Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUAD TRI 0.5 ML 2024-25

Facility

$0.01

Service Code	HCPCS 90653
Hospital Charge Code	606390626
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

FLUARIX 0.5ML 2024-25

Facility

$0.01

Service Code	HCPCS 90656
Hospital Charge Code	606390625
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUARIX 0.5ML 2024-25

Facility

$0.01

Service Code	HCPCS 90656
Hospital Charge Code	606390625
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

FLUARIX PF 0.5ML>6MO 2023-2024

Facility

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	606390525
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUARIX PF 0.5ML>6MO 2023-2024

Facility

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	606390525
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

FLUARIX QUAD PF .5ML 2022-23

Facility

$107.55

Service Code	HCPCS 90686
Hospital Charge Code	412390686B
Hospital Revenue Code	636
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$53.77
Rate for Payer: Aetna Commercial	$40.87
Rate for Payer: Aetna Medicare Advantage	$32.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.43
Rate for Payer: Cigna Commercial	$53.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.03
Rate for Payer: Qualcare PPO/HMO/WC	$16.13
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.85

FLUARIX QUAD PF .5ML 2022-23

Facility

$107.55

Service Code	HCPCS 90686
Hospital Charge Code	412390686B
Hospital Revenue Code	636
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$26.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.03
Rate for Payer: Qualcare PPO/HMO/WC	$16.13

FLUCELVAX PFSTRI 0.5MLSYR24-25

Facility

$0.01

Service Code	HCPCS 90661
Hospital Charge Code	606390627
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

FLUCELVAX PFSTRI 0.5MLSYR24-25

Facility

$0.01

Service Code	HCPCS 90661
Hospital Charge Code	606390627
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

FLUCELVAX TRIVALENT 0.5ML

Facility

$132.79

Service Code	NDC 70461065404
Hospital Charge Code	6063943393
Hospital Revenue Code	250
Min. Negotiated Rate	$19.92
Max. Negotiated Rate	$19.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.92

FLUCELVAX TRIVALENT 0.5ML

Facility

$132.79

Service Code	NDC 70461065404
Hospital Charge Code	6063943393
Hospital Revenue Code	250
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$66.39
Rate for Payer: Aetna Commercial	$50.46
Rate for Payer: Aetna Medicare Advantage	$39.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.86
Rate for Payer: Cigna Commercial	$66.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.84
Rate for Payer: Oxford Commercial	$26.56
Rate for Payer: Qualcare PPO/HMO/WC	$19.92
Rate for Payer: UnitedHealthcare Commercial	$26.56
Rate for Payer: UnitedHealthcare Community & State	$3.20
Rate for Payer: Wellpoint Medicaid Managed Care	$3.52

FLUCONAZOLE 100 MG TAB

Facility

$58.49

Service Code	NDC 49342041
Hospital Charge Code	6008478
Hospital Revenue Code	250
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

FLUCONAZOLE 100 MG TAB

Facility

$58.49

Service Code	NDC 49342041
Hospital Charge Code	6008478
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Commercial	$22.23
Rate for Payer: Aetna Medicare Advantage	$17.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.91
Rate for Payer: Cigna Commercial	$29.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.55
Rate for Payer: Oxford Commercial	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.77
Rate for Payer: UnitedHealthcare Commercial	$11.70
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

FLUCONAZOLE 150MG TAB

Facility

$261.84

Service Code	NDC 49350079
Hospital Charge Code	6063943110
Hospital Revenue Code	250
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$130.92
Rate for Payer: Aetna Commercial	$99.50
Rate for Payer: Aetna Medicare Advantage	$78.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.77
Rate for Payer: Cigna Commercial	$130.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.55
Rate for Payer: Oxford Commercial	$52.37
Rate for Payer: Qualcare PPO/HMO/WC	$39.28
Rate for Payer: UnitedHealthcare Commercial	$52.37
Rate for Payer: UnitedHealthcare Community & State	$6.31
Rate for Payer: Wellpoint Medicaid Managed Care	$6.94

