Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUCYTOSINE 250MG CAPSULE

Facility

$549.87

Service Code	NDC 64980017901
Hospital Charge Code	60631460
Hospital Revenue Code	250
Min. Negotiated Rate	$82.48
Max. Negotiated Rate	$82.48
Rate for Payer: Qualcare PPO/HMO/WC	$82.48

FLUCYTOSINE 250MG CAPSULE

Facility

$549.87

Service Code	NDC 64980017901
Hospital Charge Code	60631460
Hospital Revenue Code	250
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$274.94
Rate for Payer: Aetna Commercial	$208.95
Rate for Payer: Aetna Medicare Advantage	$164.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.22
Rate for Payer: Cigna Commercial	$274.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.96
Rate for Payer: Oxford Commercial	$109.97
Rate for Payer: Qualcare PPO/HMO/WC	$82.48
Rate for Payer: UnitedHealthcare Commercial	$109.97
Rate for Payer: UnitedHealthcare Community & State	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

FLUDARA/500MG/INJ

Facility

$845.00

Hospital Charge Code	60634724
Hospital Revenue Code	636
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

FLUDARA/500MG/INJ

Facility

$845.00

Hospital Charge Code	60634724
Hospital Revenue Code	636
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

FLUDARABINE 50 MG INJ

Facility

$2,459.03

Service Code	HCPCS J9185
Hospital Charge Code	60627382
Hospital Revenue Code	636
Min. Negotiated Rate	$368.85
Max. Negotiated Rate	$595.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.09
Rate for Payer: Qualcare PPO/HMO/WC	$368.85

FLUDARABINE 50 MG INJ

Facility

$2,459.03

Service Code	HCPCS J9185
Hospital Charge Code	60627382
Hospital Revenue Code	636
Min. Negotiated Rate	$59.26
Max. Negotiated Rate	$1,229.52
Rate for Payer: Aetna Commercial	$934.43
Rate for Payer: Aetna Medicare Advantage	$737.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$627.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$627.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$627.05
Rate for Payer: Cigna Commercial	$1,229.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.09
Rate for Payer: Qualcare PPO/HMO/WC	$368.85
Rate for Payer: UnitedHealthcare Community & State	$59.26
Rate for Payer: Wellpoint Medicaid Managed Care	$65.16

FLUDARABINE INJ 50MG

Facility

$1,310.10

Hospital Charge Code	6006969
Hospital Revenue Code	636
Min. Negotiated Rate	$31.57
Max. Negotiated Rate	$655.05
Rate for Payer: Aetna Commercial	$497.84
Rate for Payer: Aetna Medicare Advantage	$393.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.08
Rate for Payer: Cigna Commercial	$655.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.04
Rate for Payer: Qualcare PPO/HMO/WC	$196.51
Rate for Payer: UnitedHealthcare Community & State	$31.57
Rate for Payer: Wellpoint Medicaid Managed Care	$34.72

FLUDARABINE INJ 50MG

Facility

$1,310.10

Hospital Charge Code	6006969
Hospital Revenue Code	636
Min. Negotiated Rate	$196.51
Max. Negotiated Rate	$317.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$317.04
Rate for Payer: Qualcare PPO/HMO/WC	$196.51

FLUDROCORTISONE 0.1 MG TAB

Facility

$7.04

Service Code	NDC 68084028801
Hospital Charge Code	60628192
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$2.68
Rate for Payer: Aetna Medicare Advantage	$2.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.80
Rate for Payer: Cigna Commercial	$3.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.11
Rate for Payer: Oxford Commercial	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.06
Rate for Payer: UnitedHealthcare Commercial	$1.41
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

FLUDROCORTISONE 0.1 MG TAB

Facility

$7.04

Service Code	NDC 68084028801
Hospital Charge Code	60628192
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$1.06

FLUENT DISPOSABLE PACK

Facility

$1,625.00

Hospital Charge Code	270693690
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

FLUENT DISPOSABLE PACK

Facility

$1,625.00

Hospital Charge Code	270693690
Hospital Revenue Code	272
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$325.00
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

FLUID AMNIOTIC GRAFT 1.0CC

Facility

$6,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270695085
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

FLUID AMNIOTIC GRAFT 1.0CC

Facility

$6,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270695085
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FLUID COLLECTION SYSTEM

Facility

$58.00

Hospital Charge Code	2008160
Hospital Revenue Code	272
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna Commercial	$22.04
Rate for Payer: Aetna Medicare Advantage	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.79
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.40
Rate for Payer: Oxford Commercial	$11.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$11.60
Rate for Payer: UnitedHealthcare Community & State	$1.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

FLUID COLLECTION SYSTEM

Facility

$58.00

Hospital Charge Code	2008160
Hospital Revenue Code	272
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

FLUID GF AMNIOT ALLOGRAFT 2CC

Facility

$12,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270694914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

FLUID GF AMNIOT ALLOGRAFT 2CC

Facility

$12,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270694914
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

FLUID MANAGEMENT SYSTM MDD520H

Facility

$917.65

Hospital Charge Code	270627701
Hospital Revenue Code	272
Min. Negotiated Rate	$137.65
Max. Negotiated Rate	$137.65
Rate for Payer: Qualcare PPO/HMO/WC	$137.65

FLUID MANAGEMENT SYSTM MDD520H

Facility

$917.65

Hospital Charge Code	270627701
Hospital Revenue Code	272
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$458.82
Rate for Payer: Aetna Commercial	$348.71
Rate for Payer: Aetna Medicare Advantage	$275.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.00
Rate for Payer: Cigna Commercial	$458.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.30
Rate for Payer: Oxford Commercial	$183.53
Rate for Payer: Qualcare PPO/HMO/WC	$137.65
Rate for Payer: UnitedHealthcare Commercial	$183.53
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$24.32

FLUIDOTHERAPY CQ

Facility

$77.65

Service Code	HCPCS 97022GP
Hospital Charge Code	904197022F
Hospital Revenue Code	420
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$1.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

FLUIDOTHERAPY CQ

Facility

$77.65

Service Code	HCPCS 97022GP
Hospital Charge Code	904197022F
Hospital Revenue Code	420
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

FLUID SET DUAL SPIKE

Facility

$1,321.65

Hospital Charge Code	270600359
Hospital Revenue Code	270
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$660.83
Rate for Payer: Aetna Commercial	$502.23
Rate for Payer: Aetna Medicare Advantage	$396.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.02
Rate for Payer: Cigna Commercial	$660.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.50
Rate for Payer: Oxford Commercial	$264.33
Rate for Payer: Qualcare PPO/HMO/WC	$198.25
Rate for Payer: UnitedHealthcare Commercial	$264.33
Rate for Payer: UnitedHealthcare Community & State	$31.85
Rate for Payer: Wellpoint Medicaid Managed Care	$35.02

FLUID SET DUAL SPIKE

Facility

$1,321.65

Hospital Charge Code	270600359
Hospital Revenue Code	270
Min. Negotiated Rate	$198.25
Max. Negotiated Rate	$198.25
Rate for Payer: Qualcare PPO/HMO/WC	$198.25

FLU INTRADERMAL >18 YR

Facility

$99.36

Service Code	HCPCS 90654
Hospital Charge Code	83652309
Hospital Revenue Code	636
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$24.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90

Know your out-of-pocket cost for care.

All Charges