	38472751
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

TEMAZEPAM (RESTORIL)

Facility

$324.00

Service Code	HCPCS 80346
Hospital Charge Code	38472751
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

TEMNO COAXIAL BIO NDLE22GX15CM

Facility

$48.23

Hospital Charge Code	270657364
Hospital Revenue Code	272
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$7.23
Rate for Payer: Qualcare PPO/HMO/WC	$7.23

TEMNO COAXIAL BIO NDLE22GX15CM

Facility

$48.23

Hospital Charge Code	270657364
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.11
Rate for Payer: Aetna Commercial	$18.33
Rate for Payer: Aetna Medicare Advantage	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.30
Rate for Payer: Cigna Commercial	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.47
Rate for Payer: Oxford Commercial	$9.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.23
Rate for Payer: UnitedHealthcare Commercial	$9.65
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.28

TEMNO COAXIAL BIO NDLE22GX15CM

Facility

$241.13

Hospital Charge Code	270657364R
Hospital Revenue Code	272
Min. Negotiated Rate	$36.17
Max. Negotiated Rate	$36.17
Rate for Payer: Qualcare PPO/HMO/WC	$36.17

TEMNO COAXIAL BIO NDLE22GX15CM

Facility

$241.13

Hospital Charge Code	270657364R
Hospital Revenue Code	272
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$120.56
Rate for Payer: Aetna Commercial	$91.63
Rate for Payer: Aetna Medicare Advantage	$72.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.49
Rate for Payer: Cigna Commercial	$120.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.34
Rate for Payer: Oxford Commercial	$48.23
Rate for Payer: Qualcare PPO/HMO/WC	$36.17
Rate for Payer: UnitedHealthcare Commercial	$48.23
Rate for Payer: UnitedHealthcare Community & State	$5.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

TEMNO COXIAL BIO NDLE 22GX11CM

Facility

$46.44

Hospital Charge Code	270655044
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.22
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.93
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

TEMNO COXIAL BIO NDLE 22GX11CM

Facility

$46.44

Hospital Charge Code	270655044
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

TEMNO COXIAL BIO NDLE 22GX11CM

Facility

$46.44

Hospital Charge Code	270655044R
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.22
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.93
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

TEMNO COXIAL BIO NDLE 22GX11CM

Facility

$46.44

Hospital Charge Code	270655044R
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

TEMODAR 250 MG CAP

Facility

$1,999.00

Hospital Charge Code	60635594
Hospital Revenue Code	636
Min. Negotiated Rate	$299.85
Max. Negotiated Rate	$483.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.76
Rate for Payer: Qualcare PPO/HMO/WC	$299.85

TEMODAR 250 MG CAP

Facility

$1,999.00

Hospital Charge Code	60635594
Hospital Revenue Code	636
Min. Negotiated Rate	$48.18
Max. Negotiated Rate	$999.50
Rate for Payer: Aetna Commercial	$759.62
Rate for Payer: Aetna Medicare Advantage	$599.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$509.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$509.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$509.75
Rate for Payer: Cigna Commercial	$999.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.76
Rate for Payer: Qualcare PPO/HMO/WC	$299.85
Rate for Payer: UnitedHealthcare Community & State	$48.18
Rate for Payer: Wellpoint Medicaid Managed Care	$52.97

TEMOVATE 0.05%/15GM

Facility

$107.00

Hospital Charge Code	60633981
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

TEMOVATE 0.05%/15GM

Facility

$107.00

Hospital Charge Code	60633982
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

TEMOVATE 0.05%/15GM

Facility

$107.00

Hospital Charge Code	60633982
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$53.50
Rate for Payer: Aetna Commercial	$40.66
Rate for Payer: Aetna Medicare Advantage	$32.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.29
Rate for Payer: Cigna Commercial	$53.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.10
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.05
Rate for Payer: UnitedHealthcare Commercial	$21.40
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

Know your out-of-pocket cost for care.

All Charges