FLUCONAZOLE 150MG TAB

Facility

$261.84

Service Code	NDC 49350079
Hospital Charge Code	6063943110
Hospital Revenue Code	250
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$39.28
Rate for Payer: Qualcare PPO/HMO/WC	$39.28

FLUCONAZOLE 200 MG TAB

Facility

$81.27

Service Code	NDC 49343030
Hospital Charge Code	6008486
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$40.63
Rate for Payer: Aetna Commercial	$30.88
Rate for Payer: Aetna Medicare Advantage	$24.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$40.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.38
Rate for Payer: Oxford Commercial	$16.25
Rate for Payer: Qualcare PPO/HMO/WC	$12.19
Rate for Payer: UnitedHealthcare Commercial	$16.25
Rate for Payer: UnitedHealthcare Community & State	$1.96
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

FLUCONAZOLE 200 MG TAB

Facility

$81.27

Service Code	NDC 49343030
Hospital Charge Code	6008486
Hospital Revenue Code	250
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$12.19

FLUCONAZOLE 50 MG TAB

Facility

$104.72

Service Code	NDC 49341030
Hospital Charge Code	60627245
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$52.36
Rate for Payer: Aetna Commercial	$39.79
Rate for Payer: Aetna Medicare Advantage	$31.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.70
Rate for Payer: Cigna Commercial	$52.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.42
Rate for Payer: Oxford Commercial	$20.94
Rate for Payer: Qualcare PPO/HMO/WC	$15.71
Rate for Payer: UnitedHealthcare Commercial	$20.94
Rate for Payer: UnitedHealthcare Community & State	$2.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

FLUCONAZOLE 50 MG TAB

Facility

$104.72

Service Code	NDC 49341030
Hospital Charge Code	60627245
Hospital Revenue Code	250
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$15.71
Rate for Payer: Qualcare PPO/HMO/WC	$15.71

FLUCONAZOLE 50MG TABLET

Facility

$0.25

Hospital Charge Code	60635743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.04

FLUCONAZOLE 50MG TABLET

Facility

$0.25

Hospital Charge Code	60635743
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.13
Rate for Payer: Aetna Commercial	$0.10
Rate for Payer: Aetna Medicare Advantage	$0.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.06
Rate for Payer: Cigna Commercial	$0.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.08
Rate for Payer: Oxford Commercial	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.04
Rate for Payer: UnitedHealthcare Commercial	$0.05
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

FLUCONAZOLE IV 200 MG/100ML NS

Facility

$137.62

Service Code	HCPCS J1450
Hospital Charge Code	6008494
Hospital Revenue Code	636
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$33.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$20.64

FLUCONAZOLE IV 200 MG/100ML NS

Facility

$137.62

Service Code	HCPCS J1450
Hospital Charge Code	6008494
Hospital Revenue Code	636
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$68.81
Rate for Payer: Aetna Commercial	$52.30
Rate for Payer: Aetna Medicare Advantage	$41.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.09
Rate for Payer: Cigna Commercial	$68.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$20.64
Rate for Payer: UnitedHealthcare Community & State	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$3.65

FLUCONAZOLE SSP 200MG/5ML 35ML

Facility

$681.00

Hospital Charge Code	60629101
Hospital Revenue Code	250
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$340.50
Rate for Payer: Aetna Commercial	$258.78
Rate for Payer: Aetna Medicare Advantage	$204.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.66
Rate for Payer: Cigna Commercial	$340.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.30
Rate for Payer: Oxford Commercial	$136.20
Rate for Payer: Qualcare PPO/HMO/WC	$102.15
Rate for Payer: UnitedHealthcare Commercial	$136.20
Rate for Payer: UnitedHealthcare Community & State	$16.41
Rate for Payer: Wellpoint Medicaid Managed Care	$18.05

FLUCONAZOLE SSP 200MG/5ML 35ML

Facility

$681.00

Hospital Charge Code	60629101
Hospital Revenue Code	250
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$102.15
Rate for Payer: Qualcare PPO/HMO/WC	$102.15

Know your out-of-pocket cost for care.

All Charges