Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VASOSULF/5ML

Facility

$43.00

Hospital Charge Code	60634548
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

VASOSULF OPHTH/5ML

Facility

$38.00

Hospital Charge Code	60634132
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

VASOSULF OPHTH/5ML

Facility

$38.00

Hospital Charge Code	60634132
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

VASOTEC/10MG/TAB

Facility

$5.00

Hospital Charge Code	60634138
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

VASOTEC/10MG/TAB

Facility

$7.00

Hospital Charge Code	60634137
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

VASOTEC/10MG/TAB

Facility

$5.00

Hospital Charge Code	60634138
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

VASOTEC/10MG/TAB

Facility

$7.00

Hospital Charge Code	60634137
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

VASOTEC/20MG/TAB

Facility

$18.56

Service Code	NDC 93002901
Hospital Charge Code	60634139
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.78

VASOTEC/20MG/TAB

Facility

$8.00

Hospital Charge Code	60634140
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

VASOTEC/20MG/TAB

Facility

$18.56

Service Code	NDC 93002901
Hospital Charge Code	60634139
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.28
Rate for Payer: Aetna Commercial	$7.05
Rate for Payer: Aetna Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.73
Rate for Payer: Cigna Commercial	$9.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Oxford Commercial	$3.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.78
Rate for Payer: UnitedHealthcare Commercial	$3.71
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

VASOTEC/20MG/TAB

Facility

$8.00

Hospital Charge Code	60634140
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

VASOTEC/2.5MG/TAB

Facility

$5.00

Hospital Charge Code	60634134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

VASOTEC/2.5MG/TAB

Facility

$5.00

Hospital Charge Code	60634135
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

VASOTEC/2.5MG/TAB

Facility

$5.00

Hospital Charge Code	60634135
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

VASOTEC/2.5MG/TAB

Facility

$5.00

Hospital Charge Code	60634134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

VASOTEC/5MG/TAB

Facility

$10.32

Service Code	NDC 904550261
Hospital Charge Code	60634133
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.16
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: Aetna Medicare Advantage	$3.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.63
Rate for Payer: Cigna Commercial	$5.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.10
Rate for Payer: Oxford Commercial	$2.06
Rate for Payer: Qualcare PPO/HMO/WC	$1.55
Rate for Payer: UnitedHealthcare Commercial	$2.06
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

VASOTEC/5MG/TAB

Facility

$10.32

Service Code	NDC 904550261
Hospital Charge Code	60634133
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$1.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.55

VASOTEC/5MG/TAB

Facility

$6.00

Hospital Charge Code	60634136
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VASOTEC/5MG/TAB

Facility

$6.00

Hospital Charge Code	60634136
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

VASOTEC I.V./1.25MG/1ML

Facility

$104.00

Hospital Charge Code	60634141
Hospital Revenue Code	250
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

VASOTEC I.V./1.25MG/1ML

Facility

$104.00

Hospital Charge Code	60634141
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$39.52
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.20
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$20.80
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

VAXELIS (DTAP-IPV-HIB-HEPB)

Facility

$607.05

Service Code	HCPCS 90697
Hospital Charge Code	395090697
Hospital Revenue Code	636
Min. Negotiated Rate	$14.63
Max. Negotiated Rate	$303.52
Rate for Payer: Aetna Commercial	$230.68
Rate for Payer: Aetna Medicare Advantage	$182.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.80
Rate for Payer: Cigna Commercial	$303.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.91
Rate for Payer: Qualcare PPO/HMO/WC	$91.06
Rate for Payer: UnitedHealthcare Community & State	$14.63
Rate for Payer: Wellpoint Medicaid Managed Care	$16.09

VAXELIS (DTAP-IPV-HIB-HEPB)

Facility

$607.05

Service Code	HCPCS 90697
Hospital Charge Code	395090697
Hospital Revenue Code	636
Min. Negotiated Rate	$91.06
Max. Negotiated Rate	$146.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.91
Rate for Payer: Qualcare PPO/HMO/WC	$91.06

VBR BOXCAR 14X14.5X7.5D ENDCAP

Facility

$4,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270696946
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

VBR BOXCAR 14X14.5X7.5D ENDCAP

Facility

$4,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270696946
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

Know your out-of-pocket cost for care.

All Charges