Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIMOLOL HCTZ TAB 10-25MG

Facility

$5.65

Hospital Charge Code	60628722
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

TIMOLOL MALEATE 0.5% 0.3ML OPT

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	606390577
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

TIMOLOL MALEATE 0.5% 0.3ML OPT

Facility

$27.00

Service Code	HCPCS C1713
Hospital Charge Code	606390577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

TIMOLOL MALEATE 2.5 ML

Facility

$74.90

Hospital Charge Code	6006597
Hospital Revenue Code	251
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$28.46
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.47
Rate for Payer: Oxford Commercial	$14.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$14.98
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

TIMOLOL MALEATE 2.5 ML

Facility

$74.90

Hospital Charge Code	6006597
Hospital Revenue Code	251
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

TIMOLOL OPH .25% 2.5ML

Facility

$64.00

Hospital Charge Code	6006118
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

TIMOLOL OPH .25% 2.5ML

Facility

$64.00

Hospital Charge Code	6006118
Hospital Revenue Code	251
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

TIMOLOL OPH .5% 2.5ML

Facility

$74.90

Hospital Charge Code	6006126
Hospital Revenue Code	251
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

TIMOLOL OPH .5% 2.5ML

Facility

$74.90

Hospital Charge Code	6006126
Hospital Revenue Code	251
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.45
Rate for Payer: Aetna Commercial	$28.46
Rate for Payer: Aetna Medicare Advantage	$22.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.10
Rate for Payer: Cigna Commercial	$37.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.47
Rate for Payer: Oxford Commercial	$14.98
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$14.98
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

TIMOLOL OPHTHALMIC 0.25% SOL

Facility

$100.50

Service Code	NDC 61314022605
Hospital Charge Code	60629863
Hospital Revenue Code	251
Min. Negotiated Rate	$15.07
Max. Negotiated Rate	$15.07
Rate for Payer: Qualcare PPO/HMO/WC	$15.07

TIMOLOL OPHTHALMIC 0.25% SOL

Facility

$100.50

Service Code	NDC 61314022605
Hospital Charge Code	60629863
Hospital Revenue Code	251
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$50.25
Rate for Payer: Aetna Commercial	$38.19
Rate for Payer: Aetna Medicare Advantage	$30.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.63
Rate for Payer: Cigna Commercial	$50.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.15
Rate for Payer: Oxford Commercial	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$15.07
Rate for Payer: UnitedHealthcare Commercial	$20.10
Rate for Payer: UnitedHealthcare Community & State	$2.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2.66

TIMOLOL OPHTHALMIC 0.5% SOLN

Facility

$113.90

Service Code	NDC 61314022705
Hospital Charge Code	6006142
Hospital Revenue Code	251
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$17.09
Rate for Payer: Qualcare PPO/HMO/WC	$17.09

TIMOLOL OPHTHALMIC 0.5% SOLN

Facility

$113.90

Service Code	NDC 61314022705
Hospital Charge Code	6006142
Hospital Revenue Code	251
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.95
Rate for Payer: Aetna Commercial	$43.28
Rate for Payer: Aetna Medicare Advantage	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.04
Rate for Payer: Cigna Commercial	$56.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.17
Rate for Payer: Oxford Commercial	$22.78
Rate for Payer: Qualcare PPO/HMO/WC	$17.09
Rate for Payer: UnitedHealthcare Commercial	$22.78
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

TIMOLOL OPHTHALMIC .25% GEL

Facility

$147.20

Hospital Charge Code	60629955
Hospital Revenue Code	250
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$73.60
Rate for Payer: Aetna Commercial	$55.94
Rate for Payer: Aetna Medicare Advantage	$44.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.54
Rate for Payer: Cigna Commercial	$73.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.16
Rate for Payer: Oxford Commercial	$29.44
Rate for Payer: Qualcare PPO/HMO/WC	$22.08
Rate for Payer: UnitedHealthcare Commercial	$29.44
Rate for Payer: UnitedHealthcare Community & State	$3.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

TIMOLOL OPHTHALMIC .25% GEL

Facility

$147.20

Hospital Charge Code	60629955
Hospital Revenue Code	250
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$22.08
Rate for Payer: Qualcare PPO/HMO/WC	$22.08

TIMOPTIC 0.25%/10ML

Facility

$150.00

Hospital Charge Code	60634033
Hospital Revenue Code	250
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

TIMOPTIC 0.25%/10ML

Facility

$150.00

Hospital Charge Code	60634033
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

TIMOPTIC 0.25%/5ML

Facility

$56.00

Hospital Charge Code	60634032
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

TIMOPTIC 0.25%/5ML

Facility

$56.00

Hospital Charge Code	60634032
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

TIMOPTIC 0.5%/5ML

Facility

$65.00

Hospital Charge Code	60634034
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$13.00
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

TIMOPTIC 0.5%/5ML

Facility

$65.00

Hospital Charge Code	60634034
Hospital Revenue Code	250
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

TINCTURE OF BENZOIN PREP SPRAY

Facility

$283.95

Service Code	NDC 40565011182
Hospital Charge Code	606390066
Hospital Revenue Code	250
Min. Negotiated Rate	$42.59
Max. Negotiated Rate	$42.59
Rate for Payer: Qualcare PPO/HMO/WC	$42.59

TINCTURE OF BENZOIN PREP SPRAY

Facility

$283.95

Service Code	NDC 40565011182
Hospital Charge Code	606390066
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$141.97
Rate for Payer: Aetna Commercial	$107.90
Rate for Payer: Aetna Medicare Advantage	$85.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.41
Rate for Payer: Cigna Commercial	$141.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.19
Rate for Payer: Oxford Commercial	$56.79
Rate for Payer: Qualcare PPO/HMO/WC	$42.59
Rate for Payer: UnitedHealthcare Commercial	$56.79
Rate for Payer: UnitedHealthcare Community & State	$6.84
Rate for Payer: Wellpoint Medicaid Managed Care	$7.52

TINED LEAD KIT - 120

Facility

$17,500.00

Hospital Charge Code	270702021
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

TINED LEAD KIT - 120

Facility

$17,500.00

Hospital Charge Code	270702021
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

Know your out-of-pocket cost for care.

All Charges