Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYLAN POLYMERS A & B 16MG/2ML

Facility

$1,267.20

Hospital Charge Code	60629006
Hospital Revenue Code	636
Min. Negotiated Rate	$190.08
Max. Negotiated Rate	$306.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.66
Rate for Payer: Qualcare PPO/HMO/WC	$190.08

HYLAN POLYMERS A & B 16MG/2ML

Facility

$1,267.20

Hospital Charge Code	60629006
Hospital Revenue Code	636
Min. Negotiated Rate	$30.54
Max. Negotiated Rate	$633.60
Rate for Payer: Aetna Commercial	$481.54
Rate for Payer: Aetna Medicare Advantage	$380.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$323.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$323.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$323.14
Rate for Payer: Cigna Commercial	$633.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.66
Rate for Payer: Qualcare PPO/HMO/WC	$190.08
Rate for Payer: UnitedHealthcare Community & State	$30.54
Rate for Payer: Wellpoint Medicaid Managed Care	$33.58

HYLENEX 150UNITS/1ML

Facility

$448.63

Service Code	HCPCS J3470
Hospital Charge Code	6000432
Hospital Revenue Code	636
Min. Negotiated Rate	$67.29
Max. Negotiated Rate	$108.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.57
Rate for Payer: Qualcare PPO/HMO/WC	$67.29

HYLENEX 150UNITS/1ML

Facility

$448.63

Service Code	HCPCS J3470
Hospital Charge Code	6000432
Hospital Revenue Code	636
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$224.31
Rate for Payer: Aetna Commercial	$170.48
Rate for Payer: Aetna Medicare Advantage	$134.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.40
Rate for Payer: Cigna Commercial	$224.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.57
Rate for Payer: Qualcare PPO/HMO/WC	$67.29
Rate for Payer: UnitedHealthcare Community & State	$10.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.89

HYODCYAMINE SULFATE

Facility

$16.25

Hospital Charge Code	601032
Hospital Revenue Code	258
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.12
Rate for Payer: Aetna Commercial	$6.17
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.14
Rate for Payer: Cigna Commercial	$8.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.88
Rate for Payer: Oxford Commercial	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.44
Rate for Payer: UnitedHealthcare Commercial	$3.25
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

HYODCYAMINE SULFATE

Facility

$16.25

Hospital Charge Code	601032
Hospital Revenue Code	258
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.44

HYOSCYAMINE 0.125MG/5ML

Facility

$7.50

Service Code	HCPCS J1980
Hospital Charge Code	6063943113
Hospital Revenue Code	636
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

HYOSCYAMINE 0.125MG/5ML

Facility

$7.50

Service Code	HCPCS J1980
Hospital Charge Code	6063943113
Hospital Revenue Code	636
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

HYOSCYAMINE INJ 0.5MG/ML

Facility

$66.60

Hospital Charge Code	60627435
Hospital Revenue Code	250
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$9.99
Rate for Payer: Qualcare PPO/HMO/WC	$9.99

HYOSCYAMINE INJ 0.5MG/ML

Facility

$66.60

Hospital Charge Code	60627435
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.30
Rate for Payer: Aetna Commercial	$25.31
Rate for Payer: Aetna Medicare Advantage	$19.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.98
Rate for Payer: Cigna Commercial	$33.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.98
Rate for Payer: Oxford Commercial	$13.32
Rate for Payer: Qualcare PPO/HMO/WC	$9.99
Rate for Payer: UnitedHealthcare Commercial	$13.32
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

HYOSCYAMINE SULFATE

Facility

$26.90

Hospital Charge Code	6010532
Hospital Revenue Code	250
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.04

HYOSCYAMINE SULFATE

Facility

$26.90

Hospital Charge Code	6010532
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$10.22
Rate for Payer: Aetna Medicare Advantage	$8.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.86
Rate for Payer: Cigna Commercial	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.07
Rate for Payer: Oxford Commercial	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.04
Rate for Payer: UnitedHealthcare Commercial	$5.38
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

HYOSCYAMINE TAB 0.125MG

Facility

$5.70

Service Code	NDC 47781001301
Hospital Charge Code	60627433
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Commercial	$2.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.71
Rate for Payer: Oxford Commercial	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.14
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

HYOSCYAMINE TAB 0.125MG

Facility

$5.70

Service Code	NDC 47781001301
Hospital Charge Code	60627433
Hospital Revenue Code	251
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

HYOSCYAMINE TAB SL 0.125MG

Facility

$4.00

Hospital Charge Code	60628914
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

HYOSCYAMINE TAB SL 0.125MG

Facility

$4.00

Hospital Charge Code	60628914
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYP-08

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666721
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

HYP-08

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666721
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

HYPAQUE

Facility

$41.60

Hospital Charge Code	6014054
Hospital Revenue Code	250
Min. Negotiated Rate	$6.24
Max. Negotiated Rate	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$6.24

HYPAQUE

Facility

$41.60

Hospital Charge Code	6014054
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$15.81
Rate for Payer: Aetna Medicare Advantage	$12.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.61
Rate for Payer: Cigna Commercial	$20.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$8.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.24
Rate for Payer: UnitedHealthcare Commercial	$8.32
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

HYPERALIMENTATION ADMIN *****

Facility

$643.00

Hospital Charge Code	3400066
Hospital Revenue Code	289
Min. Negotiated Rate	$96.45
Max. Negotiated Rate	$96.45
Rate for Payer: Qualcare PPO/HMO/WC	$96.45

HYPERALIMENTATION ADMIN *****

Facility

$643.00

Hospital Charge Code	3400066
Hospital Revenue Code	289
Min. Negotiated Rate	$15.50
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$244.34
Rate for Payer: Aetna Medicare Advantage	$192.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.97
Rate for Payer: Cigna Commercial	$321.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.90
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.45
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$15.50
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

HYPERBARIC CHAMBER DOUBLE****

Facility

$600.00

Service Code	HCPCS 99183
Hospital Charge Code	9000373
Hospital Revenue Code	413
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$3,554.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$2,027.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$3,554.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

HYPERBARIC CHAMBER DOUBLE****

Facility

$600.00

Service Code	HCPCS 99183
Hospital Charge Code	9000373
Hospital Revenue Code	413
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

HYPERBARIC CHAMBER SGL****

Facility

$300.00

Service Code	HCPCS 99183
Hospital Charge Code	9000365
Hospital Revenue Code	413
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

Know your out-of-pocket cost for care.

All Charges