Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLECAINIDE***

Facility

$28.00

Hospital Charge Code	3010923
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

FLECAINIDE 100MG TAB

Facility

$8.52

Hospital Charge Code	60635781
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.26
Rate for Payer: Aetna Commercial	$3.24
Rate for Payer: Aetna Medicare Advantage	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.17
Rate for Payer: Cigna Commercial	$4.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.56
Rate for Payer: Oxford Commercial	$1.70
Rate for Payer: Qualcare PPO/HMO/WC	$1.28
Rate for Payer: UnitedHealthcare Commercial	$1.70
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

FLECAINIDE 100MG TAB

Facility

$8.52

Hospital Charge Code	60635781
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Qualcare PPO/HMO/WC	$1.28

FLECAINIDE ACETATE

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472670
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

FLECAINIDE ACETATE

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472670
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

FLEET CASTOR OIL LAXATIVE

Facility

$5.00

Hospital Charge Code	60634770
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

FLEET CASTOR OIL LAXATIVE

Facility

$5.00

Hospital Charge Code	60634770
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

FLEET ENEMA

Facility

$13.20

Service Code	NDC 132020140
Hospital Charge Code	60628138
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.96
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

FLEET ENEMA

Facility

$13.20

Service Code	NDC 132020140
Hospital Charge Code	60628138
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

FLEET ENEMA (PED )

Facility

$16.42

Service Code	NDC 132020220
Hospital Charge Code	60628750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.21
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: Aetna Medicare Advantage	$4.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.19
Rate for Payer: Cigna Commercial	$8.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.93
Rate for Payer: Oxford Commercial	$3.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.46
Rate for Payer: UnitedHealthcare Commercial	$3.28
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

FLEET ENEMA (PED )

Facility

$16.42

Service Code	NDC 132020220
Hospital Charge Code	60628750
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.46

FLEET PEDIATRIC/66.6ML

Facility

$6.00

Hospital Charge Code	60632994
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

FLEET PEDIATRIC/66.6ML

Facility

$6.00

Hospital Charge Code	60632994
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

FLEET PHOSPHO-SODA 45ML

Facility

$15.00

Hospital Charge Code	60635638
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

FLEET PHOSPHO-SODA 45ML

Facility

$15.00

Hospital Charge Code	60635638
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

FLEET PHOSPHO SODA 90ML

Facility

$18.00

Hospital Charge Code	60634769
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

FLEET PHOSPHO SODA 90ML

Facility

$18.00

Hospital Charge Code	60634769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

FLEXBAND DYNAMIC MATRIX

Facility

$16,150.00

Service Code	HCPCS C1889
Hospital Charge Code	270704270
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.50
Max. Negotiated Rate	$3,908.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,908.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,553.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.50

FLEXBAND DYNAMIC MATRIX

Facility

$16,150.00

Service Code	HCPCS C1889
Hospital Charge Code	270704270
Hospital Revenue Code	278
Min. Negotiated Rate	$389.21
Max. Negotiated Rate	$8,075.00
Rate for Payer: Aetna Commercial	$6,137.00
Rate for Payer: Aetna Medicare Advantage	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,118.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,118.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,118.25
Rate for Payer: Cigna Commercial	$8,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,908.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,553.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.50
Rate for Payer: UnitedHealthcare Community & State	$389.21
Rate for Payer: Wellpoint Medicaid Managed Care	$427.98

FLEXBAND DYNAMIC MATRIX 0.5X8C

Facility

$15,238.90

Service Code	HCPCS C1713
Hospital Charge Code	270704739
Hospital Revenue Code	278
Min. Negotiated Rate	$2,285.84
Max. Negotiated Rate	$3,687.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,047.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,687.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,352.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,285.84

FLEXBAND DYNAMIC MATRIX 0.5X8C

Facility

$15,238.90

Service Code	HCPCS C1713
Hospital Charge Code	270704739
Hospital Revenue Code	278
Min. Negotiated Rate	$367.26
Max. Negotiated Rate	$7,619.45
Rate for Payer: Aetna Commercial	$5,790.78
Rate for Payer: Aetna Medicare Advantage	$4,571.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,885.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,885.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,047.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,885.92
Rate for Payer: Cigna Commercial	$7,619.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,687.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,352.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,285.84
Rate for Payer: UnitedHealthcare Community & State	$367.26
Rate for Payer: Wellpoint Medicaid Managed Care	$403.83

FLEXBAND PLUS MATRIX GFT .3X16

Facility

$15,930.00

Service Code	HCPCS C1763
Hospital Charge Code	270700040
Hospital Revenue Code	278
Min. Negotiated Rate	$383.91
Max. Negotiated Rate	$7,965.00
Rate for Payer: Aetna Commercial	$6,053.40
Rate for Payer: Aetna Medicare Advantage	$4,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,062.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,062.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,186.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,062.15
Rate for Payer: Cigna Commercial	$7,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,855.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,504.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,389.50
Rate for Payer: UnitedHealthcare Community & State	$383.91
Rate for Payer: Wellpoint Medicaid Managed Care	$422.14

FLEXBAND PLUS MATRIX GFT .3X16

Facility

$15,930.00

Service Code	HCPCS C1763
Hospital Charge Code	270700040
Hospital Revenue Code	278
Min. Negotiated Rate	$2,389.50
Max. Negotiated Rate	$3,855.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,855.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,504.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,389.50

FLEXBAND TWIST.12

Facility

$26,101.25

Service Code	HCPCS C1713
Hospital Charge Code	270705115
Hospital Revenue Code	278
Min. Negotiated Rate	$629.04
Max. Negotiated Rate	$13,050.62
Rate for Payer: Aetna Commercial	$9,918.48
Rate for Payer: Aetna Medicare Advantage	$7,830.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,655.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,655.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,220.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,655.82
Rate for Payer: Cigna Commercial	$13,050.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,316.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,742.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,915.19
Rate for Payer: UnitedHealthcare Community & State	$629.04
Rate for Payer: Wellpoint Medicaid Managed Care	$691.68

FLEXBAND TWIST.12

Facility

$26,101.25

Service Code	HCPCS C1713
Hospital Charge Code	270705115
Hospital Revenue Code	278
Min. Negotiated Rate	$3,915.19
Max. Negotiated Rate	$6,316.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,220.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,316.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,742.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,915.19

Know your out-of-pocket cost for care.

All Charges