Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CARAFATE/1GM/TAB

Facility

$7.00

Hospital Charge Code	60632618
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CARAFATE SUSPENSION/GM/10

Facility

$13.00

Hospital Charge Code	60634926
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

CARAFATE SUSPENSION/GM/10

Facility

$13.00

Hospital Charge Code	60634926
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

CARBACHOL 0.01% OPHTH SOLN

Facility

$281.65

Hospital Charge Code	60628052
Hospital Revenue Code	250
Min. Negotiated Rate	$42.25
Max. Negotiated Rate	$42.25
Rate for Payer: Qualcare PPO/HMO/WC	$42.25

CARBACHOL 0.01% OPHTH SOLN

Facility

$281.65

Hospital Charge Code	60628052
Hospital Revenue Code	250
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.82
Rate for Payer: Aetna Commercial	$107.03
Rate for Payer: Aetna Medicare Advantage	$84.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.82
Rate for Payer: Cigna Commercial	$140.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$56.33
Rate for Payer: Qualcare PPO/HMO/WC	$42.25
Rate for Payer: UnitedHealthcare Commercial	$56.33
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

CARBACHOL 0.75% OPHTH SOLN

Facility

$192.85

Hospital Charge Code	60628053
Hospital Revenue Code	250
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

CARBACHOL 0.75% OPHTH SOLN

Facility

$192.85

Hospital Charge Code	60628053
Hospital Revenue Code	250
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$96.42
Rate for Payer: Aetna Commercial	$73.28
Rate for Payer: Aetna Medicare Advantage	$57.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.18
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.85
Rate for Payer: Oxford Commercial	$38.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$38.57
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

CARBACHOL 0PHT .01% 1.5ML

Facility

$229.80

Hospital Charge Code	6000889
Hospital Revenue Code	251
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$34.47
Rate for Payer: Qualcare PPO/HMO/WC	$34.47

CARBACHOL 0PHT .01% 1.5ML

Facility

$229.80

Hospital Charge Code	6000889
Hospital Revenue Code	251
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$114.90
Rate for Payer: Aetna Commercial	$87.32
Rate for Payer: Aetna Medicare Advantage	$68.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.60
Rate for Payer: Cigna Commercial	$114.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.94
Rate for Payer: Oxford Commercial	$45.96
Rate for Payer: Qualcare PPO/HMO/WC	$34.47
Rate for Payer: UnitedHealthcare Commercial	$45.96
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

CARBACHOL 1.5% OPHTH SOLN

Facility

$242.10

Hospital Charge Code	60628054
Hospital Revenue Code	250
Min. Negotiated Rate	$36.31
Max. Negotiated Rate	$36.31
Rate for Payer: Qualcare PPO/HMO/WC	$36.31

CARBACHOL 1.5% OPHTH SOLN

Facility

$242.10

Hospital Charge Code	60628054
Hospital Revenue Code	250
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$121.05
Rate for Payer: Aetna Commercial	$92.00
Rate for Payer: Aetna Medicare Advantage	$72.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.74
Rate for Payer: Cigna Commercial	$121.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.63
Rate for Payer: Oxford Commercial	$48.42
Rate for Payer: Qualcare PPO/HMO/WC	$36.31
Rate for Payer: UnitedHealthcare Commercial	$48.42
Rate for Payer: UnitedHealthcare Community & State	$5.83
Rate for Payer: Wellpoint Medicaid Managed Care	$6.42

CARBACHOL 3% OPHTH SOLN

Facility

$12.85

Hospital Charge Code	6000871
Hospital Revenue Code	251
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

CARBACHOL 3% OPHTH SOLN

Facility

$12.85

Hospital Charge Code	6000871
Hospital Revenue Code	251
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

CARBACHOL OPHT 1.5% 15ML

Facility

$125.45

Hospital Charge Code	6000863
Hospital Revenue Code	251
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$18.82

CARBACHOL OPHT 1.5% 15ML

Facility

$125.45

Hospital Charge Code	6000863
Hospital Revenue Code	251
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$62.73
Rate for Payer: Aetna Commercial	$47.67
Rate for Payer: Aetna Medicare Advantage	$37.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.99
Rate for Payer: Cigna Commercial	$62.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.63
Rate for Payer: Oxford Commercial	$25.09
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Commercial	$25.09
Rate for Payer: UnitedHealthcare Community & State	$3.02
Rate for Payer: Wellpoint Medicaid Managed Care	$3.32

CARBAMAZEPINE 100 MG/5 ML SUSP

Facility

$6.57

Service Code	NDC 51672404704
Hospital Charge Code	60628753
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna Medicare Advantage	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.68
Rate for Payer: Cigna Commercial	$3.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.97
Rate for Payer: Oxford Commercial	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$1.31
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

CARBAMAZEPINE 100 MG/5 ML SUSP

Facility

$6.57

Service Code	NDC 51672404704
Hospital Charge Code	60628753
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

CARBAMAZEPINE 100 MG CHEW TAB

Facility

$4.42

Service Code	NDC 51672404101
Hospital Charge Code	60627746
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$0.88
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

CARBAMAZEPINE 100 MG CHEW TAB

Facility

$4.42

Service Code	NDC 51672404101
Hospital Charge Code	60627746
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

CARBAMAZEPINE 200 MG TAB

Facility

$13.94

Service Code	NDC 78050905
Hospital Charge Code	6023162
Hospital Revenue Code	251
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

CARBAMAZEPINE 200 MG TAB

Facility

$13.94

Service Code	NDC 78050905
Hospital Charge Code	6023162
Hospital Revenue Code	251
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.09

CARBAMAZEPINE FREE,LC/MS/MS

Facility

$90.30

Service Code	HCPCS 80157
Hospital Charge Code	3970738
Hospital Revenue Code	306
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.83
Rate for Payer: Cigna Commercial	$45.15
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.54
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.39

CARBAMAZEPINE FREE,LC/MS/MS

Facility

$90.30

Service Code	HCPCS 80157
Hospital Charge Code	3970738
Hospital Revenue Code	306
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$13.54
Rate for Payer: Qualcare PPO/HMO/WC	$13.54

CARBAMAZEPINE (TEGRETOL)

Facility

$339.00

Service Code	HCPCS 80156
Hospital Charge Code	38472158
Hospital Revenue Code	301
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$50.85
Rate for Payer: Qualcare PPO/HMO/WC	$50.85

CARBAMAZEPINE (TEGRETOL)

Facility

$339.00

Service Code	HCPCS 80156
Hospital Charge Code	38472158
Hospital Revenue Code	301
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$169.50
Rate for Payer: Aetna Commercial	$39.63
Rate for Payer: Aetna Medicare Advantage	$47.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.59
Rate for Payer: Cigna Commercial	$169.50
Rate for Payer: Cigna Medicare Advantage	$14.57
Rate for Payer: Clover Medicare Advantage	$13.84
Rate for Payer: EmblemHealth Commercial	$43.71
Rate for Payer: Humana Medicare Advantage	$15.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.57
Rate for Payer: Wellcare Medicare Advantage	$14.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.98

Know your out-of-pocket cost for care.

All Charges