Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDROCORT CRM 1% 28GM

Facility

$10.90

Hospital Charge Code	6002943
Hospital Revenue Code	251
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

HYDROCORT CRM 2.5%

Facility

$585.11

Service Code	NDC 64980030130
Hospital Charge Code	60628395
Hospital Revenue Code	250
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$292.56
Rate for Payer: Aetna Commercial	$222.34
Rate for Payer: Aetna Medicare Advantage	$175.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.20
Rate for Payer: Cigna Commercial	$292.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.53
Rate for Payer: Oxford Commercial	$117.02
Rate for Payer: Qualcare PPO/HMO/WC	$87.77
Rate for Payer: UnitedHealthcare Commercial	$117.02
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: Wellpoint Medicaid Managed Care	$15.51

HYDROCORT CRM 2.5%

Facility

$585.11

Service Code	NDC 64980030130
Hospital Charge Code	60628395
Hospital Revenue Code	250
Min. Negotiated Rate	$87.77
Max. Negotiated Rate	$87.77
Rate for Payer: Qualcare PPO/HMO/WC	$87.77

HYDROCORT CRM 2.5%

Facility

$67.20

Hospital Charge Code	60628394
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna Commercial	$25.54
Rate for Payer: Aetna Medicare Advantage	$20.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.14
Rate for Payer: Cigna Commercial	$33.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.16
Rate for Payer: Oxford Commercial	$13.44
Rate for Payer: Qualcare PPO/HMO/WC	$10.08
Rate for Payer: UnitedHealthcare Commercial	$13.44
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

HYDROCORT CRM 2.5%

Facility

$67.20

Hospital Charge Code	60628394
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$10.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.08

HYDROCORT CRM 2.5% 28GM

Facility

$5.80

Hospital Charge Code	6002950
Hospital Revenue Code	251
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

HYDROCORT CRM 2.5% 28GM

Facility

$5.80

Hospital Charge Code	6002950
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

HYDROCORT DIBUCNE REC CRM 28GM

Facility

$53.80

Hospital Charge Code	6002968
Hospital Revenue Code	251
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

HYDROCORT DIBUCNE REC CRM 28GM

Facility

$53.80

Hospital Charge Code	6002968
Hospital Revenue Code	251
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

HYDROCORT ENEMA 100MG/60ML

Facility

$48.00

Hospital Charge Code	6002927
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

HYDROCORT ENEMA 100MG/60ML

Facility

$48.00

Hospital Charge Code	6002927
Hospital Revenue Code	251
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

HYDROCORT ENEMA 100MG/60ML

Facility

$81.20

Service Code	NDC 51991072867
Hospital Charge Code	60628393
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$40.60
Rate for Payer: Aetna Commercial	$30.86
Rate for Payer: Aetna Medicare Advantage	$24.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.71
Rate for Payer: Cigna Commercial	$40.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.36
Rate for Payer: Oxford Commercial	$16.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.18
Rate for Payer: UnitedHealthcare Commercial	$16.24
Rate for Payer: UnitedHealthcare Community & State	$1.96
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

HYDROCORT ENEMA 100MG/60ML

Facility

$81.20

Service Code	NDC 51991072867
Hospital Charge Code	60628393
Hospital Revenue Code	250
Min. Negotiated Rate	$12.18
Max. Negotiated Rate	$12.18
Rate for Payer: Qualcare PPO/HMO/WC	$12.18

HYDROCORT HEMORR CRM 28GM

Facility

$64.00

Hospital Charge Code	6002844
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

HYDROCORT HEMORR CRM 28GM

Facility

$64.00

Hospital Charge Code	6002844
Hospital Revenue Code	251
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

HYDROCORT INJ 125MG/ML

Facility

$10.90

Hospital Charge Code	6002919
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.45
Rate for Payer: Aetna Commercial	$4.14
Rate for Payer: Aetna Medicare Advantage	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

HYDROCORT INJ 125MG/ML

Facility

$10.90

Hospital Charge Code	6002919
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

HYDROCORT INJ 50MG/ML 2ML

Facility

$15.40

Hospital Charge Code	6002901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

HYDROCORT INJ 50MG/ML 2ML

Facility

$15.40

Hospital Charge Code	6002901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

HYDROCORT IODOQUINOL CRM

Facility

$136.85

Hospital Charge Code	6002976
Hospital Revenue Code	252
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$68.42
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Medicare Advantage	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.90
Rate for Payer: Cigna Commercial	$68.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.05
Rate for Payer: Oxford Commercial	$27.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.53
Rate for Payer: UnitedHealthcare Commercial	$27.37
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

HYDROCORT IODOQUINOL CRM

Facility

$136.85

Hospital Charge Code	6002976
Hospital Revenue Code	252
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.53

HYDROCORTISONE 0.5%/30GM

Facility

$9.00

Hospital Charge Code	60633118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

HYDROCORTISONE 0.5%/30GM

Facility

$9.00

Hospital Charge Code	60633118
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

HYDROCORTISONE 0.5 % OIN

Facility

$26.53

Service Code	NDC 168001631
Hospital Charge Code	60628389
Hospital Revenue Code	250
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.98

HYDROCORTISONE 0.5 % OIN

Facility

$26.53

Service Code	NDC 168001631
Hospital Charge Code	60628389
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.27
Rate for Payer: Aetna Commercial	$10.08
Rate for Payer: Aetna Medicare Advantage	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.77
Rate for Payer: Cigna Commercial	$13.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.96
Rate for Payer: Oxford Commercial	$5.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.98
Rate for Payer: UnitedHealthcare Commercial	$5.31
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

Know your out-of-pocket cost for care.

All Charges