Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUOXYMESTERONE 10 MG TAB

Facility

$18.45

Hospital Charge Code	60628213
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

FLUOXYMESTERONE TAB 10MG

Facility

$15.40

Hospital Charge Code	6009401
Hospital Revenue Code	252
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

FLUOXYMESTERONE TAB 10MG

Facility

$15.40

Hospital Charge Code	6009401
Hospital Revenue Code	252
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

FLUPHENAZIN DEC25MG/ML INJ 5ML

Facility

$160.80

Service Code	HCPCS J2680
Hospital Charge Code	60627795
Hospital Revenue Code	636
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$38.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12

FLUPHENAZIN DEC25MG/ML INJ 5ML

Facility

$160.80

Service Code	HCPCS J2680
Hospital Charge Code	60627795
Hospital Revenue Code	636
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$80.40
Rate for Payer: Aetna Commercial	$61.10
Rate for Payer: Aetna Medicare Advantage	$48.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.00
Rate for Payer: Cigna Commercial	$80.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12
Rate for Payer: UnitedHealthcare Community & State	$3.88
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

FLUPHENAZINE 10 MG TAB

Facility

$11.19

Service Code	NDC 378609701
Hospital Charge Code	60628980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.59
Rate for Payer: Aetna Commercial	$4.25
Rate for Payer: Aetna Medicare Advantage	$3.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.85
Rate for Payer: Cigna Commercial	$5.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.36
Rate for Payer: Oxford Commercial	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.68
Rate for Payer: UnitedHealthcare Commercial	$2.24
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

FLUPHENAZINE 10 MG TAB

Facility

$11.19

Service Code	NDC 378609701
Hospital Charge Code	60628980
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Qualcare PPO/HMO/WC	$1.68

FLUPHENAZINE 1 MG TAB

Facility

$4.22

Service Code	NDC 378600401
Hospital Charge Code	60627796
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.11
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.27
Rate for Payer: Oxford Commercial	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.63
Rate for Payer: UnitedHealthcare Commercial	$0.84
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

FLUPHENAZINE 1 MG TAB

Facility

$4.22

Service Code	NDC 378600401
Hospital Charge Code	60627796
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

FLUPHENAZINE 2.5 MG TAB

Facility

$4.62

Service Code	NDC 51079048620
Hospital Charge Code	6027023
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.18
Rate for Payer: Cigna Commercial	$2.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.69
Rate for Payer: UnitedHealthcare Commercial	$0.92
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

FLUPHENAZINE 2.5 MG TAB

Facility

$4.62

Service Code	NDC 51079048620
Hospital Charge Code	6027023
Hospital Revenue Code	251
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Qualcare PPO/HMO/WC	$0.69

FLUPHENAZINE 5MG/ML ORAL SOL

Facility

$21.04

Service Code	NDC 121065304
Hospital Charge Code	6063943111
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$3.16
Rate for Payer: Qualcare PPO/HMO/WC	$3.16

FLUPHENAZINE 5MG/ML ORAL SOL

Facility

$21.04

Service Code	NDC 121065304
Hospital Charge Code	6063943111
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.52
Rate for Payer: Aetna Commercial	$8.00
Rate for Payer: Aetna Medicare Advantage	$6.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.37
Rate for Payer: Cigna Commercial	$10.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.31
Rate for Payer: Oxford Commercial	$4.21
Rate for Payer: Qualcare PPO/HMO/WC	$3.16
Rate for Payer: UnitedHealthcare Commercial	$4.21
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

FLUPHENAZINE 5 MG TAB

Facility

$5.36

Service Code	NDC 51079048720
Hospital Charge Code	6027015
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

FLUPHENAZINE 5 MG TAB

Facility

$5.36

Service Code	NDC 51079048720
Hospital Charge Code	6027015
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.61
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

FLUPHENAZINE/5MG/TAB

Facility

$5.00

Hospital Charge Code	60633006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

FLUPHENAZINE/5MG/TAB

Facility

$5.00

Hospital Charge Code	60633006
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

FLUPHENAZINE DC INJ 25MG/ML 5M

Facility

$149.15

Hospital Charge Code	6002471
Hospital Revenue Code	250
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$22.37
Rate for Payer: Qualcare PPO/HMO/WC	$22.37

FLUPHENAZINE DC INJ 25MG/ML 5M

Facility

$149.15

Hospital Charge Code	6002471
Hospital Revenue Code	250
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$74.58
Rate for Payer: Aetna Commercial	$56.68
Rate for Payer: Aetna Medicare Advantage	$44.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.03
Rate for Payer: Cigna Commercial	$74.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.74
Rate for Payer: Oxford Commercial	$29.83
Rate for Payer: Qualcare PPO/HMO/WC	$22.37
Rate for Payer: UnitedHealthcare Commercial	$29.83
Rate for Payer: UnitedHealthcare Community & State	$3.59
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

FLUPHENAZINE ELX 0.5 MG/ML

Facility

$234.25

Hospital Charge Code	6011027
Hospital Revenue Code	251
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$117.12
Rate for Payer: Aetna Commercial	$89.02
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.73
Rate for Payer: Cigna Commercial	$117.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.28
Rate for Payer: Oxford Commercial	$46.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.14
Rate for Payer: UnitedHealthcare Commercial	$46.85
Rate for Payer: UnitedHealthcare Community & State	$5.65
Rate for Payer: Wellpoint Medicaid Managed Care	$6.21

FLUPHENAZINE ELX 0.5 MG/ML

Facility

$234.25

Hospital Charge Code	6011027
Hospital Revenue Code	251
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$35.14
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

FLUPHENAZINE ELX 2.5MG/5ML

Facility

$21.44

Service Code	NDC 121065402
Hospital Charge Code	60627797
Hospital Revenue Code	250
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.22

FLUPHENAZINE ELX 2.5MG/5ML

Facility

$21.44

Service Code	NDC 121065402
Hospital Charge Code	60627797
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.72
Rate for Payer: Aetna Commercial	$8.15
Rate for Payer: Aetna Medicare Advantage	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.47
Rate for Payer: Cigna Commercial	$10.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.43
Rate for Payer: Oxford Commercial	$4.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.22
Rate for Payer: UnitedHealthcare Commercial	$4.29
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

FLUPHENAZINE ELX 5MG/ML

Facility

$6.40

Hospital Charge Code	60627799
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.20
Rate for Payer: Aetna Commercial	$2.43
Rate for Payer: Aetna Medicare Advantage	$1.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.63
Rate for Payer: Cigna Commercial	$3.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$1.28
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$1.28
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

FLUPHENAZINE ELX 5MG/ML

Facility

$6.40

Hospital Charge Code	60627799
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

Know your out-of-pocket cost for care.

All Charges