Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CARBAMAZEPINE TEGRETOL

Facility

$390.00

Service Code	HCPCS 80156
Hospital Charge Code	3006376
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

CARBAMAZEPINE TEGRETOL

Facility

$390.00

Service Code	HCPCS 80156
Hospital Charge Code	3006376
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARBAMAZIPINE 100MG/5ML 450ML

Facility

$204.80

Hospital Charge Code	6009294
Hospital Revenue Code	251
Min. Negotiated Rate	$30.72
Max. Negotiated Rate	$30.72
Rate for Payer: Qualcare PPO/HMO/WC	$30.72

CARBAMAZIPINE 100MG/5ML 450ML

Facility

$204.80

Hospital Charge Code	6009294
Hospital Revenue Code	251
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$102.40
Rate for Payer: Aetna Commercial	$77.82
Rate for Payer: Aetna Medicare Advantage	$61.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.22
Rate for Payer: Cigna Commercial	$102.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.44
Rate for Payer: Oxford Commercial	$40.96
Rate for Payer: Qualcare PPO/HMO/WC	$30.72
Rate for Payer: UnitedHealthcare Commercial	$40.96
Rate for Payer: UnitedHealthcare Community & State	$4.94
Rate for Payer: Wellpoint Medicaid Managed Care	$5.43

CARBAMEZAPINE TAB 200MG

Facility

$1.95

Hospital Charge Code	6023253
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

CARBAMEZAPINE TAB 200MG

Facility

$1.95

Hospital Charge Code	6023253
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

CARBAMIDE PEROXIDE 15 ML SOL

Facility

$16.62

Service Code	NDC 904322035
Hospital Charge Code	60628085
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$2.49

CARBAMIDE PEROXIDE 15 ML SOL

Facility

$16.62

Service Code	NDC 904322035
Hospital Charge Code	60628085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.31
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: Aetna Medicare Advantage	$4.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.24
Rate for Payer: Cigna Commercial	$8.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.99
Rate for Payer: Oxford Commercial	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.49
Rate for Payer: UnitedHealthcare Commercial	$3.32
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

CARBAMIDE PEROX OTIC 6.5% 15ML

Facility

$34.60

Hospital Charge Code	6000897
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

CARBAMIDE PEROX OTIC 6.5% 15ML

Facility

$34.60

Hospital Charge Code	6000897
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

CARBENICIL OPH GTT 100MG/ML

Facility

$131.85

Hospital Charge Code	6000921
Hospital Revenue Code	251
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$65.92
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$39.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.62
Rate for Payer: Cigna Commercial	$65.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.55
Rate for Payer: Oxford Commercial	$26.37
Rate for Payer: Qualcare PPO/HMO/WC	$19.78
Rate for Payer: UnitedHealthcare Commercial	$26.37
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

CARBENICIL OPH GTT 100MG/ML

Facility

$131.85

Hospital Charge Code	6000921
Hospital Revenue Code	251
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.78

CARBENICIL OPH ITV 20MG/ML

Facility

$90.90

Hospital Charge Code	6000905
Hospital Revenue Code	251
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$45.45
Rate for Payer: Aetna Commercial	$34.54
Rate for Payer: Aetna Medicare Advantage	$27.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.18
Rate for Payer: Cigna Commercial	$45.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.27
Rate for Payer: Oxford Commercial	$18.18
Rate for Payer: Qualcare PPO/HMO/WC	$13.63
Rate for Payer: UnitedHealthcare Commercial	$18.18
Rate for Payer: UnitedHealthcare Community & State	$2.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

CARBENICIL OPH ITV 20MG/ML

Facility

$90.90

Hospital Charge Code	6000905
Hospital Revenue Code	251
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$13.63
Rate for Payer: Qualcare PPO/HMO/WC	$13.63

CARBENICIL OPH SBCNJ 400MG/ML

Facility

$227.85

Hospital Charge Code	6000913
Hospital Revenue Code	251
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$113.92
Rate for Payer: Aetna Commercial	$86.58
Rate for Payer: Aetna Medicare Advantage	$68.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.10
Rate for Payer: Cigna Commercial	$113.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.36
Rate for Payer: Oxford Commercial	$45.57
Rate for Payer: Qualcare PPO/HMO/WC	$34.18
Rate for Payer: UnitedHealthcare Commercial	$45.57
Rate for Payer: UnitedHealthcare Community & State	$5.49
Rate for Payer: Wellpoint Medicaid Managed Care	$6.04

CARBENICIL OPH SBCNJ 400MG/ML

Facility

$227.85

Hospital Charge Code	6000913
Hospital Revenue Code	251
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$34.18
Rate for Payer: Qualcare PPO/HMO/WC	$34.18

CARBETAP/CHLRPHEN/PHNYLE 60 ML

Facility

$929.65

Hospital Charge Code	60628961
Hospital Revenue Code	250
Min. Negotiated Rate	$139.45
Max. Negotiated Rate	$139.45
Rate for Payer: Qualcare PPO/HMO/WC	$139.45

CARBETAP/CHLRPHEN/PHNYLE 60 ML

Facility

$929.65

Hospital Charge Code	60628961
Hospital Revenue Code	250
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$464.82
Rate for Payer: Aetna Commercial	$353.27
Rate for Payer: Aetna Medicare Advantage	$278.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.06
Rate for Payer: Cigna Commercial	$464.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.89
Rate for Payer: Oxford Commercial	$185.93
Rate for Payer: Qualcare PPO/HMO/WC	$139.45
Rate for Payer: UnitedHealthcare Commercial	$185.93
Rate for Payer: UnitedHealthcare Community & State	$22.40
Rate for Payer: Wellpoint Medicaid Managed Care	$24.64

CARBIDE CUTTER BUR AM-52

Facility

$357.00

Hospital Charge Code	270335565
Hospital Revenue Code	272
Min. Negotiated Rate	$8.60
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$135.66
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.10
Rate for Payer: Oxford Commercial	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$53.55
Rate for Payer: UnitedHealthcare Commercial	$71.40
Rate for Payer: UnitedHealthcare Community & State	$8.60
Rate for Payer: Wellpoint Medicaid Managed Care	$9.46

CARBIDE CUTTER BUR AM-52

Facility

$357.00

Hospital Charge Code	270335565
Hospital Revenue Code	272
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

CARBIDE DRILL 3MM

Facility

$1,075.00

Hospital Charge Code	270690527
Hospital Revenue Code	272
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.50
Rate for Payer: Oxford Commercial	$215.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Commercial	$215.00
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

CARBIDE DRILL 3MM

Facility

$1,075.00

Hospital Charge Code	270690527
Hospital Revenue Code	272
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$161.25
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CARBIDOPA 25/LEVOD 100MG SATAB

Facility

$7.20

Hospital Charge Code	606350914
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna Commercial	$2.74
Rate for Payer: Aetna Medicare Advantage	$2.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.84
Rate for Payer: Cigna Commercial	$3.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.16
Rate for Payer: Oxford Commercial	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$1.44
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

CARBIDOPA 25/LEVOD 100MG SATAB

Facility

$7.20

Hospital Charge Code	606350914
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

CARBIDOPA/LEVODOPA 48.7-195MG

Facility

$54.35

Hospital Charge Code	606390046
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$8.15
Rate for Payer: Qualcare PPO/HMO/WC	$8.15

Know your out-of-pocket cost for care.

All Charges