Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYALURONIDASE INJ 150U/1ML****

Facility

$79.00

Service Code	HCPCS J3470
Hospital Charge Code	60627983
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$39.50
Rate for Payer: Aetna Commercial	$30.02
Rate for Payer: Aetna Medicare Advantage	$23.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.14
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.12
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Community & State	$1.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

HYALURONIDASE INJ 150U/ML 10ML

Facility

$152.00

Hospital Charge Code	6002802
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$57.76
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

HYALURONIDASE INJ 150U/ML 10ML

Facility

$152.00

Hospital Charge Code	6002802
Hospital Revenue Code	250
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

HYALURONIDASE VIAL 150 UNIT

Facility

$75.00

Hospital Charge Code	6015002
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

HYALURONIDASE VIAL 150 UNIT

Facility

$75.00

Hospital Charge Code	6015002
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

HYBRID KNEE FIBER TAK

Facility

$2,703.75

Service Code	HCPCS C1713
Hospital Charge Code	270703168
Hospital Revenue Code	278
Min. Negotiated Rate	$405.56
Max. Negotiated Rate	$654.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$594.83
Rate for Payer: Qualcare PPO/HMO/WC	$405.56

HYBRID KNEE FIBER TAK

Facility

$2,703.75

Service Code	HCPCS C1713
Hospital Charge Code	270703168
Hospital Revenue Code	278
Min. Negotiated Rate	$65.16
Max. Negotiated Rate	$1,351.88
Rate for Payer: Aetna Commercial	$1,027.42
Rate for Payer: Aetna Medicare Advantage	$811.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$689.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$689.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$689.46
Rate for Payer: Cigna Commercial	$1,351.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$594.83
Rate for Payer: Qualcare PPO/HMO/WC	$405.56
Rate for Payer: UnitedHealthcare Community & State	$65.16
Rate for Payer: Wellpoint Medicaid Managed Care	$71.65

HYBRID VASCULAR GRAFT 5 X 8 MM

Facility

$12,555.00

Service Code	HCPCS C1768
Hospital Charge Code	270659424
Hospital Revenue Code	278
Min. Negotiated Rate	$1,883.25
Max. Negotiated Rate	$3,038.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,511.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,038.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,762.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,883.25

HYBRID VASCULAR GRAFT 5 X 8 MM

Facility

$12,555.00

Service Code	HCPCS C1768
Hospital Charge Code	270659424
Hospital Revenue Code	278
Min. Negotiated Rate	$302.58
Max. Negotiated Rate	$6,277.50
Rate for Payer: Aetna Commercial	$4,770.90
Rate for Payer: Aetna Medicare Advantage	$3,766.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,201.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,201.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,511.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,201.53
Rate for Payer: Cigna Commercial	$6,277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,038.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,762.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,883.25
Rate for Payer: UnitedHealthcare Community & State	$302.58
Rate for Payer: Wellpoint Medicaid Managed Care	$332.71

HYCAMTIN 4MG VIAL

Facility

$1,662.00

Hospital Charge Code	60635233
Hospital Revenue Code	636
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$831.00
Rate for Payer: Aetna Commercial	$631.56
Rate for Payer: Aetna Medicare Advantage	$498.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.81
Rate for Payer: Cigna Commercial	$831.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.20
Rate for Payer: Qualcare PPO/HMO/WC	$249.30
Rate for Payer: UnitedHealthcare Community & State	$40.05
Rate for Payer: Wellpoint Medicaid Managed Care	$44.04

HYCAMTIN 4MG VIAL

Facility

$1,662.00

Hospital Charge Code	60635233
Hospital Revenue Code	636
Min. Negotiated Rate	$249.30
Max. Negotiated Rate	$402.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.20
Rate for Payer: Qualcare PPO/HMO/WC	$249.30

HYCODAN SYRUP/5ML/U/D

Facility

$3.00

Hospital Charge Code	60634973
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYCODAN SYRUP/5ML/U/D

Facility

$3.00

Hospital Charge Code	60634973
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

HYCOMINE 25-5/480ML

Facility

$290.00

Hospital Charge Code	60633101
Hospital Revenue Code	250
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

HYCOMINE 25-5/480ML

Facility

$290.00

Hospital Charge Code	60633101
Hospital Revenue Code	250
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$110.20
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.00
Rate for Payer: Oxford Commercial	$58.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$58.00
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

HYCOMINE PEDIATRIC 12.5/2

Facility

$250.00

Hospital Charge Code	60633100
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

HYCOMINE PEDIATRIC 12.5/2

Facility

$250.00

Hospital Charge Code	60633100
Hospital Revenue Code	250
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HYDELTRA-T.B.A./20MG/1ML

Facility

$118.00

Hospital Charge Code	60633102
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

HYDELTRA-T.B.A./20MG/1ML

Facility

$118.00

Hospital Charge Code	60633102
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$59.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.40
Rate for Payer: Oxford Commercial	$23.60
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$23.60
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

HYDERGINE/1MG/1ML

Facility

$69.00

Hospital Charge Code	60633103
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

HYDERGINE/1MG/1ML

Facility

$69.00

Hospital Charge Code	60633103
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

HYDERGINE LC/1MG/CAP

Facility

$3.00

Hospital Charge Code	60633104
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

HYDERGINE LC/1MG/CAP

Facility

$3.00

Hospital Charge Code	60633104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDERGINE SL/0.5MG/TAB

Facility

$3.00

Hospital Charge Code	60634642
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDERGINE SL/0.5MG/TAB

Facility

$3.00

Hospital Charge Code	60634642
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

Know your out-of-pocket cost for care.

All Charges