Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FURADANTIN/25MG/5ML

Facility

$69.00

Hospital Charge Code	60633019
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$13.80
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

FUROSEMIDE 100 MG/10ML INJ

Facility

$18.83

Service Code	HCPCS J1941
Hospital Charge Code	60627964
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.41
Rate for Payer: Aetna Commercial	$7.16
Rate for Payer: Aetna Medicare Advantage	$5.65
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) PPO	$4.80
Rate for Payer: Cigna Commercial	$9.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.82
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

FUROSEMIDE 100 MG/10ML INJ

Facility

$18.83

Service Code	HCPCS J1941
Hospital Charge Code	60627964
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$4.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.82

FUROSEMIDE/10MG/1ML

Facility

$7.00

Hospital Charge Code	60633025
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

FUROSEMIDE/10MG/1ML

Facility

$8.00

Hospital Charge Code	60633027
Hospital Revenue Code	636
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

FUROSEMIDE/10MG/1ML

Facility

$8.00

Hospital Charge Code	60633027
Hospital Revenue Code	636
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

FUROSEMIDE/10MG/1ML

Facility

$13.00

Hospital Charge Code	60633026
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

FUROSEMIDE/10MG/1ML

Facility

$7.00

Hospital Charge Code	60633025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

FUROSEMIDE/10MG/1ML

Facility

$13.00

Hospital Charge Code	60633026
Hospital Revenue Code	636
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$3.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

FUROSEMIDE 10 MG/ML LIQ (60ML)

Facility

$60.97

Service Code	NDC 54329446
Hospital Charge Code	60627965
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

FUROSEMIDE 10 MG/ML LIQ (60ML)

Facility

$60.97

Service Code	NDC 54329446
Hospital Charge Code	60627965
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.48
Rate for Payer: Aetna Commercial	$23.17
Rate for Payer: Aetna Medicare Advantage	$18.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.29
Rate for Payer: Oxford Commercial	$12.19
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.19
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

FUROSEMIDE 20 MG/2ML INJ

Facility

$21.98

Service Code	HCPCS J1941
Hospital Charge Code	6002547
Hospital Revenue Code	636
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$10.99
Rate for Payer: Aetna Commercial	$8.35
Rate for Payer: Aetna Medicare Advantage	$6.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.60
Rate for Payer: Cigna Commercial	$10.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.30
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

FUROSEMIDE 20 MG/2ML INJ

Facility

$21.98

Service Code	HCPCS J1941
Hospital Charge Code	6002547
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$5.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.30

FUROSEMIDE 20 MG TAB

Facility

$4.00

Service Code	NDC 54829725
Hospital Charge Code	6023071
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

FUROSEMIDE 20 MG TAB

Facility

$4.00

Service Code	NDC 54829725
Hospital Charge Code	6023071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FUROSEMIDE/20MG/TAB

Facility

$4.00

Hospital Charge Code	60633020
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

FUROSEMIDE/20MG/TAB

Facility

$3.00

Hospital Charge Code	60633023
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

FUROSEMIDE/20MG/TAB

Facility

$4.00

Hospital Charge Code	60633020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FUROSEMIDE/20MG/TAB

Facility

$3.00

Hospital Charge Code	60633023
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FUROSEMIDE/40MG/4ML

Facility

$5.00

Hospital Charge Code	60633022
Hospital Revenue Code	636
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	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

FUROSEMIDE/40MG/4ML

Facility

$5.00

Hospital Charge Code	60633022
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

FUROSEMIDE 40 MG/4ML INJ

Facility

$14.67

Service Code	HCPCS J1941
Hospital Charge Code	60627967
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.33
Rate for Payer: Aetna Commercial	$5.57
Rate for Payer: Aetna Medicare Advantage	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.74
Rate for Payer: Cigna Commercial	$7.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

FUROSEMIDE 40 MG/4ML INJ

Facility

$14.67

Service Code	HCPCS J1941
Hospital Charge Code	60627967
Hospital Revenue Code	636
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.20

FUROSEMIDE 40MG/4ML ORAL SOLN

Facility

$16.48

Service Code	NDC 68094075659
Hospital Charge Code	606380020
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$6.26
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$3.30
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

FUROSEMIDE 40MG/4ML ORAL SOLN

Facility

$16.48

Service Code	NDC 68094075659
Hospital Charge Code	606380020
Hospital Revenue Code	250
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

Know your out-of-pocket cost for care.

All Charges