Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VANTIN 100MGU/D TAB

Facility

$45.16

Service Code	NDC 781543820
Hospital Charge Code	60635215
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$22.58
Rate for Payer: Aetna Commercial	$17.16
Rate for Payer: Aetna Medicare Advantage	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.52
Rate for Payer: Cigna Commercial	$22.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.55
Rate for Payer: Oxford Commercial	$9.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.77
Rate for Payer: UnitedHealthcare Commercial	$9.03
Rate for Payer: UnitedHealthcare Community & State	$1.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

VANTIN 200MG U/D TAB

Facility

$21.00

Hospital Charge Code	60635216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

VANTIN 200MG U/D TAB

Facility

$21.00

Hospital Charge Code	60635216
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

VANTIN 50MG/5ML SUSP100ML

Facility

$101.00

Hospital Charge Code	60635219
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

VANTIN 50MG/5ML SUSP100ML

Facility

$101.00

Hospital Charge Code	60635219
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

VANTIN 50MG/5ML SUSP 50ML

Facility

$46.00

Hospital Charge Code	60635217
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

VANTIN 50MG/5ML SUSP 50ML

Facility

$46.00

Hospital Charge Code	60635217
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.80
Rate for Payer: Oxford Commercial	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.20
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

VANTIN 50MG/5ML SUSP 75ML

Facility

$84.00

Hospital Charge Code	60635218
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

VANTIN 50MG/5ML SUSP 75ML

Facility

$84.00

Hospital Charge Code	60635218
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Oxford Commercial	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

VAP CHOLESTEROL I

Facility

$390.00

Service Code	HCPCS 83701
Hospital Charge Code	39990143A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VAP CHOLESTEROL I

Facility

$390.00

Service Code	HCPCS 83701
Hospital Charge Code	39990143A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$92.10
Rate for Payer: Aetna Medicare Advantage	$109.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.22
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$33.86
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$27.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.86
Rate for Payer: Wellcare Medicare Advantage	$33.86
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VAP CHOLESTEROL II

Facility

$390.00

Service Code	HCPCS 84478
Hospital Charge Code	39990143B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VAP CHOLESTEROL II

Facility

$390.00

Service Code	HCPCS 84478
Hospital Charge Code	39990143B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.61
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.74
Rate for Payer: Clover Medicare Advantage	$5.45
Rate for Payer: EmblemHealth Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$5.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.74
Rate for Payer: Wellcare Medicare Advantage	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VAPONEPHRINE/15ML

Facility

$66.00

Hospital Charge Code	60634605
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

VAPONEPHRINE/15ML

Facility

$66.00

Hospital Charge Code	60634605
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

VAPORTRODE

Facility

$733.00

Hospital Charge Code	270335243
Hospital Revenue Code	272
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$366.50
Rate for Payer: Aetna Commercial	$278.54
Rate for Payer: Aetna Medicare Advantage	$219.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.91
Rate for Payer: Cigna Commercial	$366.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.90
Rate for Payer: Oxford Commercial	$146.60
Rate for Payer: Qualcare PPO/HMO/WC	$109.95
Rate for Payer: UnitedHealthcare Commercial	$146.60
Rate for Payer: UnitedHealthcare Community & State	$17.67
Rate for Payer: Wellpoint Medicaid Managed Care	$19.42

VAPORTRODE

Facility

$733.00

Hospital Charge Code	270335243
Hospital Revenue Code	272
Min. Negotiated Rate	$109.95
Max. Negotiated Rate	$109.95
Rate for Payer: Qualcare PPO/HMO/WC	$109.95

VAPR 2.3 MM THERM END

Facility

$1,300.00

Hospital Charge Code	270658637
Hospital Revenue Code	270
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$260.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Commercial	$260.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

VAPR 2.3 MM THERM END

Facility

$1,300.00

Hospital Charge Code	270658649
Hospital Revenue Code	270
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

VAPR 2.3 MM THERM END

Facility

$1,300.00

Hospital Charge Code	270658649
Hospital Revenue Code	270
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$260.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Commercial	$260.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

VAPR 2.3 MM THERM END

Facility

$1,300.00

Hospital Charge Code	270658637
Hospital Revenue Code	270
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

VAPRISOL 20MG AMP

Facility

$1,737.00

Hospital Charge Code	60635570
Hospital Revenue Code	250
Min. Negotiated Rate	$41.86
Max. Negotiated Rate	$868.50
Rate for Payer: Aetna Commercial	$660.06
Rate for Payer: Aetna Medicare Advantage	$521.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$442.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$442.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$442.94
Rate for Payer: Cigna Commercial	$868.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.10
Rate for Payer: Oxford Commercial	$347.40
Rate for Payer: Qualcare PPO/HMO/WC	$260.55
Rate for Payer: UnitedHealthcare Commercial	$347.40
Rate for Payer: UnitedHealthcare Community & State	$41.86
Rate for Payer: Wellpoint Medicaid Managed Care	$46.03

VAPRISOL 20MG AMP

Facility

$1,737.00

Hospital Charge Code	60635570
Hospital Revenue Code	250
Min. Negotiated Rate	$260.55
Max. Negotiated Rate	$260.55
Rate for Payer: Qualcare PPO/HMO/WC	$260.55

VAPRISOL 20MG AMPULE

Facility

$2,067.00

Hospital Charge Code	60635619
Hospital Revenue Code	250
Min. Negotiated Rate	$49.81
Max. Negotiated Rate	$1,033.50
Rate for Payer: Aetna Commercial	$785.46
Rate for Payer: Aetna Medicare Advantage	$620.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$527.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$527.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$527.09
Rate for Payer: Cigna Commercial	$1,033.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.10
Rate for Payer: Oxford Commercial	$413.40
Rate for Payer: Qualcare PPO/HMO/WC	$310.05
Rate for Payer: UnitedHealthcare Commercial	$413.40
Rate for Payer: UnitedHealthcare Community & State	$49.81
Rate for Payer: Wellpoint Medicaid Managed Care	$54.78

VAPRISOL 20MG AMPULE

Facility

$2,067.00

Hospital Charge Code	60635619
Hospital Revenue Code	250
Min. Negotiated Rate	$310.05
Max. Negotiated Rate	$310.05
Rate for Payer: Qualcare PPO/HMO/WC	$310.05

Know your out-of-pocket cost for care.

All Charges