Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUSH IMPIMG 1ST SCREW

Facility

$725.00

Service Code	HCPCS C1713
Hospital Charge Code	270694628
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
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

FLUSHING A PORTA CATH/PICC

Facility

$264.80

Service Code	HCPCS 96523
Hospital Charge Code	93500099
Hospital Revenue Code	761
Min. Negotiated Rate	$39.72
Max. Negotiated Rate	$39.72
Rate for Payer: Qualcare PPO/HMO/WC	$39.72

FLUSHING A PORTA CATH/PICC

Facility

$264.80

Service Code	HCPCS 96523
Hospital Charge Code	93500099
Hospital Revenue Code	761
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$252.97
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.44
Rate for Payer: Oxford Commercial	$52.96
Rate for Payer: Qualcare PPO/HMO/WC	$39.72
Rate for Payer: UnitedHealthcare Commercial	$52.96
Rate for Payer: UnitedHealthcare Community & State	$6.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

FLUTAMIDE 125 MG CAP

Facility

$18.45

Hospital Charge Code	60627384
Hospital Revenue Code	252
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

FLUTAMIDE 125 MG CAP

Facility

$18.45

Hospital Charge Code	60627384
Hospital Revenue Code	252
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

FLUTE TIP GUIDEWIRE LENGTH 400

Facility

$1,620.00

Service Code	HCPCS C1769
Hospital Charge Code	270687816
Hospital Revenue Code	278
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00
Rate for Payer: UnitedHealthcare Community & State	$39.04
Rate for Payer: Wellpoint Medicaid Managed Care	$42.93

FLUTE TIP GUIDEWIRE LENGTH 400

Facility

$1,620.00

Service Code	HCPCS C1769
Hospital Charge Code	270687816
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

FLUTICASONE 110MCG AEROSOL

Facility

$345.65

Hospital Charge Code	60629017
Hospital Revenue Code	250
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$51.85
Rate for Payer: Qualcare PPO/HMO/WC	$51.85

FLUTICASONE 110MCG AEROSOL

Facility

$345.65

Hospital Charge Code	60629017
Hospital Revenue Code	250
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$172.82
Rate for Payer: Aetna Commercial	$131.35
Rate for Payer: Aetna Medicare Advantage	$103.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.14
Rate for Payer: Cigna Commercial	$172.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.69
Rate for Payer: Oxford Commercial	$69.13
Rate for Payer: Qualcare PPO/HMO/WC	$51.85
Rate for Payer: UnitedHealthcare Commercial	$69.13
Rate for Payer: UnitedHealthcare Community & State	$8.33
Rate for Payer: Wellpoint Medicaid Managed Care	$9.16

FLUTICASONE 220 MCG AEROSOL

Facility

$541.65

Hospital Charge Code	60629018
Hospital Revenue Code	250
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$81.25
Rate for Payer: Qualcare PPO/HMO/WC	$81.25

FLUTICASONE 220 MCG AEROSOL

Facility

$541.65

Hospital Charge Code	60629018
Hospital Revenue Code	250
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$270.82
Rate for Payer: Aetna Commercial	$205.83
Rate for Payer: Aetna Medicare Advantage	$162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.12
Rate for Payer: Cigna Commercial	$270.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$108.33
Rate for Payer: Qualcare PPO/HMO/WC	$81.25
Rate for Payer: UnitedHealthcare Commercial	$108.33
Rate for Payer: UnitedHealthcare Community & State	$13.05
Rate for Payer: Wellpoint Medicaid Managed Care	$14.35

FLUTICASONE 44MCG AEROSOL

Facility

$271.25

Hospital Charge Code	60628621
Hospital Revenue Code	250
Min. Negotiated Rate	$40.69
Max. Negotiated Rate	$40.69
Rate for Payer: Qualcare PPO/HMO/WC	$40.69

FLUTICASONE 44MCG AEROSOL

Facility

$271.25

Hospital Charge Code	60628621
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$135.62
Rate for Payer: Aetna Commercial	$103.08
Rate for Payer: Aetna Medicare Advantage	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.17
Rate for Payer: Cigna Commercial	$135.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.38
Rate for Payer: Oxford Commercial	$54.25
Rate for Payer: Qualcare PPO/HMO/WC	$40.69
Rate for Payer: UnitedHealthcare Commercial	$54.25
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

