Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDRATION INF EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96361
Hospital Charge Code	395096361
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

HYDRATION INF EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96361
Hospital Charge Code	2400618
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

HYDRATION INF EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96361
Hospital Charge Code	2250417
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

HYDRATION INF EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96361
Hospital Charge Code	100134
Hospital Revenue Code	260
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.81
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.56
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.78
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

HYDRATION INF EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96361
Hospital Charge Code	8200520
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

HYDRATION INF EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96361
Hospital Charge Code	73237020
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

HYDRATION INF EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96361
Hospital Charge Code	100137
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

HYDRATION INF EA ADDL HR

Facility

$331.87

Service Code	HCPCS 96361
Hospital Charge Code	73190091
Hospital Revenue Code	260
Min. Negotiated Rate	$49.78
Max. Negotiated Rate	$49.78
Rate for Payer: Qualcare PPO/HMO/WC	$49.78

HYDRATION IV INFUSION ADDON H1

Facility

$116.48

Service Code	HCPCS 90761
Hospital Charge Code	3701115
Hospital Revenue Code	260
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

HYDRATION IV INFUSION ADDON H1

Facility

$116.48

Service Code	HCPCS 90761
Hospital Charge Code	3701115
Hospital Revenue Code	260
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$44.26
Rate for Payer: Aetna Medicare Advantage	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.70
Rate for Payer: Cigna Commercial	$58.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$2.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

HYDRATION IV INFUSION ADDON H5

Facility

$116.48

Service Code	HCPCS 90761
Hospital Charge Code	3401135
Hospital Revenue Code	260
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$17.47
Rate for Payer: Qualcare PPO/HMO/WC	$17.47

HYDRATION IV INFUSION ADDON H5

Facility

$116.48

Service Code	HCPCS 90761
Hospital Charge Code	3401135
Hospital Revenue Code	260
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$919.00
Rate for Payer: Aetna Commercial	$44.26
Rate for Payer: Aetna Medicare Advantage	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.70
Rate for Payer: Cigna Commercial	$58.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.94
Rate for Payer: Oxford Commercial	$707.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.47
Rate for Payer: UnitedHealthcare Commercial	$919.00
Rate for Payer: UnitedHealthcare Community & State	$2.81
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

HYDRATOME RX 44

Facility

$2,029.75

Hospital Charge Code	270638446
Hospital Revenue Code	272
Min. Negotiated Rate	$304.46
Max. Negotiated Rate	$304.46
Rate for Payer: Qualcare PPO/HMO/WC	$304.46

HYDRATOME RX 44

Facility

$2,029.75

Hospital Charge Code	270638446
Hospital Revenue Code	272
Min. Negotiated Rate	$48.92
Max. Negotiated Rate	$1,014.88
Rate for Payer: Aetna Commercial	$771.30
Rate for Payer: Aetna Medicare Advantage	$608.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.59
Rate for Payer: Cigna Commercial	$1,014.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$608.92
Rate for Payer: Oxford Commercial	$405.95
Rate for Payer: Qualcare PPO/HMO/WC	$304.46
Rate for Payer: UnitedHealthcare Commercial	$405.95
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$53.79

HYDRATOME RX 44x20x 450cm

Facility

$2,257.50

Service Code	HCPCS C1769
Hospital Charge Code	270653660
Hospital Revenue Code	278
Min. Negotiated Rate	$54.41
Max. Negotiated Rate	$1,128.75
Rate for Payer: Aetna Commercial	$857.85
Rate for Payer: Aetna Medicare Advantage	$677.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.66
Rate for Payer: Cigna Commercial	$1,128.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.65
Rate for Payer: Qualcare PPO/HMO/WC	$338.62
Rate for Payer: UnitedHealthcare Community & State	$54.41
Rate for Payer: Wellpoint Medicaid Managed Care	$59.82

HYDRATOME RX 44x20x 450cm

Facility

$2,257.50

Service Code	HCPCS C1769
Hospital Charge Code	270653660
Hospital Revenue Code	278
Min. Negotiated Rate	$338.62
Max. Negotiated Rate	$546.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$546.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.65
Rate for Payer: Qualcare PPO/HMO/WC	$338.62

HYDRAWIRE JAG SUPER STIFF

Facility

$2,945.00

Hospital Charge Code	270637106
Hospital Revenue Code	272
Min. Negotiated Rate	$70.97
Max. Negotiated Rate	$1,472.50
Rate for Payer: Aetna Commercial	$1,119.10
Rate for Payer: Aetna Medicare Advantage	$883.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$750.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$750.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$750.98
Rate for Payer: Cigna Commercial	$1,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.50
Rate for Payer: Oxford Commercial	$589.00
Rate for Payer: Qualcare PPO/HMO/WC	$441.75
Rate for Payer: UnitedHealthcare Commercial	$589.00
Rate for Payer: UnitedHealthcare Community & State	$70.97
Rate for Payer: Wellpoint Medicaid Managed Care	$78.04

HYDRAWIRE JAG SUPER STIFF

Facility

$2,945.00

Hospital Charge Code	270637106
Hospital Revenue Code	272
Min. Negotiated Rate	$441.75
Max. Negotiated Rate	$441.75
Rate for Payer: Qualcare PPO/HMO/WC	$441.75

HYDRAWIRE ST TIP 0.035INX450CM

Facility

$862.50

Service Code	HCPCS C1769
Hospital Charge Code	270689958
Hospital Revenue Code	278
Min. Negotiated Rate	$129.38
Max. Negotiated Rate	$208.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.75
Rate for Payer: Qualcare PPO/HMO/WC	$129.38

HYDRAWIRE ST TIP 0.035INX450CM

Facility

$862.50

Service Code	HCPCS C1769
Hospital Charge Code	270689958
Hospital Revenue Code	278
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) NJ Health	$172.50
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	$208.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.75
Rate for Payer: Qualcare PPO/HMO/WC	$129.38
Rate for Payer: UnitedHealthcare Community & State	$20.79
Rate for Payer: Wellpoint Medicaid Managed Care	$22.86

HYDROCAM CANNULA SYSTEM DISP

Facility

$650.00

Service Code	HCPCS A4649
Hospital Charge Code	270698071
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

HYDROCAM CANNULA SYSTEM DISP

Facility

$650.00

Service Code	HCPCS A4649
Hospital Charge Code	270698071
Hospital Revenue Code	272
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

HYDROCHLOROTHIAZIDE 12.5M

Facility

$1.00

Hospital Charge Code	60635468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

HYDROCHLOROTHIAZIDE 12.5M

Facility

$1.00

Hospital Charge Code	60635468
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

HYDROCHLOROTHIAZIDE 12.5MG CAP

Facility

$5.49

Service Code	NDC 16729018201
Hospital Charge Code	60629943
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Qualcare PPO/HMO/WC	$0.82

Know your out-of-pocket cost for care.

All Charges