Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FENOFIBRATE 145MG TAB

Facility

$32.23

Service Code	NDC 54569575002
Hospital Charge Code	60632250
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$4.83

FENOFIBRATE 48 MG TAB

Facility

$8.05

Hospital Charge Code	60629850
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

FENOFIBRATE 48 MG TAB

Facility

$8.05

Hospital Charge Code	60629850
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.03
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.42
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

FENOFIBRATE 48MG TAB

Facility

$17.49

Service Code	NDC 54868522400
Hospital Charge Code	60632251
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.74
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Aetna Medicare Advantage	$5.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.46
Rate for Payer: Cigna Commercial	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.25
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.62
Rate for Payer: UnitedHealthcare Commercial	$3.50
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

FENOFIBRATE 48MG TAB

Facility

$17.49

Service Code	NDC 54868522400
Hospital Charge Code	60632251
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

FENOFIBRATE 67 MG CAP

Facility

$5.65

Hospital Charge Code	60628967
Hospital Revenue Code	252
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

FENOFIBRATE 67 MG CAP

Facility

$5.65

Hospital Charge Code	60628967
Hospital Revenue Code	252
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

FENO SAMPLING

Facility

$203.74

Service Code	HCPCS 95012
Hospital Charge Code	95090387
Hospital Revenue Code	460
Min. Negotiated Rate	$30.56
Max. Negotiated Rate	$30.56
Rate for Payer: Qualcare PPO/HMO/WC	$30.56

FENO SAMPLING

Facility

$203.74

Service Code	HCPCS 95012
Hospital Charge Code	95090387
Hospital Revenue Code	460
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.16
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.12
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.56
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$4.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.40

FENT2MCG/BIPUV 0.125%100

Facility

$54.00

Hospital Charge Code	60635864
Hospital Revenue Code	258
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.20
Rate for Payer: Oxford Commercial	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

FENT2MCG/BIPUV 0.125%100

Facility

$54.00

Hospital Charge Code	60635864
Hospital Revenue Code	258
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

FENT2MCG/BIPUV 0.125%250

Facility

$68.00

Hospital Charge Code	60635865
Hospital Revenue Code	258
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$34.00
Rate for Payer: Aetna Commercial	$25.84
Rate for Payer: Aetna Medicare Advantage	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.34
Rate for Payer: Cigna Commercial	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.40
Rate for Payer: Oxford Commercial	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.20
Rate for Payer: UnitedHealthcare Commercial	$13.60
Rate for Payer: UnitedHealthcare Community & State	$1.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

FENT2MCG/BIPUV 0.125%250

Facility

$68.00

Hospital Charge Code	60635865
Hospital Revenue Code	258
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.20

FENT500

Facility

$6.00

Hospital Charge Code	60635714
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

FENT500

Facility

$6.00

Hospital Charge Code	60635714
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

FENTANYL

Facility

$47.35

Hospital Charge Code	270656756
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

FENTANYL

Facility

$47.35

Hospital Charge Code	270656756
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$9.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$9.47
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

FENTANYL 0.10 MG/2ML INJ

Facility

$12.86

Service Code	HCPCS J3010
Hospital Charge Code	60627708
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.43
Rate for Payer: Aetna Commercial	$4.89
Rate for Payer: Aetna Medicare Advantage	$3.86
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	$6.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

FENTANYL 0.10 MG/2ML INJ

Facility

$12.86

Service Code	HCPCS J3010
Hospital Charge Code	60627708
Hospital Revenue Code	636
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$3.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

FENTANYL 100MCG/HR

Facility

$19.00

Hospital Charge Code	6012009
Hospital Revenue Code	251
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

FENTANYL 100MCG/HR

Facility

$19.00

Hospital Charge Code	6012009
Hospital Revenue Code	251
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

FENTANYL 100 MCG/HR TRANSDERM

Facility

$985.44

Service Code	NDC 50458010605
Hospital Charge Code	60627704
Hospital Revenue Code	250
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$492.72
Rate for Payer: Aetna Commercial	$374.47
Rate for Payer: Aetna Medicare Advantage	$295.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.29
Rate for Payer: Cigna Commercial	$492.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.63
Rate for Payer: Oxford Commercial	$197.09
Rate for Payer: Qualcare PPO/HMO/WC	$147.82
Rate for Payer: UnitedHealthcare Commercial	$197.09
Rate for Payer: UnitedHealthcare Community & State	$23.75
Rate for Payer: Wellpoint Medicaid Managed Care	$26.11

FENTANYL 100 MCG/HR TRANSDERM

Facility

$985.44

Service Code	NDC 50458010605
Hospital Charge Code	60627704
Hospital Revenue Code	250
Min. Negotiated Rate	$147.82
Max. Negotiated Rate	$147.82
Rate for Payer: Qualcare PPO/HMO/WC	$147.82

FENTANYL 2500MG/50ML VIAL

Facility

$4.00

Service Code	HCPCS J3010
Hospital Charge Code	60635772
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FENTANYL 2500MG/50ML VIAL

Facility

$4.00

Service Code	HCPCS J3010
Hospital Charge Code	60635772
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges