Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 25 MG SUPP

Facility

$64.72

Service Code	NDC 65649041124
Hospital Charge Code	60628397
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$32.36
Rate for Payer: Aetna Commercial	$24.59
Rate for Payer: Aetna Medicare Advantage	$19.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.50
Rate for Payer: Cigna Commercial	$32.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.42
Rate for Payer: Oxford Commercial	$12.94
Rate for Payer: Qualcare PPO/HMO/WC	$9.71
Rate for Payer: UnitedHealthcare Commercial	$12.94
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

HYDROCORTISONE 2.5% OIN

Facility

$77.99

Service Code	NDC 168014630
Hospital Charge Code	60628396
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$38.99
Rate for Payer: Aetna Commercial	$29.64
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.89
Rate for Payer: Cigna Commercial	$38.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$15.60
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

HYDROCORTISONE 2.5% OIN

Facility

$77.99

Service Code	NDC 168014630
Hospital Charge Code	60628396
Hospital Revenue Code	250
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

HYDROCORTISONE 2.5% OINT

Facility

$33.23

Service Code	NDC 45802001402
Hospital Charge Code	60635805
Hospital Revenue Code	250
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$4.98
Rate for Payer: Qualcare PPO/HMO/WC	$4.98

HYDROCORTISONE 2.5% OINT

Facility

$33.23

Service Code	NDC 45802001402
Hospital Charge Code	60635805
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.61
Rate for Payer: Aetna Commercial	$12.63
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.47
Rate for Payer: Cigna Commercial	$16.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Oxford Commercial	$6.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.98
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

HYDROCORTISONE 5 MG TAB

Facility

$4.36

Service Code	NDC 9001201
Hospital Charge Code	60628195
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

HYDROCORTISONE 5 MG TAB

Facility

$4.36

Service Code	NDC 9001201
Hospital Charge Code	60628195
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.66
Rate for Payer: Aetna Medicare Advantage	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.11
Rate for Payer: Cigna Commercial	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.31
Rate for Payer: Oxford Commercial	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.65
Rate for Payer: UnitedHealthcare Commercial	$0.87
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

HYDROCORTISONE OINT 0.2%/15GM

Facility

$659.28

Service Code	NDC 45802045535
Hospital Charge Code	60628866
Hospital Revenue Code	250
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$329.64
Rate for Payer: Aetna Commercial	$250.53
Rate for Payer: Aetna Medicare Advantage	$197.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.12
Rate for Payer: Cigna Commercial	$329.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.78
Rate for Payer: Oxford Commercial	$131.86
Rate for Payer: Qualcare PPO/HMO/WC	$98.89
Rate for Payer: UnitedHealthcare Commercial	$131.86
Rate for Payer: UnitedHealthcare Community & State	$15.89
Rate for Payer: Wellpoint Medicaid Managed Care	$17.47

HYDROCORTISONE OINT 0.2%/15GM

Facility

$659.28

Service Code	NDC 45802045535
Hospital Charge Code	60628866
Hospital Revenue Code	250
Min. Negotiated Rate	$98.89
Max. Negotiated Rate	$98.89
Rate for Payer: Qualcare PPO/HMO/WC	$98.89

HYDROCORTISONE-PRAMOXINE FOAM

Facility

$1,006.21

Service Code	NDC 37682210
Hospital Charge Code	6007397
Hospital Revenue Code	251
Min. Negotiated Rate	$24.25
Max. Negotiated Rate	$503.11
Rate for Payer: Aetna Commercial	$382.36
Rate for Payer: Aetna Medicare Advantage	$301.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.58
Rate for Payer: Cigna Commercial	$503.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.86
Rate for Payer: Oxford Commercial	$201.24
Rate for Payer: Qualcare PPO/HMO/WC	$150.93
Rate for Payer: UnitedHealthcare Commercial	$201.24
Rate for Payer: UnitedHealthcare Community & State	$24.25
Rate for Payer: Wellpoint Medicaid Managed Care	$26.66

HYDROCORTISONE-PRAMOXINE FOAM

Facility

$1,006.21

Service Code	NDC 37682210
Hospital Charge Code	6007397
Hospital Revenue Code	251
Min. Negotiated Rate	$150.93
Max. Negotiated Rate	$150.93
Rate for Payer: Qualcare PPO/HMO/WC	$150.93

HYDROCORTISONE SUCC 250MG VIAL

Facility

$127.57

Service Code	HCPCS J1720
Hospital Charge Code	6063943206
Hospital Revenue Code	636
Min. Negotiated Rate	$19.14
Max. Negotiated Rate	$30.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.87
Rate for Payer: Qualcare PPO/HMO/WC	$19.14

HYDROCORTISONE SUCC 250MG VIAL

Facility

$127.57

Service Code	HCPCS J1720
Hospital Charge Code	6063943206
Hospital Revenue Code	636
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$63.78
Rate for Payer: Aetna Commercial	$48.48
Rate for Payer: Aetna Medicare Advantage	$38.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.53
Rate for Payer: Cigna Commercial	$63.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.87
Rate for Payer: Qualcare PPO/HMO/WC	$19.14
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.38

HYDROCORT LOT 1%

Facility

$73.00

Hospital Charge Code	60628391
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

HYDROCORT LOT 1%

Facility

$73.00

Hospital Charge Code	60628391
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

HYDROCORT NEO PLY BAC 3.5GM ON

Facility

$109.45

Hospital Charge Code	6002893
Hospital Revenue Code	251
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

HYDROCORT NEO PLY BAC 3.5GM ON

Facility

$109.45

Hospital Charge Code	6002893
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

HYDROCORT NEO POLY CRM 7.5GM

Facility

$19.25

Hospital Charge Code	6002851
Hospital Revenue Code	251
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

HYDROCORT NEO POLY CRM 7.5GM

Facility

$19.25

Hospital Charge Code	6002851
Hospital Revenue Code	251
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

HYDROCORT NEO POLY OINT 15GM

Facility

$64.00

Hospital Charge Code	6002869
Hospital Revenue Code	251
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

HYDROCORT NEO POLY OINT 15GM

Facility

$64.00

Hospital Charge Code	6002869
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 NEO POLY OPHT 7.5ML

Facility

$109.45

Hospital Charge Code	6002877
Hospital Revenue Code	251
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

HYDROCORT NEO POLY OPHT 7.5ML

Facility

$109.45

Hospital Charge Code	6002877
Hospital Revenue Code	251
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

HYDROCORT NEO POLY OTIC 10ML

Facility

$86.40

Hospital Charge Code	6002885
Hospital Revenue Code	251
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

HYDROCORT NEO POLY OTIC 10ML

Facility

$86.40

Hospital Charge Code	6002885
Hospital Revenue Code	251
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.20
Rate for Payer: Aetna Commercial	$32.83
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.92
Rate for Payer: Oxford Commercial	$17.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$17.28
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

Know your out-of-pocket cost for care.

All Charges