Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TOPICAL SOL *******

Facility

$38.00

Hospital Charge Code	8001778
Hospital Revenue Code	279
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

TOPICAL THROMBIN VL 10,000U

Facility

$515.20

Hospital Charge Code	6006803
Hospital Revenue Code	250
Min. Negotiated Rate	$77.28
Max. Negotiated Rate	$77.28
Rate for Payer: Qualcare PPO/HMO/WC	$77.28

TOPICAL THROMBIN VL 10,000U

Facility

$515.20

Hospital Charge Code	6006803
Hospital Revenue Code	250
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$257.60
Rate for Payer: Aetna Commercial	$195.78
Rate for Payer: Aetna Medicare Advantage	$154.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.38
Rate for Payer: Cigna Commercial	$257.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.56
Rate for Payer: Oxford Commercial	$103.04
Rate for Payer: Qualcare PPO/HMO/WC	$77.28
Rate for Payer: UnitedHealthcare Commercial	$103.04
Rate for Payer: UnitedHealthcare Community & State	$12.42
Rate for Payer: Wellpoint Medicaid Managed Care	$13.65

TOPICORT 0.25%/15GM

Facility

$8.00

Hospital Charge Code	60634044
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

TOPICORT 0.25%/15GM

Facility

$8.00

Hospital Charge Code	60634044
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

TOPICORT 0.25%/60GM

Facility

$158.00

Hospital Charge Code	60634045
Hospital Revenue Code	250
Min. Negotiated Rate	$23.70
Max. Negotiated Rate	$23.70
Rate for Payer: Qualcare PPO/HMO/WC	$23.70

TOPICORT 0.25%/60GM

Facility

$158.00

Hospital Charge Code	60634045
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$79.00
Rate for Payer: Aetna Commercial	$60.04
Rate for Payer: Aetna Medicare Advantage	$47.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.29
Rate for Payer: Cigna Commercial	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.40
Rate for Payer: Oxford Commercial	$31.60
Rate for Payer: Qualcare PPO/HMO/WC	$23.70
Rate for Payer: UnitedHealthcare Commercial	$31.60
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

TOPIRAMATE

Facility

$390.00

Service Code	HCPCS 80201
Hospital Charge Code	39900012
Hospital Revenue Code	301
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.42
Rate for Payer: Aetna Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.03
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.92
Rate for Payer: Clover Medicare Advantage	$11.32
Rate for Payer: EmblemHealth Commercial	$35.76
Rate for Payer: Humana Medicare Advantage	$12.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.92
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	$9.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.92
Rate for Payer: Wellcare Medicare Advantage	$11.92
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TOPIRAMATE

Facility

$390.00

Service Code	HCPCS 80201
Hospital Charge Code	39900012
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TOPIRAMATE 200 MG TAB

Facility

$112.02

Service Code	NDC 50458064265
Hospital Charge Code	60629916
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

TOPIRAMATE 200 MG TAB

Facility

$112.02

Service Code	NDC 50458064265
Hospital Charge Code	60629916
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$56.01
Rate for Payer: Aetna Commercial	$42.57
Rate for Payer: Aetna Medicare Advantage	$33.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.57
Rate for Payer: Cigna Commercial	$56.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.61
Rate for Payer: Oxford Commercial	$22.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$22.40
Rate for Payer: UnitedHealthcare Community & State	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

TOPIRAMATE 25 MG TAB

Facility

$35.11

Service Code	NDC 50458063965
Hospital Charge Code	60628972
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$5.27

TOPIRAMATE 25 MG TAB

Facility

$35.11

Service Code	NDC 50458063965
Hospital Charge Code	60628972
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$17.55
Rate for Payer: Aetna Commercial	$13.34
Rate for Payer: Aetna Medicare Advantage	$10.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.95
Rate for Payer: Cigna Commercial	$17.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.53
Rate for Payer: Oxford Commercial	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$5.27
Rate for Payer: UnitedHealthcare Commercial	$7.02
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

TOPIRAMATE SERUM (TOPAMAX)

Facility

$128.00

Service Code	HCPCS 80201
Hospital Charge Code	3002583
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

TOPIRAMATE SERUM (TOPAMAX)

Facility

$128.00

Service Code	HCPCS 80201
Hospital Charge Code	3002583
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.42
Rate for Payer: Aetna Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.03
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$11.92
Rate for Payer: Clover Medicare Advantage	$11.32
Rate for Payer: EmblemHealth Commercial	$35.76
Rate for Payer: Humana Medicare Advantage	$12.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.92
Rate for Payer: Wellcare Medicare Advantage	$11.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

TOPIRAMATE (TOPAMAX) 100MF TAB

Facility

$40.47

Service Code	NDC 68462010960
Hospital Charge Code	60630146
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$20.23
Rate for Payer: Aetna Commercial	$15.38
Rate for Payer: Aetna Medicare Advantage	$12.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.32
Rate for Payer: Cigna Commercial	$20.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.14
Rate for Payer: Oxford Commercial	$8.09
Rate for Payer: Qualcare PPO/HMO/WC	$6.07
Rate for Payer: UnitedHealthcare Commercial	$8.09
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

TOPIRAMATE (TOPAMAX) 100MF TAB

Facility

$40.47

Service Code	NDC 68462010960
Hospital Charge Code	60630146
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$6.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.07

TOPIRAMATE (TOPAMAX) 50MG TAB

Facility

$29.61

Service Code	NDC 68462015360
Hospital Charge Code	60630145
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.80
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: Aetna Medicare Advantage	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.55
Rate for Payer: Cigna Commercial	$14.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: Oxford Commercial	$5.92
Rate for Payer: Qualcare PPO/HMO/WC	$4.44
Rate for Payer: UnitedHealthcare Commercial	$5.92
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

TOPIRAMATE (TOPAMAX) 50MG TAB

Facility

$29.61

Service Code	NDC 68462015360
Hospital Charge Code	60630145
Hospital Revenue Code	250
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$4.44
Rate for Payer: Qualcare PPO/HMO/WC	$4.44

TOPOTECAN HCL INJ 4MG

Facility

$2,073.00

Hospital Charge Code	6017024
Hospital Revenue Code	636
Min. Negotiated Rate	$49.96
Max. Negotiated Rate	$1,036.50
Rate for Payer: Aetna Commercial	$787.74
Rate for Payer: Aetna Medicare Advantage	$621.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$528.62
Rate for Payer: Cigna Commercial	$1,036.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$501.67
Rate for Payer: Qualcare PPO/HMO/WC	$310.95
Rate for Payer: UnitedHealthcare Community & State	$49.96
Rate for Payer: Wellpoint Medicaid Managed Care	$54.93

TOPOTECAN HCL INJ 4MG

Facility

$2,073.00

Hospital Charge Code	6017024
Hospital Revenue Code	636
Min. Negotiated Rate	$310.95
Max. Negotiated Rate	$501.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$501.67
Rate for Payer: Qualcare PPO/HMO/WC	$310.95

TOPROL-XL 100MG TAB

Facility

$7.00

Hospital Charge Code	60635167
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

TOPROL-XL 100MG TAB

Facility

$7.00

Hospital Charge Code	60635167
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

TOPROL XL 200MG

Facility

$16.88

Service Code	NDC 70347020002
Hospital Charge Code	60635251
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

TOPROL XL 200MG

Facility

$16.88

Service Code	NDC 70347020002
Hospital Charge Code	60635251
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.06
Rate for Payer: Oxford Commercial	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.38
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

Know your out-of-pocket cost for care.

All Charges