Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDROGEN PEROXIDE 3% SOLN

Facility

$105.26

Service Code	NDC 49348003138
Hospital Charge Code	60628351
Hospital Revenue Code	250
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$15.79
Rate for Payer: Qualcare PPO/HMO/WC	$15.79

HYDROGLIDE WIRE

Facility

$73.50

Hospital Charge Code	270702095
Hospital Revenue Code	278
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna Commercial	$27.93
Rate for Payer: Aetna Medicare Advantage	$22.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.74
Rate for Payer: Cigna Commercial	$36.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.03
Rate for Payer: UnitedHealthcare Community & State	$1.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.95

HYDROGLIDE WIRE

Facility

$73.50

Hospital Charge Code	270702095
Hospital Revenue Code	278
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.03

HYDROLYSATE COLLAGEN WND FILL

Facility

$4,251.25

Service Code	HCPCS A6010
Hospital Charge Code	270695509
Hospital Revenue Code	272
Min. Negotiated Rate	$637.69
Max. Negotiated Rate	$637.69
Rate for Payer: Qualcare PPO/HMO/WC	$637.69

HYDROLYSATE COLLAGEN WND FILL

Facility

$4,251.25

Service Code	HCPCS A6010
Hospital Charge Code	270695509
Hospital Revenue Code	272
Min. Negotiated Rate	$102.46
Max. Negotiated Rate	$2,125.62
Rate for Payer: Aetna Commercial	$1,615.47
Rate for Payer: Aetna Medicare Advantage	$1,275.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,084.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,084.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,084.07
Rate for Payer: Cigna Commercial	$2,125.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,275.38
Rate for Payer: Oxford Commercial	$850.25
Rate for Payer: Qualcare PPO/HMO/WC	$637.69
Rate for Payer: UnitedHealthcare Commercial	$850.25
Rate for Payer: UnitedHealthcare Community & State	$102.46
Rate for Payer: Wellpoint Medicaid Managed Care	$112.66

HYDROMORPHONE 0.2 MG/ML (25ML)

Facility

$84.82

Service Code	HCPCS J1171
Hospital Charge Code	60629207
Hospital Revenue Code	636
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$20.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$12.72

HYDROMORPHONE 0.2 MG/ML (25ML)

Facility

$84.82

Service Code	HCPCS J1171
Hospital Charge Code	60629207
Hospital Revenue Code	636
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$42.41
Rate for Payer: Aetna Commercial	$32.23
Rate for Payer: Aetna Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.63
Rate for Payer: Cigna Commercial	$42.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$12.72
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

HYDROMORPHONE 0.2 MG/ML PCA

Facility

$67.00

Service Code	HCPCS J1171
Hospital Charge Code	6063943360
Hospital Revenue Code	636
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

HYDROMORPHONE 0.2 MG/ML PCA

Facility

$67.00

Service Code	HCPCS J1171
Hospital Charge Code	6063943360
Hospital Revenue Code	636
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

HYDROMORPHONE 0.5MG/0.5ML

Facility

$18.49

Service Code	HCPCS J1171
Hospital Charge Code	60630189
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.24
Rate for Payer: Aetna Commercial	$7.03
Rate for Payer: Aetna Medicare Advantage	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.71
Rate for Payer: Cigna Commercial	$9.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

HYDROMORPHONE 0.5MG/0.5ML

Facility

$18.49

Service Code	HCPCS J1171
Hospital Charge Code	60630189
Hospital Revenue Code	636
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$4.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

HYDROMORPHONE 1 MG/ML SYRINGE

Facility

$7.95

Service Code	HCPCS J1171
Hospital Charge Code	60630072
Hospital Revenue Code	636
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

HYDROMORPHONE 1 MG/ML SYRINGE

Facility

$7.95

Service Code	HCPCS J1171
Hospital Charge Code	60630072
Hospital Revenue Code	636
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna Medicare Advantage	$2.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.19
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

HYDROMORPHONE/2MG/1ML

Facility

$7.00

Hospital Charge Code	60633123
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

HYDROMORPHONE/2MG/1ML

Facility

$7.00

Hospital Charge Code	60633123
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

HYDROMORPHONE 2 MG/ML SYRINGE

Facility

$18.09

Service Code	HCPCS J1171
Hospital Charge Code	6012017
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.04
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna Medicare Advantage	$5.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.61
Rate for Payer: Cigna Commercial	$9.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

HYDROMORPHONE 2 MG/ML SYRINGE

Facility

$18.09

Service Code	HCPCS J1171
Hospital Charge Code	6012017
Hospital Revenue Code	636
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$4.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

HYDROMORPHONE 2 MG TAB

Facility

$13.74

Service Code	NDC 42858030125
Hospital Charge Code	6012116
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.06

HYDROMORPHONE 2 MG TAB

Facility

$13.74

Service Code	NDC 42858030125
Hospital Charge Code	6012116
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.87
Rate for Payer: Aetna Commercial	$5.22
Rate for Payer: Aetna Medicare Advantage	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.50
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.12
Rate for Payer: Oxford Commercial	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.06
Rate for Payer: UnitedHealthcare Commercial	$2.75
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

HYDROMORPHONE 30MG PCA

Facility

$85.00

Hospital Charge Code	60635704
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.50
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$17.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

HYDROMORPHONE 30MG PCA

Facility

$85.00

Hospital Charge Code	60635704
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

HYDROMORPHONE/4MG/1ML

Facility

$5.00

Hospital Charge Code	60633122
Hospital Revenue Code	636
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

HYDROMORPHONE/4MG/1ML

Facility

$5.00

Hospital Charge Code	60633122
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

HYDROMORPHONE 4 MG/ML SYRINGE

Facility

$7.64

Service Code	HCPCS J1171
Hospital Charge Code	60629024
Hospital Revenue Code	636
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$3.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

HYDROMORPHONE 4 MG/ML SYRINGE

Facility

$7.64

Service Code	HCPCS J1171
Hospital Charge Code	60629024
Hospital Revenue Code	636
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.85
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

Know your out-of-pocket cost for care.

All Charges