Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDROMORPHONE 4 MG TAB

Facility

$4.00

Service Code	NDC 42858030225
Hospital Charge Code	60628872
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HYDROMORPHONE 4 MG TAB

Facility

$4.00

Service Code	NDC 42858030225
Hospital Charge Code	60628872
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROMORPHONE 60MG/30 ML PCA I

Facility

$16.70

Hospital Charge Code	60629286
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.50

HYDROMORPHONE 60MG/30 ML PCA I

Facility

$16.70

Hospital Charge Code	60629286
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.35
Rate for Payer: Aetna Commercial	$6.35
Rate for Payer: Aetna Medicare Advantage	$5.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.26
Rate for Payer: Cigna Commercial	$8.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.01
Rate for Payer: Oxford Commercial	$3.34
Rate for Payer: Qualcare PPO/HMO/WC	$2.50
Rate for Payer: UnitedHealthcare Commercial	$3.34
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

HYDROMORPHONE INJ 50MG/5ML

Facility

$164.00

Hospital Charge Code	60627710
Hospital Revenue Code	250
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$82.00
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	$32.80
Rate for Payer: Qualcare PPO/HMO/WC	$24.60
Rate for Payer: UnitedHealthcare Commercial	$32.80
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

HYDROMORPHONE INJ 50MG/5ML

Facility

$164.00

Hospital Charge Code	60627710
Hospital Revenue Code	250
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$24.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.60

HYDROMORPHONE ISEC 1MG/ML

Facility

$8.58

Service Code	HCPCS J1171
Hospital Charge Code	60630220
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

HYDROMORPHONE ISEC 1MG/ML

Facility

$8.58

Service Code	HCPCS J1171
Hospital Charge Code	60630220
Hospital Revenue Code	636
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

HYDROPES-25/TAB

Facility

$3.00

Hospital Charge Code	60634380
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

HYDROPES-25/TAB

Facility

$3.00

Hospital Charge Code	60634380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROPHILIC OINT 52GM

Facility

$29.35

Hospital Charge Code	606350911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.68
Rate for Payer: Aetna Commercial	$11.15
Rate for Payer: Aetna Medicare Advantage	$8.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.48
Rate for Payer: Cigna Commercial	$14.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.80
Rate for Payer: Oxford Commercial	$5.87
Rate for Payer: Qualcare PPO/HMO/WC	$4.40
Rate for Payer: UnitedHealthcare Commercial	$5.87
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

HYDROPHILIC OINT 52GM

Facility

$29.35

Hospital Charge Code	606350911
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.40

HYDROPOL DRESS 5 7/8 X 7 3/4

Facility

$82.00

Hospital Charge Code	9808250
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

HYDROPOL DRESS 5 7/8 X 7 3/4

Facility

$82.00

Hospital Charge Code	9808250
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$31.16
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.60
Rate for Payer: Oxford Commercial	$16.40
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$16.40
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

HYDROPRES-50/TAB

Facility

$3.00

Hospital Charge Code	60633124
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

HYDROPRES-50/TAB

Facility

$3.00

Hospital Charge Code	60633124
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROSCOPIC HUMIDIFIER ADULT

Facility

$9.50

Hospital Charge Code	270655463
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

HYDROSCOPIC HUMIDIFIER ADULT

Facility

$9.50

Hospital Charge Code	270655463
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.75
Rate for Payer: Aetna Commercial	$3.61
Rate for Payer: Aetna Medicare Advantage	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.42
Rate for Payer: Cigna Commercial	$4.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.85
Rate for Payer: Oxford Commercial	$1.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.90
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

HYDROSET

Facility

$15,002.35

Hospital Charge Code	270656509
Hospital Revenue Code	272
Min. Negotiated Rate	$2,250.35
Max. Negotiated Rate	$2,250.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.35

HYDROSET

Facility

$15,002.35

Hospital Charge Code	270656509
Hospital Revenue Code	272
Min. Negotiated Rate	$361.56
Max. Negotiated Rate	$7,501.18
Rate for Payer: Aetna Commercial	$5,700.89
Rate for Payer: Aetna Medicare Advantage	$4,500.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.60
Rate for Payer: Cigna Commercial	$7,501.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,500.70
Rate for Payer: Oxford Commercial	$3,000.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.35
Rate for Payer: UnitedHealthcare Commercial	$3,000.47
Rate for Payer: UnitedHealthcare Community & State	$361.56
Rate for Payer: Wellpoint Medicaid Managed Care	$397.56

HYDROSET

Facility

$22,500.00

Hospital Charge Code	270656507
Hospital Revenue Code	272
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$3,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

HYDROSET

Facility

$22,500.00

Hospital Charge Code	270656507
Hospital Revenue Code	272
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$8,550.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,750.00
Rate for Payer: Oxford Commercial	$4,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Commercial	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$542.25
Rate for Payer: Wellpoint Medicaid Managed Care	$596.25

HYDROSET 5cc 397005

Facility

$7,803.90

Hospital Charge Code	270647992
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.59
Max. Negotiated Rate	$1,888.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,716.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.59

HYDROSET 5cc 397005

Facility

$7,803.90

Hospital Charge Code	270647992
Hospital Revenue Code	278
Min. Negotiated Rate	$188.07
Max. Negotiated Rate	$3,901.95
Rate for Payer: Aetna Commercial	$2,965.48
Rate for Payer: Aetna Medicare Advantage	$2,341.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.99
Rate for Payer: Cigna Commercial	$3,901.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,888.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,716.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.59
Rate for Payer: UnitedHealthcare Community & State	$188.07
Rate for Payer: Wellpoint Medicaid Managed Care	$206.80

HYDROSET XT 5CC

Facility

$13,030.00

Service Code	HCPCS C1713
Hospital Charge Code	270687945
Hospital Revenue Code	278
Min. Negotiated Rate	$314.02
Max. Negotiated Rate	$6,515.00
Rate for Payer: Aetna Commercial	$4,951.40
Rate for Payer: Aetna Medicare Advantage	$3,909.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,322.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,322.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,322.65
Rate for Payer: Cigna Commercial	$6,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,153.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,866.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,954.50
Rate for Payer: UnitedHealthcare Community & State	$314.02
Rate for Payer: Wellpoint Medicaid Managed Care	$345.30

Know your out-of-pocket cost for care.

All Charges