Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUOCINOLONE TOP 60GM

Facility

$21.15

Hospital Charge Code	6002414
Hospital Revenue Code	251
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

FLUOCINOLONE TOP 60GM

Facility

$21.15

Hospital Charge Code	6002414
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

FLUOCINONIDE 0.05%/15GM

Facility

$34.00

Hospital Charge Code	60633000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

FLUOCINONIDE 0.05%/15GM

Facility

$34.00

Hospital Charge Code	60633000
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

FLUOCINONIDE 0.05%/30GM

Facility

$43.00

Hospital Charge Code	60633001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

FLUOCINONIDE 0.05%/30GM

Facility

$43.00

Hospital Charge Code	60633001
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

FLUOCINONIDE 0.05 % CRE

Facility

$224.00

Hospital Charge Code	60628384
Hospital Revenue Code	250
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$33.60

FLUOCINONIDE 0.05 % CRE

Facility

$224.00

Hospital Charge Code	60628384
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.00
Rate for Payer: Aetna Commercial	$85.12
Rate for Payer: Aetna Medicare Advantage	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.12
Rate for Payer: Cigna Commercial	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: Oxford Commercial	$44.80
Rate for Payer: Qualcare PPO/HMO/WC	$33.60
Rate for Payer: UnitedHealthcare Commercial	$44.80
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

FLUOCINONIDE 0.05 % CREAM

Facility

$172.00

Hospital Charge Code	60628385
Hospital Revenue Code	250
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

FLUOCINONIDE 0.05 % CREAM

Facility

$172.00

Hospital Charge Code	60628385
Hospital Revenue Code	250
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$86.00
Rate for Payer: Aetna Commercial	$65.36
Rate for Payer: Aetna Medicare Advantage	$51.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.86
Rate for Payer: Cigna Commercial	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.60
Rate for Payer: Oxford Commercial	$34.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$34.40
Rate for Payer: UnitedHealthcare Community & State	$4.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

fLUOCINONIDE 0.05% CREAM 15G

Facility

$305.19

Service Code	NDC 51672125301
Hospital Charge Code	60630178
Hospital Revenue Code	250
Min. Negotiated Rate	$45.78
Max. Negotiated Rate	$45.78
Rate for Payer: Qualcare PPO/HMO/WC	$45.78

fLUOCINONIDE 0.05% CREAM 15G

Facility

$305.19

Service Code	NDC 51672125301
Hospital Charge Code	60630178
Hospital Revenue Code	250
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$152.59
Rate for Payer: Aetna Commercial	$115.97
Rate for Payer: Aetna Medicare Advantage	$91.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.82
Rate for Payer: Cigna Commercial	$152.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.56
Rate for Payer: Oxford Commercial	$61.04
Rate for Payer: Qualcare PPO/HMO/WC	$45.78
Rate for Payer: UnitedHealthcare Commercial	$61.04
Rate for Payer: UnitedHealthcare Community & State	$7.36
Rate for Payer: Wellpoint Medicaid Managed Care	$8.09

FLUOCINONIDE 0.05% OIN

Facility

$225.65

Hospital Charge Code	60628386
Hospital Revenue Code	250
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$112.83
Rate for Payer: Aetna Commercial	$85.75
Rate for Payer: Aetna Medicare Advantage	$67.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.54
Rate for Payer: Cigna Commercial	$112.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.69
Rate for Payer: Oxford Commercial	$45.13
Rate for Payer: Qualcare PPO/HMO/WC	$33.85
Rate for Payer: UnitedHealthcare Commercial	$45.13
Rate for Payer: UnitedHealthcare Community & State	$5.44
Rate for Payer: Wellpoint Medicaid Managed Care	$5.98

FLUOCINONIDE 0.05% OIN

Facility

$225.65

Hospital Charge Code	60628386
Hospital Revenue Code	250
Min. Negotiated Rate	$33.85
Max. Negotiated Rate	$33.85
Rate for Payer: Qualcare PPO/HMO/WC	$33.85

FLUOCINONIDE 0.05% OINTMENT 15

Facility

$191.15

Service Code	NDC 168014015
Hospital Charge Code	60630177
Hospital Revenue Code	250
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$95.58
Rate for Payer: Aetna Commercial	$72.64
Rate for Payer: Aetna Medicare Advantage	$57.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.74
Rate for Payer: Cigna Commercial	$95.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.34
Rate for Payer: Oxford Commercial	$38.23
Rate for Payer: Qualcare PPO/HMO/WC	$28.67
Rate for Payer: UnitedHealthcare Commercial	$38.23
Rate for Payer: UnitedHealthcare Community & State	$4.61
Rate for Payer: Wellpoint Medicaid Managed Care	$5.07

FLUOCINONIDE 0.05% OINTMENT 15

Facility

$191.15

Service Code	NDC 168014015
Hospital Charge Code	60630177
Hospital Revenue Code	250
Min. Negotiated Rate	$28.67
Max. Negotiated Rate	$28.67
Rate for Payer: Qualcare PPO/HMO/WC	$28.67

FLUOCINONIDE/0.05% SOL

Facility

$385.72

Service Code	NDC 51672127302
Hospital Charge Code	60634870
Hospital Revenue Code	250
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$192.86
Rate for Payer: Aetna Commercial	$146.57
Rate for Payer: Aetna Medicare Advantage	$115.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.36
Rate for Payer: Cigna Commercial	$192.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.72
Rate for Payer: Oxford Commercial	$77.14
Rate for Payer: Qualcare PPO/HMO/WC	$57.86
Rate for Payer: UnitedHealthcare Commercial	$77.14
Rate for Payer: UnitedHealthcare Community & State	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.22

FLUOCINONIDE/0.05% SOL

Facility

$385.72

Service Code	NDC 51672127302
Hospital Charge Code	60634870
Hospital Revenue Code	250
Min. Negotiated Rate	$57.86
Max. Negotiated Rate	$57.86
Rate for Payer: Qualcare PPO/HMO/WC	$57.86

FLUOCINONIDE CRM 15GM

Facility

$48.00

Hospital Charge Code	6002422
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

FLUOCINONIDE CRM 15GM

Facility

$48.00

Hospital Charge Code	6002422
Hospital Revenue Code	251
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

FLUOCINONIDE CRM 60GM

Facility

$97.30

Hospital Charge Code	6002455
Hospital Revenue Code	251
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$48.65
Rate for Payer: Aetna Commercial	$36.97
Rate for Payer: Aetna Medicare Advantage	$29.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.81
Rate for Payer: Cigna Commercial	$48.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.19
Rate for Payer: Oxford Commercial	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.60
Rate for Payer: UnitedHealthcare Commercial	$19.46
Rate for Payer: UnitedHealthcare Community & State	$2.34
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

FLUOCINONIDE CRM 60GM

Facility

$97.30

Hospital Charge Code	6002455
Hospital Revenue Code	251
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.60

FLUOCINONIDE GEL 15GM

Facility

$70.40

Hospital Charge Code	6002430
Hospital Revenue Code	251
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

FLUOCINONIDE GEL 15GM

Facility

$70.40

Hospital Charge Code	6002430
Hospital Revenue Code	251
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

FLUOCINONIDE SOL 60ML

Facility

$154.25

Hospital Charge Code	6002448
Hospital Revenue Code	251
Min. Negotiated Rate	$23.14
Max. Negotiated Rate	$23.14
Rate for Payer: Qualcare PPO/HMO/WC	$23.14

Know your out-of-pocket cost for care.

All Charges