Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

$26,545.00

Service Code	MSDRG 807
Min. Negotiated Rate	$7,284.95
Max. Negotiated Rate	$26,545.00
Rate for Payer: Aetna Commercial	$16,696.74
Rate for Payer: Aetna Medicare Advantage	$23,925.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,119.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,119.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,668.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,119.65
Rate for Payer: Cigna Commercial	$12,616.98
Rate for Payer: Cigna Medicare Advantage	$7,668.37
Rate for Payer: Clover Medicare Advantage	$7,284.95
Rate for Payer: EmblemHealth Commercial	$23,005.11
Rate for Payer: Humana Medicare Advantage	$7,898.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,668.37
Rate for Payer: Oxford Commercial	$15,138.00
Rate for Payer: UnitedHealthcare Commercial	$26,545.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,668.37
Rate for Payer: Wellcare Medicare Advantage	$7,668.37

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$8,020.26

Service Code	APR-DRG 5412
Min. Negotiated Rate	$7,863.00
Max. Negotiated Rate	$8,020.26
Rate for Payer: UnitedHealthcare Community & State	$7,863.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,020.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7,863.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$7,651.33

Service Code	APR-DRG 5411
Min. Negotiated Rate	$7,501.30
Max. Negotiated Rate	$7,651.33
Rate for Payer: UnitedHealthcare Community & State	$7,501.30
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,651.33
Rate for Payer: Wellpoint Medicaid Managed Care	$7,501.30

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$10,083.43

Service Code	APR-DRG 5413
Min. Negotiated Rate	$9,885.72
Max. Negotiated Rate	$10,083.43
Rate for Payer: UnitedHealthcare Community & State	$9,885.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,083.43
Rate for Payer: Wellpoint Medicaid Managed Care	$9,885.72

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$15,294.97

Service Code	APR-DRG 5414
Min. Negotiated Rate	$14,995.07
Max. Negotiated Rate	$15,294.97
Rate for Payer: UnitedHealthcare Community & State	$14,995.07
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,294.97
Rate for Payer: Wellpoint Medicaid Managed Care	$14,995.07

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

$34,468.67

Service Code	MSDRG 797
Min. Negotiated Rate	$10,495.27
Max. Negotiated Rate	$34,468.67
Rate for Payer: Aetna Commercial	$23,941.21
Rate for Payer: Aetna Medicare Advantage	$34,468.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,047.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,261.00
Rate for Payer: Cigna Commercial	$18,721.49
Rate for Payer: Cigna Medicare Advantage	$11,047.65
Rate for Payer: Clover Medicare Advantage	$10,495.27
Rate for Payer: EmblemHealth Commercial	$33,142.95
Rate for Payer: Humana Medicare Advantage	$11,379.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,047.65
Rate for Payer: Oxford Commercial	$15,138.00
Rate for Payer: UnitedHealthcare Commercial	$26,545.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,047.65
Rate for Payer: Wellcare Medicare Advantage	$11,047.65

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC

Facility

$39,853.44

Service Code	MSDRG 796
Min. Negotiated Rate	$12,134.86
Max. Negotiated Rate	$39,853.44
Rate for Payer: Aetna Commercial	$27,641.17
Rate for Payer: Aetna Medicare Advantage	$39,853.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,030.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,030.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,773.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,030.62
Rate for Payer: Cigna Commercial	$21,839.24
Rate for Payer: Cigna Medicare Advantage	$12,773.54
Rate for Payer: Clover Medicare Advantage	$12,134.86
Rate for Payer: EmblemHealth Commercial	$38,320.62
Rate for Payer: Humana Medicare Advantage	$13,156.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,773.54
Rate for Payer: Oxford Commercial	$15,138.00
Rate for Payer: UnitedHealthcare Commercial	$26,545.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,773.54
Rate for Payer: Wellcare Medicare Advantage	$12,773.54

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC

Facility

$33,069.16

Service Code	MSDRG 798
Min. Negotiated Rate	$10,069.14
Max. Negotiated Rate	$33,069.16
Rate for Payer: Aetna Commercial	$22,979.60
Rate for Payer: Aetna Medicare Advantage	$33,069.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,539.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,539.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10,599.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,539.24
Rate for Payer: Cigna Commercial	$17,911.17
Rate for Payer: Cigna Medicare Advantage	$10,599.09
Rate for Payer: Clover Medicare Advantage	$10,069.14
Rate for Payer: EmblemHealth Commercial	$31,797.27
Rate for Payer: Humana Medicare Advantage	$10,917.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10,599.09
Rate for Payer: Oxford Commercial	$15,138.00
Rate for Payer: UnitedHealthcare Commercial	$26,545.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,599.09
Rate for Payer: Wellcare Medicare Advantage	$10,599.09

VAGINAL HYSTERECTOMY =<250 GM

Facility

$42,695.42

Service Code	HCPCS 58260
Hospital Charge Code	1600000861
Hospital Revenue Code	360
Min. Negotiated Rate	$6,404.31
Max. Negotiated Rate	$6,404.31
Rate for Payer: Qualcare PPO/HMO/WC	$6,404.31