FLUTICASONE & SALMETERL INH113

Facility

$1,027.91

Service Code	NDC 93360882
Hospital Charge Code	606390251
Hospital Revenue Code	250
Min. Negotiated Rate	$24.77
Max. Negotiated Rate	$513.96
Rate for Payer: Aetna Commercial	$390.61
Rate for Payer: Aetna Medicare Advantage	$308.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.12
Rate for Payer: Cigna Commercial	$513.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.37
Rate for Payer: Oxford Commercial	$205.58
Rate for Payer: Qualcare PPO/HMO/WC	$154.19
Rate for Payer: UnitedHealthcare Commercial	$205.58
Rate for Payer: UnitedHealthcare Community & State	$24.77
Rate for Payer: Wellpoint Medicaid Managed Care	$27.24

FLUTICASONE & SALMETERL INH113

Facility

$1,027.91

Service Code	NDC 93360882
Hospital Charge Code	606390251
Hospital Revenue Code	250
Min. Negotiated Rate	$154.19
Max. Negotiated Rate	$154.19
Rate for Payer: Qualcare PPO/HMO/WC	$154.19

FLUTICASONE & SALMETERL INH232

Facility

$1,027.91

Service Code	NDC 93360982
Hospital Charge Code	606390252
Hospital Revenue Code	250
Min. Negotiated Rate	$154.19
Max. Negotiated Rate	$154.19
Rate for Payer: Qualcare PPO/HMO/WC	$154.19

FLUTICASONE & SALMETERL INH232

Facility

$1,027.91

Service Code	NDC 93360982
Hospital Charge Code	606390252
Hospital Revenue Code	250
Min. Negotiated Rate	$24.77
Max. Negotiated Rate	$513.96
Rate for Payer: Aetna Commercial	$390.61
Rate for Payer: Aetna Medicare Advantage	$308.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.12
Rate for Payer: Cigna Commercial	$513.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.37
Rate for Payer: Oxford Commercial	$205.58
Rate for Payer: Qualcare PPO/HMO/WC	$154.19
Rate for Payer: UnitedHealthcare Commercial	$205.58
Rate for Payer: UnitedHealthcare Community & State	$24.77
Rate for Payer: Wellpoint Medicaid Managed Care	$27.24

FLUTICASONE & SALMETEROL INH55

Facility

$1,027.91

Service Code	NDC 93360782
Hospital Charge Code	606390250
Hospital Revenue Code	250
Min. Negotiated Rate	$24.77
Max. Negotiated Rate	$513.96
Rate for Payer: Aetna Commercial	$390.61
Rate for Payer: Aetna Medicare Advantage	$308.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.12
Rate for Payer: Cigna Commercial	$513.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.37
Rate for Payer: Oxford Commercial	$205.58
Rate for Payer: Qualcare PPO/HMO/WC	$154.19
Rate for Payer: UnitedHealthcare Commercial	$205.58
Rate for Payer: UnitedHealthcare Community & State	$24.77
Rate for Payer: Wellpoint Medicaid Managed Care	$27.24

FLUTICASONE & SALMETEROL INH55

Facility

$1,027.91

Service Code	NDC 93360782
Hospital Charge Code	606390250
Hospital Revenue Code	250
Min. Negotiated Rate	$154.19
Max. Negotiated Rate	$154.19
Rate for Payer: Qualcare PPO/HMO/WC	$154.19

FLU VACC.TRIVALENT(A&B)'05-'06

Facility

$42.65

Service Code	HCPCS 90658
Hospital Charge Code	60629841
Hospital Revenue Code	636
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$10.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.40

FLU VACC.TRIVALENT(A&B)'05-'06

Facility

$42.65

Service Code	HCPCS 90658
Hospital Charge Code	60629841
Hospital Revenue Code	636
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$16.21
Rate for Payer: Aetna Medicare Advantage	$12.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.88
Rate for Payer: Cigna Commercial	$21.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.40
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$76.92

Service Code	HCPCS 90657
Hospital Charge Code	83652605
Hospital Revenue Code	636
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$47.32
Rate for Payer: Aetna Commercial	$29.23
Rate for Payer: Aetna Medicare Advantage	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.61
Rate for Payer: Cigna Commercial	$38.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$76.92

Service Code	HCPCS 90657
Hospital Charge Code	83652605
Hospital Revenue Code	636
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$18.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$107.20

Service Code	HCPCS 90658
Hospital Charge Code	83652313
Hospital Revenue Code	636
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$131.65
Rate for Payer: Aetna Commercial	$40.74
Rate for Payer: Aetna Medicare Advantage	$32.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.34
Rate for Payer: Cigna Commercial	$53.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$107.20

Service Code	HCPCS 90658
Hospital Charge Code	83652313
Hospital Revenue Code	636
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$25.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

Know your out-of-pocket cost for care.

All Charges