Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 100 MG INJ

Facility

$59.97

Service Code	HCPCS J1720
Hospital Charge Code	60628196
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$29.98
Rate for Payer: Aetna Commercial	$22.79
Rate for Payer: Aetna Medicare Advantage	$17.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.29
Rate for Payer: Cigna Commercial	$29.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

HYDROCORTISONE 100 MG INJ

Facility

$59.97

Service Code	HCPCS J1720
Hospital Charge Code	60628196
Hospital Revenue Code	636
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$14.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

HYDROCORTISONE 10 MG TAB

Facility

$7.30

Service Code	NDC 9003101
Hospital Charge Code	60628194
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

HYDROCORTISONE 10 MG TAB

Facility

$7.30

Service Code	NDC 9003101
Hospital Charge Code	60628194
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

HYDROCORTISONE 1%/30GM

Facility

$12.00

Hospital Charge Code	60633119
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

HYDROCORTISONE 1%/30GM

Facility

$12.00

Hospital Charge Code	60633119
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

HYDROCORTISONE 1% CREAM

Facility

$45.76

Service Code	NDC 472032126
Hospital Charge Code	60628390
Hospital Revenue Code	250
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

HYDROCORTISONE 1% CREAM

Facility

$45.76

Service Code	NDC 472032126
Hospital Charge Code	60628390
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$22.88
Rate for Payer: Aetna Commercial	$17.39
Rate for Payer: Aetna Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.67
Rate for Payer: Cigna Commercial	$22.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.73
Rate for Payer: Oxford Commercial	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$9.15
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

HYDROCORTISONE 1% OIN

Facility

$32.16

Service Code	NDC 168018131
Hospital Charge Code	60628392
Hospital Revenue Code	250
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$4.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.82

HYDROCORTISONE 1% OIN

Facility

$32.16

Service Code	NDC 168018131
Hospital Charge Code	60628392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.08
Rate for Payer: Aetna Commercial	$12.22
Rate for Payer: Aetna Medicare Advantage	$9.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.20
Rate for Payer: Cigna Commercial	$16.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.65
Rate for Payer: Oxford Commercial	$6.43
Rate for Payer: Qualcare PPO/HMO/WC	$4.82
Rate for Payer: UnitedHealthcare Commercial	$6.43
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

HYDROCORTISONE 1% PACKETS

Facility

$3.00

Hospital Charge Code	60634961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROCORTISONE 1% PACKETS

Facility

$3.00

Hospital Charge Code	60634961
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

HYDROCORTISONE 20 MG TAB

Facility

$7.30

Service Code	NDC 54505033310
Hospital Charge Code	60628813
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

HYDROCORTISONE 20 MG TAB

Facility

$7.30

Service Code	NDC 54505033310
Hospital Charge Code	60628813
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

HYDROCORTISONE/20MG/TAB

Facility

$3.00

Hospital Charge Code	60633117
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROCORTISONE/20MG/TAB

Facility

$3.00

Hospital Charge Code	60633117
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

HYDROCORTISONE 2.5%/20GM

Facility

$23.00

Hospital Charge Code	60633120
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

HYDROCORTISONE 2.5%/20GM

Facility

$23.00

Hospital Charge Code	60633120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

HYDROCORTISONE 2.5%/30GM

Facility

$27.00

Hospital Charge Code	60633121
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

HYDROCORTISONE 2.5%/30GM

Facility

$27.00

Hospital Charge Code	60633121
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

HYDROCORTISONE 2.5% CREAM

Facility

$32.83

Service Code	NDC 45802000402
Hospital Charge Code	6063943316
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.41
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$9.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.37
Rate for Payer: Cigna Commercial	$16.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.85
Rate for Payer: Oxford Commercial	$6.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.92
Rate for Payer: UnitedHealthcare Commercial	$6.57
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

HYDROCORTISONE 2.5% CREAM

Facility

$32.83

Service Code	NDC 45802000402
Hospital Charge Code	6063943316
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$4.92
Rate for Payer: Qualcare PPO/HMO/WC	$4.92

HYDROCORTISONE 2.5% LOTION

Facility

$348.60

Service Code	NDC 168028802
Hospital Charge Code	6063943112
Hospital Revenue Code	250
Min. Negotiated Rate	$52.29
Max. Negotiated Rate	$52.29
Rate for Payer: Qualcare PPO/HMO/WC	$52.29

HYDROCORTISONE 2.5% LOTION

Facility

$348.60

Service Code	NDC 168028802
Hospital Charge Code	6063943112
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$174.30
Rate for Payer: Aetna Commercial	$132.47
Rate for Payer: Aetna Medicare Advantage	$104.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.89
Rate for Payer: Cigna Commercial	$174.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.58
Rate for Payer: Oxford Commercial	$69.72
Rate for Payer: Qualcare PPO/HMO/WC	$52.29
Rate for Payer: UnitedHealthcare Commercial	$69.72
Rate for Payer: UnitedHealthcare Community & State	$8.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9.24

HYDROCORTISONE 25 MG SUPP

Facility

$64.72

Service Code	NDC 65649041124
Hospital Charge Code	60628397
Hospital Revenue Code	250
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$9.71
Rate for Payer: Qualcare PPO/HMO/WC	$9.71

Know your out-of-pocket cost for care.

All Charges