VAGINAL HYSTERECTOMY =<250 GM

Facility

$42,695.42

Service Code	HCPCS 58260
Hospital Charge Code	1600000861
Hospital Revenue Code	360
Min. Negotiated Rate	$1,028.96
Max. Negotiated Rate	$21,452.59
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,452.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,452.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,452.59
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,808.63
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,404.31
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,028.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,131.43

VAGINITIS/VAGINOSIS, DNA PROBE

Facility

$137.85

Service Code	HCPCS 87480
Hospital Charge Code	3038082
Hospital Revenue Code	300
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.37
Rate for Payer: Cigna Commercial	$68.92
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.35
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.68
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.65

VAGINITIS/VAGINOSIS, DNA PROBE

Facility

$137.85

Service Code	HCPCS 87480
Hospital Charge Code	3038082
Hospital Revenue Code	300
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$20.68
Rate for Payer: Qualcare PPO/HMO/WC	$20.68

VALACYCLOVIR 500 MG TAB

Facility

$66.26

Service Code	NDC 173093308
Hospital Charge Code	60628874
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.13
Rate for Payer: Aetna Commercial	$25.18
Rate for Payer: Aetna Medicare Advantage	$19.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.90
Rate for Payer: Cigna Commercial	$33.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.88
Rate for Payer: Oxford Commercial	$13.25
Rate for Payer: Qualcare PPO/HMO/WC	$9.94
Rate for Payer: UnitedHealthcare Commercial	$13.25
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

VALACYCLOVIR 500 MG TAB

Facility

$66.26

Service Code	NDC 173093308
Hospital Charge Code	60628874
Hospital Revenue Code	250
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$9.94
Rate for Payer: Qualcare PPO/HMO/WC	$9.94

VALACYCLOVIR (VALTREX) 1000MG

Facility

$82.95

Service Code	NDC 65862044930
Hospital Charge Code	60630148
Hospital Revenue Code	250
Min. Negotiated Rate	$12.44
Max. Negotiated Rate	$12.44
Rate for Payer: Qualcare PPO/HMO/WC	$12.44

VALACYCLOVIR (VALTREX) 1000MG

Facility

$82.95

Service Code	NDC 65862044930
Hospital Charge Code	60630148
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$41.48
Rate for Payer: Aetna Commercial	$31.52
Rate for Payer: Aetna Medicare Advantage	$24.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.15
Rate for Payer: Cigna Commercial	$41.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.89
Rate for Payer: Oxford Commercial	$16.59
Rate for Payer: Qualcare PPO/HMO/WC	$12.44
Rate for Payer: UnitedHealthcare Commercial	$16.59
Rate for Payer: UnitedHealthcare Community & State	$2.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

VALGANCICLOVIR 450 MG TAB

Facility

$517.78

Service Code	NDC 4003822
Hospital Charge Code	60629946
Hospital Revenue Code	250
Min. Negotiated Rate	$77.67
Max. Negotiated Rate	$77.67
Rate for Payer: Qualcare PPO/HMO/WC	$77.67

VALGANCICLOVIR 450 MG TAB

Facility

$517.78

Service Code	NDC 4003822
Hospital Charge Code	60629946
Hospital Revenue Code	250
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$258.89
Rate for Payer: Aetna Commercial	$196.76
Rate for Payer: Aetna Medicare Advantage	$155.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.03
Rate for Payer: Cigna Commercial	$258.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.33
Rate for Payer: Oxford Commercial	$103.56
Rate for Payer: Qualcare PPO/HMO/WC	$77.67
Rate for Payer: UnitedHealthcare Commercial	$103.56
Rate for Payer: UnitedHealthcare Community & State	$12.48
Rate for Payer: Wellpoint Medicaid Managed Care	$13.72

VALIUM/10MG/TAB

Facility

$8.00

Hospital Charge Code	60634340
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

VALIUM/10MG/TAB

Facility

$8.00

Hospital Charge Code	60634340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

VALIUM/2MG/TAB

Facility

$6.00

Hospital Charge Code	60634338
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

VALIUM/2MG/TAB

Facility

$6.00

Hospital Charge Code	60634338
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VALIUM/5MG/TAB

Facility

$6.00

Hospital Charge Code	60634339
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VALIUM/5MG/TAB

Facility

$6.00

Hospital Charge Code	60634339
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

VALOR NAIL, RIGHT

Facility

$13,895.00

Hospital Charge Code	270702424
Hospital Revenue Code	278
Min. Negotiated Rate	$334.87
Max. Negotiated Rate	$6,947.50
Rate for Payer: Aetna Commercial	$5,280.10
Rate for Payer: Aetna Medicare Advantage	$4,168.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,543.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,543.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,543.22
Rate for Payer: Cigna Commercial	$6,947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,362.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,056.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,084.25
Rate for Payer: UnitedHealthcare Community & State	$334.87
Rate for Payer: Wellpoint Medicaid Managed Care	$368.22

Know your out-of-pocket cost for care.

All Charges