Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FOSAMAX, 70MG TABLET

Facility

$25.00

Hospital Charge Code	60635417
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

FOSAMAX, 70MG TABLET

Facility

$25.00

Hospital Charge Code	60635417
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

FOSAMAX TABS

Facility

$9.00

Hospital Charge Code	60635068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

FOSAMAX TABS

Facility

$9.00

Hospital Charge Code	60635068
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FOSAPREPITANT DIMEGLUMIN 150MG

Facility

$2,065.95

Service Code	HCPCS J1453
Hospital Charge Code	60630084
Hospital Revenue Code	636
Min. Negotiated Rate	$309.89
Max. Negotiated Rate	$499.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.96
Rate for Payer: Qualcare PPO/HMO/WC	$309.89

FOSAPREPITANT DIMEGLUMIN 150MG

Facility

$2,065.95

Service Code	HCPCS J1453
Hospital Charge Code	60630084
Hospital Revenue Code	636
Min. Negotiated Rate	$49.79
Max. Negotiated Rate	$1,032.97
Rate for Payer: Aetna Commercial	$785.06
Rate for Payer: Aetna Medicare Advantage	$619.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.82
Rate for Payer: Cigna Commercial	$1,032.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.96
Rate for Payer: Qualcare PPO/HMO/WC	$309.89
Rate for Payer: UnitedHealthcare Community & State	$49.79
Rate for Payer: Wellpoint Medicaid Managed Care	$54.75

FOSCAVIR INJ

Facility

$994.00

Hospital Charge Code	60635090
Hospital Revenue Code	636
Min. Negotiated Rate	$23.96
Max. Negotiated Rate	$497.00
Rate for Payer: Aetna Commercial	$377.72
Rate for Payer: Aetna Medicare Advantage	$298.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.47
Rate for Payer: Cigna Commercial	$497.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.55
Rate for Payer: Qualcare PPO/HMO/WC	$149.10
Rate for Payer: UnitedHealthcare Community & State	$23.96
Rate for Payer: Wellpoint Medicaid Managed Care	$26.34

FOSCAVIR INJ

Facility

$994.00

Hospital Charge Code	60635090
Hospital Revenue Code	636
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$240.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.55
Rate for Payer: Qualcare PPO/HMO/WC	$149.10

FOSFOMYCIN 3G

Facility

$267.45

Hospital Charge Code	60630235
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$133.72
Rate for Payer: Aetna Commercial	$101.63
Rate for Payer: Aetna Medicare Advantage	$80.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.20
Rate for Payer: Cigna Commercial	$133.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.23
Rate for Payer: Oxford Commercial	$53.49
Rate for Payer: Qualcare PPO/HMO/WC	$40.12
Rate for Payer: UnitedHealthcare Commercial	$53.49
Rate for Payer: UnitedHealthcare Community & State	$6.45
Rate for Payer: Wellpoint Medicaid Managed Care	$7.09

FOSFOMYCIN 3G

Facility

$267.45

Hospital Charge Code	60630235
Hospital Revenue Code	250
Min. Negotiated Rate	$40.12
Max. Negotiated Rate	$40.12
Rate for Payer: Qualcare PPO/HMO/WC	$40.12

FOSFOMYCIN 3GM PACKET

Facility

$486.49

Service Code	NDC 456430001
Hospital Charge Code	6063943345
Hospital Revenue Code	250
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$72.97
Rate for Payer: Qualcare PPO/HMO/WC	$72.97

FOSFOMYCIN 3GM PACKET

Facility

$486.49

Service Code	NDC 456430001
Hospital Charge Code	6063943345
Hospital Revenue Code	250
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$243.25
Rate for Payer: Aetna Commercial	$184.87
Rate for Payer: Aetna Medicare Advantage	$145.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.05
Rate for Payer: Cigna Commercial	$243.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.95
Rate for Payer: Oxford Commercial	$97.30
Rate for Payer: Qualcare PPO/HMO/WC	$72.97
Rate for Payer: UnitedHealthcare Commercial	$97.30
Rate for Payer: UnitedHealthcare Community & State	$11.72
Rate for Payer: Wellpoint Medicaid Managed Care	$12.89

