Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDROSET XT 5CC

Facility

$13,030.00

Service Code	HCPCS C1713
Hospital Charge Code	270687945
Hospital Revenue Code	278
Min. Negotiated Rate	$1,954.50
Max. Negotiated Rate	$3,153.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,606.00
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

HYDROSORB MEDT 8 26 092005

Facility

$15,813.65

Hospital Charge Code	270629193
Hospital Revenue Code	272
Min. Negotiated Rate	$381.11
Max. Negotiated Rate	$7,906.82
Rate for Payer: Aetna Commercial	$6,009.19
Rate for Payer: Aetna Medicare Advantage	$4,744.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,032.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,032.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,032.48
Rate for Payer: Cigna Commercial	$7,906.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,744.10
Rate for Payer: Oxford Commercial	$3,162.73
Rate for Payer: Qualcare PPO/HMO/WC	$2,372.05
Rate for Payer: UnitedHealthcare Commercial	$3,162.73
Rate for Payer: UnitedHealthcare Community & State	$381.11
Rate for Payer: Wellpoint Medicaid Managed Care	$419.06

HYDROSORB MEDT 8 26 092005

Facility

$15,813.65

Hospital Charge Code	270629193
Hospital Revenue Code	272
Min. Negotiated Rate	$2,372.05
Max. Negotiated Rate	$2,372.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,372.05

HYDROX 24

Facility

$183.75

Service Code	HCPCS 83500
Hospital Charge Code	3000369B
Hospital Revenue Code	301
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$27.56
Rate for Payer: Qualcare PPO/HMO/WC	$27.56

HYDROX 24

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	3000369A
Hospital Revenue Code	301
Min. Negotiated Rate	$22.90
Max. Negotiated Rate	$22.90
Rate for Payer: Qualcare PPO/HMO/WC	$22.90

HYDROX 24

Facility

$152.65

Service Code	HCPCS 82570
Hospital Charge Code	3000369A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.70
Rate for Payer: Cigna Commercial	$76.33
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

HYDROX 24

Facility

$183.75

Service Code	HCPCS 83500
Hospital Charge Code	3000369B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$61.61
Rate for Payer: Aetna Medicare Advantage	$73.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.76
Rate for Payer: Cigna Commercial	$91.88
Rate for Payer: Cigna Medicare Advantage	$22.65
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.56
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Medicare Advantage	$22.65
Rate for Payer: Wellpoint Medicaid Managed Care	$4.87

HYDROXYCHLOROQUINE 200 MG TAB

Facility

$27.40

Service Code	NDC 66993005702
Hospital Charge Code	6016596
Hospital Revenue Code	251
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.11

HYDROXYCHLOROQUINE 200 MG TAB

Facility

$27.40

Service Code	NDC 66993005702
Hospital Charge Code	6016596
Hospital Revenue Code	251
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.70
Rate for Payer: Aetna Commercial	$10.41
Rate for Payer: Aetna Medicare Advantage	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.99
Rate for Payer: Cigna Commercial	$13.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.22
Rate for Payer: Oxford Commercial	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.11
Rate for Payer: UnitedHealthcare Commercial	$5.48
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

HYDROXYPROLINE FREE

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474101
Hospital Revenue Code	301
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$61.61
Rate for Payer: Aetna Medicare Advantage	$73.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.76
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: Cigna Medicare Advantage	$22.65
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Medicare Advantage	$22.65
Rate for Payer: Wellpoint Medicaid Managed Care	$15.00

HYDROXYPROLINE FREE

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474101
Hospital Revenue Code	301
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

HYDROXYPROLINE,FREE

Facility

$239.25

Service Code	HCPCS 83505
Hospital Charge Code	3001616
Hospital Revenue Code	301
Min. Negotiated Rate	$35.89
Max. Negotiated Rate	$35.89
Rate for Payer: Qualcare PPO/HMO/WC	$35.89

HYDROXYPROLINE,FREE

Facility

$239.25

Service Code	HCPCS 83505
Hospital Charge Code	3001616
Hospital Revenue Code	301
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$66.10
Rate for Payer: Aetna Medicare Advantage	$78.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.72
Rate for Payer: Cigna Commercial	$119.62
Rate for Payer: Cigna Medicare Advantage	$24.30
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Medicare Advantage	$24.30
Rate for Payer: Wellpoint Medicaid Managed Care	$6.34

