Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUPHENAZINE INJ 25MG/10ML

Facility

$26.45

Hospital Charge Code	60627798
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$5.29
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

FLUPHENAZINE INJ 25MG/10ML

Facility

$26.45

Hospital Charge Code	60627798
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

FLUPHENAZINE,URINE

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000777
Hospital Revenue Code	301
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

FLUPHENAZINE,URINE

Facility

$67.25

Service Code	HCPCS 80342
Hospital Charge Code	3000777
Hospital Revenue Code	301
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

FLURANDRENOLIDE 0.05 % OIN

Facility

$131.25

Hospital Charge Code	60628387
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.62
Rate for Payer: Aetna Commercial	$49.88
Rate for Payer: Aetna Medicare Advantage	$39.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.47
Rate for Payer: Cigna Commercial	$65.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.38
Rate for Payer: Oxford Commercial	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$19.69
Rate for Payer: UnitedHealthcare Commercial	$26.25
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

FLURANDRENOLIDE 0.05 % OIN

Facility

$131.25

Hospital Charge Code	60628387
Hospital Revenue Code	250
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$19.69
Rate for Payer: Qualcare PPO/HMO/WC	$19.69

FLURANDRENOLIDE TAPE 4MCG

Facility

$229.80

Hospital Charge Code	6002497
Hospital Revenue Code	252
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$114.90
Rate for Payer: Aetna Commercial	$87.32
Rate for Payer: Aetna Medicare Advantage	$68.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.60
Rate for Payer: Cigna Commercial	$114.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.94
Rate for Payer: Oxford Commercial	$45.96
Rate for Payer: Qualcare PPO/HMO/WC	$34.47
Rate for Payer: UnitedHealthcare Commercial	$45.96
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

FLURANDRENOLIDE TAPE 4MCG

Facility

$229.80

Hospital Charge Code	6002497
Hospital Revenue Code	252
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$34.47
Rate for Payer: Qualcare PPO/HMO/WC	$34.47

FLURANDRENOLIDE TOP .05% 60ML

Facility

$254.75

Hospital Charge Code	6002489
Hospital Revenue Code	252
Min. Negotiated Rate	$38.21
Max. Negotiated Rate	$38.21
Rate for Payer: Qualcare PPO/HMO/WC	$38.21

FLURANDRENOLIDE TOP .05% 60ML

Facility

$254.75

Hospital Charge Code	6002489
Hospital Revenue Code	252
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$127.38
Rate for Payer: Aetna Commercial	$96.81
Rate for Payer: Aetna Medicare Advantage	$76.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.96
Rate for Payer: Cigna Commercial	$127.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.42
Rate for Payer: Oxford Commercial	$50.95
Rate for Payer: Qualcare PPO/HMO/WC	$38.21
Rate for Payer: UnitedHealthcare Commercial	$50.95
Rate for Payer: UnitedHealthcare Community & State	$6.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.75

FLURATE OPH SOL 0.25% B&L 5ML

Facility

$46.75

Hospital Charge Code	60629352
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.38
Rate for Payer: Aetna Commercial	$17.77
Rate for Payer: Aetna Medicare Advantage	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.92
Rate for Payer: Cigna Commercial	$23.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.03
Rate for Payer: Oxford Commercial	$9.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.01
Rate for Payer: UnitedHealthcare Commercial	$9.35
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

FLURATE OPH SOL 0.25% B&L 5ML

Facility

$46.75

Hospital Charge Code	60629352
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$7.01
Rate for Payer: Qualcare PPO/HMO/WC	$7.01

FLURAZEPAM 15MG

Facility

$1.95

Hospital Charge Code	6021117
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

FLURAZEPAM 15MG

Facility

$1.95

Hospital Charge Code	6021117
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

FLURAZEPAM 15 MG CAP

Facility

$4.00

Hospital Charge Code	60629105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FLURAZEPAM 15 MG CAP

Facility

$4.00

Hospital Charge Code	60629105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

FLURAZEPAM 30 MG CAP

Facility

$4.00

Hospital Charge Code	60627844
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FLURAZEPAM 30 MG CAP

Facility

$4.00

Hospital Charge Code	60627844
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

FLURBIPROFEN 0.03% OPHTH SOLN

Facility

$261.97

Service Code	NDC 11980080103
Hospital Charge Code	60628088
Hospital Revenue Code	250
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$130.99
Rate for Payer: Aetna Commercial	$99.55
Rate for Payer: Aetna Medicare Advantage	$78.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.80
Rate for Payer: Cigna Commercial	$130.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.59
Rate for Payer: Oxford Commercial	$52.39
Rate for Payer: Qualcare PPO/HMO/WC	$39.30
Rate for Payer: UnitedHealthcare Commercial	$52.39
Rate for Payer: UnitedHealthcare Community & State	$6.31
Rate for Payer: Wellpoint Medicaid Managed Care	$6.94

FLURBIPROFEN 0.03% OPHTH SOLN

Facility

$261.97

Service Code	NDC 11980080103
Hospital Charge Code	60628088
Hospital Revenue Code	250
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$39.30
Rate for Payer: Qualcare PPO/HMO/WC	$39.30

FLURBIPROFEN OPH .03% 2.5ML

Facility

$109.45

Hospital Charge Code	6002505
Hospital Revenue Code	251
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

FLURBIPROFEN OPH .03% 2.5ML

Facility

$109.45

Hospital Charge Code	6002505
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

FLURO GUID PERCUT DRN/PL CATH

Facility

$3,407.60

Service Code	HCPCS 75989
Hospital Charge Code	2001630
Hospital Revenue Code	320
Min. Negotiated Rate	$82.12
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,294.89
Rate for Payer: Aetna Medicare Advantage	$1,022.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$868.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$253.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$868.94
Rate for Payer: Cigna Commercial	$1,703.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.28
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$511.14
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$82.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.30

FLURO GUID PERCUT DRN/PL CATH

Facility

$3,407.60

Service Code	HCPCS 75989
Hospital Charge Code	2001630
Hospital Revenue Code	320
Min. Negotiated Rate	$511.14
Max. Negotiated Rate	$511.14
Rate for Payer: Qualcare PPO/HMO/WC	$511.14

FLUSH IMPIMG 1ST SCREW

Facility

$725.00

Service Code	HCPCS C1713
Hospital Charge Code	270694628
Hospital Revenue Code	278
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

Know your out-of-pocket cost for care.

All Charges