FOSINOPRIL 10 MG TAB

Facility

$9.65

Hospital Charge Code	60627566
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

FOSINOPRIL 10 MG TAB

Facility

$9.65

Hospital Charge Code	60627566
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

FOSINOPRIL 20 MG TAB

Facility

$9.65

Hospital Charge Code	60627567
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

FOSINOPRIL 20 MG TAB

Facility

$9.65

Hospital Charge Code	60627567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

FOSINOPRIL SODIUM TAB 10MG

Facility

$7.70

Hospital Charge Code	6017941
Hospital Revenue Code	252
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

FOSINOPRIL SODIUM TAB 10MG

Facility

$7.70

Hospital Charge Code	6017941
Hospital Revenue Code	252
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

FOSPHENYTOIN 100 MG/2ML INJ

Facility

$192.83

Service Code	HCPCS Q2009
Hospital Charge Code	6017610
Hospital Revenue Code	636
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$46.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.66
Rate for Payer: Qualcare PPO/HMO/WC	$28.92

FOSPHENYTOIN 100 MG/2ML INJ

Facility

$192.83

Service Code	HCPCS Q2009
Hospital Charge Code	6017610
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$46.66
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.80
Rate for Payer: Cigna Medicare Advantage	$1.33
Rate for Payer: Clover Medicare Advantage	$1.26
Rate for Payer: EmblemHealth Commercial	$3.99
Rate for Payer: Humana Medicare Advantage	$1.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.66
Rate for Payer: Qualcare PPO/HMO/WC	$28.92
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.33
Rate for Payer: Wellcare Medicare Advantage	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

FOSPHENYTOIN 500 MG/10ML INJ

Facility

$578.41

Service Code	HCPCS Q2009
Hospital Charge Code	6017628
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$139.98
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.80
Rate for Payer: Cigna Medicare Advantage	$1.33
Rate for Payer: Clover Medicare Advantage	$1.26
Rate for Payer: EmblemHealth Commercial	$3.99
Rate for Payer: Humana Medicare Advantage	$1.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.76
Rate for Payer: UnitedHealthcare Community & State	$13.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.33
Rate for Payer: Wellcare Medicare Advantage	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$15.33

FOSPHENYTOIN 500 MG/10ML INJ

Facility

$578.41

Service Code	HCPCS Q2009
Hospital Charge Code	6017628
Hospital Revenue Code	636
Min. Negotiated Rate	$86.76
Max. Negotiated Rate	$139.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.76

FP 1ST DEGREE INITIAL TREAT

Facility

$1,083.25

Service Code	HCPCS 16000
Hospital Charge Code	87502510
Hospital Revenue Code	761
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.98
Rate for Payer: Oxford Commercial	$216.65
Rate for Payer: Qualcare PPO/HMO/WC	$162.49
Rate for Payer: UnitedHealthcare Commercial	$216.65
Rate for Payer: UnitedHealthcare Community & State	$26.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$554.01
Rate for Payer: Wellpoint Medicaid Managed Care	$28.71

FP 1ST DEGREE INITIAL TREAT

Facility

$1,083.25

Service Code	HCPCS 16000
Hospital Charge Code	87502510
Hospital Revenue Code	761
Min. Negotiated Rate	$162.49
Max. Negotiated Rate	$162.49
Rate for Payer: Qualcare PPO/HMO/WC	$162.49

FP ARTHROCENTESIS INTER JOINT

Facility

$186.04

Service Code	HCPCS 20605
Hospital Charge Code	87502535
Hospital Revenue Code	761
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$1,316.35
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.81
Rate for Payer: Oxford Commercial	$37.21
Rate for Payer: Qualcare PPO/HMO/WC	$27.91
Rate for Payer: UnitedHealthcare Commercial	$37.21
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

Know your out-of-pocket cost for care.

All Charges