Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDROCOD HOMATROP 5MG/1.5MG/5M

Facility

$5.80

Hospital Charge Code	6011167
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.20
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

HYDROCOD HOMATROP 5MG/1.5MG/5M

Facility

$5.80

Hospital Charge Code	6011167
Hospital Revenue Code	251
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

HYDROCODONE

Facility

$324.00

Service Code	HCPCS 80361
Hospital Charge Code	38472025
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

HYDROCODONE

Facility

$324.00

Service Code	HCPCS 80361
Hospital Charge Code	38472025
Hospital Revenue Code	301
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$8.59

HYDROCODONE CHORPHENITRAM SUSP

Facility

$1.95

Hospital Charge Code	60627989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

HYDROCODONE CHORPHENITRAM SUSP

Facility

$1.95

Hospital Charge Code	60627989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

HYDROCODONE COMPOUND/480M

Facility

$56.00

Hospital Charge Code	60633116
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

HYDROCODONE COMPOUND/480M

Facility

$56.00

Hospital Charge Code	60633116
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

HYDROCODONE PHENYLTO SUSP 480M

Facility

$534.40

Hospital Charge Code	6002828
Hospital Revenue Code	252
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$267.20
Rate for Payer: Aetna Commercial	$203.07
Rate for Payer: Aetna Medicare Advantage	$160.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.27
Rate for Payer: Cigna Commercial	$267.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.32
Rate for Payer: Oxford Commercial	$106.88
Rate for Payer: Qualcare PPO/HMO/WC	$80.16
Rate for Payer: UnitedHealthcare Commercial	$106.88
Rate for Payer: UnitedHealthcare Community & State	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$14.16

HYDROCODONE PHENYLTO SUSP 480M

Facility

$534.40

Hospital Charge Code	6002828
Hospital Revenue Code	252
Min. Negotiated Rate	$80.16
Max. Negotiated Rate	$80.16
Rate for Payer: Qualcare PPO/HMO/WC	$80.16

HYDROCODONE SYRP(HYCODAN)

Facility

$293.00

Hospital Charge Code	60634413
Hospital Revenue Code	250
Min. Negotiated Rate	$7.06
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.90
Rate for Payer: Oxford Commercial	$58.60
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$58.60
Rate for Payer: UnitedHealthcare Community & State	$7.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

HYDROCODONE SYRP(HYCODAN)

Facility

$293.00

Hospital Charge Code	60634413
Hospital Revenue Code	250
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

HYDROCODONE, URINE

Facility

$164.00

Service Code	HCPCS 80361
Hospital Charge Code	38478099
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.32
Rate for Payer: Aetna Medicare Advantage	$49.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.82
Rate for Payer: Cigna Commercial	$82.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

HYDROCODONE, URINE

Facility

$164.00

Service Code	HCPCS 80361
Hospital Charge Code	38478099
Hospital Revenue Code	301
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

HYDROCOD PSEUDOEPH LIQ PT

Facility

$122.90

Hospital Charge Code	6002836
Hospital Revenue Code	251
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$46.70
Rate for Payer: Aetna Medicare Advantage	$36.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.34
Rate for Payer: Cigna Commercial	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Oxford Commercial	$24.58
Rate for Payer: Qualcare PPO/HMO/WC	$18.43
Rate for Payer: UnitedHealthcare Commercial	$24.58
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

HYDROCOD PSEUDOEPH LIQ PT

Facility

$122.90

Hospital Charge Code	6002836
Hospital Revenue Code	251
Min. Negotiated Rate	$18.43
Max. Negotiated Rate	$18.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.43

HYDROCORT AUTIC ACID O.S

Facility

$19.85

Hospital Charge Code	6016240
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

HYDROCORT AUTIC ACID O.S

Facility

$19.85

Hospital Charge Code	6016240
Hospital Revenue Code	251
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

HYDROCORT CRM 0.2%

Facility

$276.00

Hospital Charge Code	60628398
Hospital Revenue Code	250
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

HYDROCORT CRM 0.2%

Facility

$276.00

Hospital Charge Code	60628398
Hospital Revenue Code	250
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$104.88
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.80
Rate for Payer: Oxford Commercial	$55.20
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$55.20
Rate for Payer: UnitedHealthcare Community & State	$6.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.31

HYDROCORT CRM 0.2% 15GM

Facility

$287.97

Service Code	NDC 45802045535
Hospital Charge Code	60628625
Hospital Revenue Code	250
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$143.99
Rate for Payer: Aetna Commercial	$109.43
Rate for Payer: Aetna Medicare Advantage	$86.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.43
Rate for Payer: Cigna Commercial	$143.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.39
Rate for Payer: Oxford Commercial	$57.59
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$57.59
Rate for Payer: UnitedHealthcare Community & State	$6.94
Rate for Payer: Wellpoint Medicaid Managed Care	$7.63

HYDROCORT CRM 0.2% 15GM

Facility

$287.97

Service Code	NDC 45802045535
Hospital Charge Code	60628625
Hospital Revenue Code	250
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

HYDROCORT CRM 0.5% 28GM

Facility

$36.85

Service Code	NDC 168001431
Hospital Charge Code	6002935
Hospital Revenue Code	251
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.43
Rate for Payer: Aetna Commercial	$14.00
Rate for Payer: Aetna Medicare Advantage	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.40
Rate for Payer: Cigna Commercial	$18.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.53
Rate for Payer: UnitedHealthcare Commercial	$7.37
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

HYDROCORT CRM 0.5% 28GM

Facility

$36.85

Service Code	NDC 168001431
Hospital Charge Code	6002935
Hospital Revenue Code	251
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.53

HYDROCORT CRM 1% 28GM

Facility

$10.90

Hospital Charge Code	6002943
Hospital Revenue Code	251
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

Know your out-of-pocket cost for care.

All Charges