HYDROXYPROLINE,FREE 24HR URINE

Facility

$183.75

Service Code	HCPCS 83500
Hospital Charge Code	3001619
Hospital Revenue Code	301
Min. Negotiated Rate	$27.56
Max. Negotiated Rate	$27.56
Rate for Payer: Qualcare PPO/HMO/WC	$27.56

HYDROXYPROLINE,FREE 24HR URINE

Facility

$183.75

Service Code	HCPCS 83500
Hospital Charge Code	3001619
Hospital Revenue Code	301
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$61.61
Rate for Payer: Aetna Medicare Advantage	$73.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.76
Rate for Payer: Cigna Commercial	$91.88
Rate for Payer: Cigna Medicare Advantage	$22.65
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.12
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.56
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Medicare Advantage	$22.65
Rate for Payer: Wellpoint Medicaid Managed Care	$4.87

HYDROXYPROLINE, FREE, SERUM

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474104
Hospital Revenue Code	301
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

HYDROXYPROLINE, FREE, SERUM

Facility

$566.00

Service Code	HCPCS 83500
Hospital Charge Code	38474104
Hospital Revenue Code	301
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$61.61
Rate for Payer: Aetna Medicare Advantage	$73.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.76
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: Cigna Medicare Advantage	$22.65
Rate for Payer: Clover Medicare Advantage	$21.52
Rate for Payer: EmblemHealth Commercial	$67.95
Rate for Payer: Humana Medicare Advantage	$23.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.65
Rate for Payer: Wellcare Medicare Advantage	$22.65
Rate for Payer: Wellpoint Medicaid Managed Care	$15.00

HYDROXYPROLINE TOTAL

Facility

$411.00

Service Code	HCPCS 83505
Hospital Charge Code	38474102
Hospital Revenue Code	301
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$205.50
Rate for Payer: Aetna Commercial	$66.10
Rate for Payer: Aetna Medicare Advantage	$78.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.72
Rate for Payer: Cigna Commercial	$205.50
Rate for Payer: Cigna Medicare Advantage	$24.30
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Medicare Advantage	$24.30
Rate for Payer: Wellpoint Medicaid Managed Care	$10.89

HYDROXYPROLINE TOTAL

Facility

$411.00

Service Code	HCPCS 83505
Hospital Charge Code	38474102
Hospital Revenue Code	301
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$61.65
Rate for Payer: Qualcare PPO/HMO/WC	$61.65

HYDROXYPROLINE (TOTAL URINE)

Facility

$239.25

Service Code	HCPCS 83505
Hospital Charge Code	3001617
Hospital Revenue Code	301
Min. Negotiated Rate	$35.89
Max. Negotiated Rate	$35.89
Rate for Payer: Qualcare PPO/HMO/WC	$35.89

HYDROXYPROLINE (TOTAL URINE)

Facility

$239.25

Service Code	HCPCS 83505
Hospital Charge Code	3001617
Hospital Revenue Code	301
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$66.10
Rate for Payer: Aetna Medicare Advantage	$78.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.72
Rate for Payer: Cigna Commercial	$119.62
Rate for Payer: Cigna Medicare Advantage	$24.30
Rate for Payer: Clover Medicare Advantage	$23.09
Rate for Payer: EmblemHealth Commercial	$72.90
Rate for Payer: Humana Medicare Advantage	$25.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.78
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.30
Rate for Payer: Wellcare Medicare Advantage	$24.30
Rate for Payer: Wellpoint Medicaid Managed Care	$6.34

HYDROXYPROPYMTHLCEL OPH 2.5%

Facility

$131.85

Hospital Charge Code	6002992
Hospital Revenue Code	251
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$65.92
Rate for Payer: Aetna Commercial	$50.10
Rate for Payer: Aetna Medicare Advantage	$39.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.62
Rate for Payer: Cigna Commercial	$65.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.55
Rate for Payer: Oxford Commercial	$26.37
Rate for Payer: Qualcare PPO/HMO/WC	$19.78
Rate for Payer: UnitedHealthcare Commercial	$26.37
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

HYDROXYPROPYMTHLCEL OPH 2.5%

Facility

$131.85

Hospital Charge Code	6002992
Hospital Revenue Code	251
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$19.78

HYDROXYUREA 500 MG CAP

Facility

$10.99

Service Code	NDC 3083050
Hospital Charge Code	6009658
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.80
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

HYDROXYUREA 500 MG CAP

Facility

$10.99

Service Code	NDC 3083050
Hospital Charge Code	6009658
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

Know your out-of-pocket cost for care.

All Charges