Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLUVOXAMINE 100 MG TAB

Facility

$17.69

Service Code	NDC 51079099320
Hospital Charge Code	60628831
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$6.72
Rate for Payer: Aetna Medicare Advantage	$5.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.51
Rate for Payer: Cigna Commercial	$8.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.31
Rate for Payer: Oxford Commercial	$3.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Commercial	$3.54
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

FLUVOXAMINE 100 MG TAB

Facility

$17.69

Service Code	NDC 51079099320
Hospital Charge Code	60628831
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.65

FLUVOXAMINE 25 MG TAB

Facility

$15.41

Service Code	NDC 62559015801
Hospital Charge Code	606390053
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.71
Rate for Payer: Aetna Commercial	$5.86
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	$7.71
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

FLUVOXAMINE 25 MG TAB

Facility

$15.41

Service Code	NDC 62559015801
Hospital Charge Code	606390053
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

FLUVOXAMINE 50MG

Facility

$17.95

Hospital Charge Code	6016463
Hospital Revenue Code	252
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

FLUVOXAMINE 50MG

Facility

$17.95

Hospital Charge Code	6016463
Hospital Revenue Code	252
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.97
Rate for Payer: Aetna Commercial	$6.82
Rate for Payer: Aetna Medicare Advantage	$5.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.58
Rate for Payer: Cigna Commercial	$8.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.38
Rate for Payer: Oxford Commercial	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.59
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

FLUVOXAMINE 50 MG TAB

Facility

$17.22

Service Code	NDC 51079099220
Hospital Charge Code	60627766
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.61
Rate for Payer: Aetna Commercial	$6.54
Rate for Payer: Aetna Medicare Advantage	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.39
Rate for Payer: Cigna Commercial	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.17
Rate for Payer: Oxford Commercial	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.58
Rate for Payer: UnitedHealthcare Commercial	$3.44
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

FLUVOXAMINE 50 MG TAB

Facility

$17.22

Service Code	NDC 51079099220
Hospital Charge Code	60627766
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.58

FLUVOXAMINE TAB 25MG

Facility

$14.75

Hospital Charge Code	60628832
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.38
Rate for Payer: Aetna Commercial	$5.61
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$2.95
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

FLUVOXAMINE TAB 25MG

Facility

$14.75

Hospital Charge Code	60628832
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

FLUVOXAMINE TAB 50MG

Facility

$57.00

Hospital Charge Code	6010573
Hospital Revenue Code	252
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

FLUVOXAMINE TAB 50MG

Facility

$57.00

Hospital Charge Code	6010573
Hospital Revenue Code	252
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$21.66
Rate for Payer: Aetna Medicare Advantage	$17.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.54
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.10
Rate for Payer: Oxford Commercial	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$11.40
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

FLUZONE P 0.5ML

Facility

$104.39

Service Code	HCPCS 90655
Hospital Charge Code	606350927
Hospital Revenue Code	636
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$25.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.66

FLUZONE P 0.5ML

Facility

$104.39

Service Code	HCPCS 90655
Hospital Charge Code	606350927
Hospital Revenue Code	636
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna Commercial	$39.67
Rate for Payer: Aetna Medicare Advantage	$31.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.62
Rate for Payer: Cigna Commercial	$52.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.66
Rate for Payer: UnitedHealthcare Community & State	$2.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

FLUZONE TRIVALANT HD 0.5 ML

Facility

$442.20

Service Code	NDC 49281012488
Hospital Charge Code	6063943392
Hospital Revenue Code	250
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$66.33
Rate for Payer: Qualcare PPO/HMO/WC	$66.33

FLUZONE TRIVALANT HD 0.5 ML

Facility

$442.20

Service Code	NDC 49281012488
Hospital Charge Code	6063943392
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$221.10
Rate for Payer: Aetna Commercial	$168.04
Rate for Payer: Aetna Medicare Advantage	$132.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.76
Rate for Payer: Cigna Commercial	$221.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.66
Rate for Payer: Oxford Commercial	$88.44
Rate for Payer: Qualcare PPO/HMO/WC	$66.33
Rate for Payer: UnitedHealthcare Commercial	$88.44
Rate for Payer: UnitedHealthcare Community & State	$10.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.72

FLZONE INFLUNZA .25ML PED

Facility

$104.79

Service Code	HCPCS 90655
Hospital Charge Code	60635785
Hospital Revenue Code	636
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.40
Rate for Payer: Aetna Commercial	$39.82
Rate for Payer: Aetna Medicare Advantage	$31.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.72
Rate for Payer: Cigna Commercial	$52.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.72
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

FLZONE INFLUNZA .25ML PED

Facility

$104.79

Service Code	HCPCS 90655
Hospital Charge Code	60635785
Hospital Revenue Code	636
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$25.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.72

FML FORTE 0.25% OPHTH/5ML

Facility

$71.00

Hospital Charge Code	60633007
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Oxford Commercial	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Commercial	$14.20
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

FML FORTE 0.25% OPHTH/5ML

Facility

$71.00

Hospital Charge Code	60633007
Hospital Revenue Code	250
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

FML LIQUIFILM 0.1% OPHTH

Facility

$434.16

Service Code	NDC 71776010005
Hospital Charge Code	60633008
Hospital Revenue Code	250
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$65.12
Rate for Payer: Qualcare PPO/HMO/WC	$65.12

FML LIQUIFILM 0.1% OPHTH

Facility

$434.16

Service Code	NDC 71776010005
Hospital Charge Code	60633008
Hospital Revenue Code	250
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$217.08
Rate for Payer: Aetna Commercial	$164.98
Rate for Payer: Aetna Medicare Advantage	$130.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.71
Rate for Payer: Cigna Commercial	$217.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.25
Rate for Payer: Oxford Commercial	$86.83
Rate for Payer: Qualcare PPO/HMO/WC	$65.12
Rate for Payer: UnitedHealthcare Commercial	$86.83
Rate for Payer: UnitedHealthcare Community & State	$10.46
Rate for Payer: Wellpoint Medicaid Managed Care	$11.51

FML S.O.P. 0.1%/3.5GM

Facility

$84.00

Hospital Charge Code	60633009
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

FML S.O.P. 0.1%/3.5GM

Facility

$84.00

Hospital Charge Code	60633009
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

FML-S OPHTHALMIC SOLUTION

Facility

$51.00

Hospital Charge Code	60634915
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

Know your out-of-pocket cost for care.

All Charges