Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUOROURACIL 500 MG/10 ML INJ

Facility

$24.12

Service Code	HCPCS J9190
Hospital Charge Code	60627383
Hospital Revenue Code	636
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$5.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

FLUOROURACIL 500 MG/10 ML INJ

Facility

$24.12

Service Code	HCPCS J9190
Hospital Charge Code	60627383
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$9.17
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$12.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

FLUOROURACIL/50MG/1ML

Facility

$21.00

Hospital Charge Code	60633004
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

FLUOROURACIL/50MG/1ML

Facility

$21.00

Hospital Charge Code	60633004
Hospital Revenue Code	636
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

FLUOROURACIL CRM 30GM

Facility

$219.55

Hospital Charge Code	6007090
Hospital Revenue Code	250
Min. Negotiated Rate	$32.93
Max. Negotiated Rate	$32.93
Rate for Payer: Qualcare PPO/HMO/WC	$32.93

FLUOROURACIL CRM 30GM

Facility

$219.55

Hospital Charge Code	6007090
Hospital Revenue Code	250
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$109.78
Rate for Payer: Aetna Commercial	$83.43
Rate for Payer: Aetna Medicare Advantage	$65.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.99
Rate for Payer: Cigna Commercial	$109.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.86
Rate for Payer: Oxford Commercial	$43.91
Rate for Payer: Qualcare PPO/HMO/WC	$32.93
Rate for Payer: UnitedHealthcare Commercial	$43.91
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: Wellpoint Medicaid Managed Care	$5.82

FLUOROURACIL INJ 500MG

Facility

$89.00

Hospital Charge Code	6009542
Hospital Revenue Code	250
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

FLUOROURACIL INJ 500MG

Facility

$89.00

Hospital Charge Code	6009542
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna Medicare Advantage	$26.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.70
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.70
Rate for Payer: Oxford Commercial	$17.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$17.80
Rate for Payer: UnitedHealthcare Community & State	$2.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

FLUOTHANE/125ML

Facility

$244.00

Hospital Charge Code	60633005
Hospital Revenue Code	250
Min. Negotiated Rate	$36.60
Max. Negotiated Rate	$36.60
Rate for Payer: Qualcare PPO/HMO/WC	$36.60

FLUOTHANE/125ML

Facility

$244.00

Hospital Charge Code	60633005
Hospital Revenue Code	250
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$122.00
Rate for Payer: Aetna Commercial	$92.72
Rate for Payer: Aetna Medicare Advantage	$73.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.22
Rate for Payer: Cigna Commercial	$122.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: Oxford Commercial	$48.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.60
Rate for Payer: UnitedHealthcare Commercial	$48.80
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$6.47

FLUOXETINE***

Facility

$116.00

Hospital Charge Code	3010592
Hospital Revenue Code	301
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

FLUOXETINE***

Facility

$116.00

Hospital Charge Code	3010592
Hospital Revenue Code	301
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$44.08
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.58
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.80
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

FLUOXETINE 10 MG CAP

Facility

$70.02

Service Code	NDC 777310402
Hospital Charge Code	60627765
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

FLUOXETINE 10 MG CAP

Facility

$70.02

Service Code	NDC 777310402
Hospital Charge Code	60627765
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$35.01
Rate for Payer: Aetna Commercial	$26.61
Rate for Payer: Aetna Medicare Advantage	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.86
Rate for Payer: Cigna Commercial	$35.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.01
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$14.00
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1.86

FLUOXETINE 20 MG/5 ML ELIX

Facility

$32.83

Service Code	NDC 121072104
Hospital Charge Code	60628620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.41
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$9.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.37
Rate for Payer: Cigna Commercial	$16.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.85
Rate for Payer: Oxford Commercial	$6.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.92
Rate for Payer: UnitedHealthcare Commercial	$6.57
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

FLUOXETINE 20 MG/5 ML ELIX

Facility

$32.83

Service Code	NDC 121072104
Hospital Charge Code	60628620
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$4.92
Rate for Payer: Qualcare PPO/HMO/WC	$4.92

FLUOXETINE 20 MG CAP

Facility

$17.89

Service Code	NDC 777310502
Hospital Charge Code	6010383
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

FLUOXETINE 20 MG CAP

Facility

$17.89

Service Code	NDC 777310502
Hospital Charge Code	6010383
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.37
Rate for Payer: Oxford Commercial	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Commercial	$3.58
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

FLUOXETINE LQ 20MG/5ML 120ML

Facility

$1,016.35

Hospital Charge Code	6010276
Hospital Revenue Code	252
Min. Negotiated Rate	$152.45
Max. Negotiated Rate	$152.45
Rate for Payer: Qualcare PPO/HMO/WC	$152.45

FLUOXETINE LQ 20MG/5ML 120ML

Facility

$1,016.35

Hospital Charge Code	6010276
Hospital Revenue Code	252
Min. Negotiated Rate	$24.49
Max. Negotiated Rate	$508.18
Rate for Payer: Aetna Commercial	$386.21
Rate for Payer: Aetna Medicare Advantage	$304.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.17
Rate for Payer: Cigna Commercial	$508.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.90
Rate for Payer: Oxford Commercial	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$152.45
Rate for Payer: UnitedHealthcare Commercial	$203.27
Rate for Payer: UnitedHealthcare Community & State	$24.49
Rate for Payer: Wellpoint Medicaid Managed Care	$26.93

FLUOXETINE (NORFLUOX/PROZAC)

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3009198
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

FLUOXETINE (NORFLUOX/PROZAC)

Facility

$231.25

Service Code	HCPCS 82542
Hospital Charge Code	3009198
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

FLUOXETINE,SERUM (PROZAC)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473104
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

FLUOXETINE,SERUM (PROZAC)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473104
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

FLUOXYMESTERONE 10 MG TAB

Facility

$18.45

Hospital Charge Code	60628213
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$7.01
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.54
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

Know your out-of-pocket cost for care.

All Charges