Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYD-JAG.035/450cmSTR M00556041

Facility

$1,975.00

Hospital Charge Code	270639824
Hospital Revenue Code	272
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.50
Rate for Payer: Oxford Commercial	$395.00
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$395.00
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$52.34

HYD-JAG.035/450cmSTR M00556041

Facility

$1,975.00

Hospital Charge Code	270639824
Hospital Revenue Code	272
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

HYDRA JAGWIRE 035260STRA 5600

Facility

$862.50

Hospital Charge Code	270634925
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$431.25
Rate for Payer: Aetna Commercial	$327.75
Rate for Payer: Aetna Medicare Advantage	$258.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.94
Rate for Payer: Cigna Commercial	$431.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.75
Rate for Payer: Oxford Commercial	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$129.38
Rate for Payer: UnitedHealthcare Commercial	$172.50
Rate for Payer: UnitedHealthcare Community & State	$20.79
Rate for Payer: Wellpoint Medicaid Managed Care	$22.86

HYDRA JAGWIRE 035260STRA 5600

Facility

$862.50

Hospital Charge Code	270634925
Hospital Revenue Code	270
Min. Negotiated Rate	$129.38
Max. Negotiated Rate	$129.38
Rate for Payer: Qualcare PPO/HMO/WC	$129.38

HYDRALAZINE/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633109
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE/100MG/TAB

Facility

$4.00

Hospital Charge Code	60633109
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

HYDRALAZINE 10 MG TAB

Facility

$4.00

Service Code	NDC 51079007420
Hospital Charge Code	60627632
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

HYDRALAZINE 10 MG TAB

Facility

$4.00

Service Code	NDC 51079007420
Hospital Charge Code	60627632
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDRALAZINE/10MG/TAB

Facility

$3.00

Hospital Charge Code	60633106
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

HYDRALAZINE 12.5MG TAB

Facility

$4.00

Service Code	NDC 62584073301
Hospital Charge Code	60635654
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE 12.5MG TAB

Facility

$4.00

Service Code	NDC 62584073301
Hospital Charge Code	60635654
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

HYDRALAZINE 20 MG/ML LNJ

Facility

$125.63

Service Code	HCPCS J0360
Hospital Charge Code	60628966
Hospital Revenue Code	636
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$62.81
Rate for Payer: Aetna Commercial	$47.74
Rate for Payer: Aetna Medicare Advantage	$37.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.04
Rate for Payer: Cigna Commercial	$62.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.84
Rate for Payer: UnitedHealthcare Community & State	$3.03
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

HYDRALAZINE 20 MG/ML LNJ

Facility

$125.63

Service Code	HCPCS J0360
Hospital Charge Code	60628966
Hospital Revenue Code	636
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$30.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.84

HYDRALAZINE 25 MG TAB

Facility

$4.15

Service Code	NDC 63739012610
Hospital Charge Code	60627633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

HYDRALAZINE 25 MG TAB

Facility

$4.15

Service Code	NDC 63739012610
Hospital Charge Code	60627633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna Medicare Advantage	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.06
Rate for Payer: Cigna Commercial	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$0.83
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HYDRALAZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633105
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

HYDRALAZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDRALAZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633107
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

HYDRALAZINE/25MG/TAB

Facility

$3.00

Hospital Charge Code	60633107
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDRALAZINE 50 MG TAB

Facility

$4.00

Service Code	NDC 50111032801
Hospital Charge Code	60627634
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDRALAZINE 50 MG TAB

Facility

$4.00

Service Code	NDC 50111032801
Hospital Charge Code	60627634
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

HYDRALAZINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633108
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

HYDRALAZINE/50MG/TAB

Facility

$3.00

Hospital Charge Code	60633108
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDRALAZINE INJ 20MG

Facility

$115.85

Hospital Charge Code	6009252
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$57.92
Rate for Payer: Aetna Commercial	$44.02
Rate for Payer: Aetna Medicare Advantage	$34.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.54
Rate for Payer: Cigna Commercial	$57.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.76
Rate for Payer: Oxford Commercial	$23.17
Rate for Payer: Qualcare PPO/HMO/WC	$17.38
Rate for Payer: UnitedHealthcare Commercial	$23.17
Rate for Payer: UnitedHealthcare Community & State	$2.79
Rate for Payer: Wellpoint Medicaid Managed Care	$3.07

Know your out-of-pocket cost for care.

All Charges