Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VENTRLEX HERNIA PATCH (SM.)

Facility

$673.00

Hospital Charge Code	270335675
Hospital Revenue Code	278
Min. Negotiated Rate	$100.95
Max. Negotiated Rate	$162.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$148.06
Rate for Payer: Qualcare PPO/HMO/WC	$100.95

VENT SET-UP W/O HUMIDITY***

Facility

$99.00

Service Code	HCPCS 91
Hospital Charge Code	9500604
Hospital Revenue Code	279
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

VENT SET-UP W/O HUMIDITY***

Facility

$99.00

Service Code	HCPCS 91
Hospital Charge Code	9500604
Hospital Revenue Code	279
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.70
Rate for Payer: Oxford Commercial	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$19.80
Rate for Payer: UnitedHealthcare Community & State	$2.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

VENT TUBE:,045 I.D. 7MM.

Facility

$42.00

Hospital Charge Code	270331854
Hospital Revenue Code	272
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

VENT TUBE:,045 I.D. 7MM.

Facility

$42.00

Hospital Charge Code	270331854
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

VEPESID 150MG INJ

Facility

$1,428.00

Hospital Charge Code	60635044
Hospital Revenue Code	636
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$345.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.58
Rate for Payer: Qualcare PPO/HMO/WC	$214.20

VEPESID 150MG INJ

Facility

$1,428.00

Hospital Charge Code	60635044
Hospital Revenue Code	636
Min. Negotiated Rate	$34.41
Max. Negotiated Rate	$714.00
Rate for Payer: Aetna Commercial	$542.64
Rate for Payer: Aetna Medicare Advantage	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$364.14
Rate for Payer: Cigna Commercial	$714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.58
Rate for Payer: Qualcare PPO/HMO/WC	$214.20
Rate for Payer: UnitedHealthcare Community & State	$34.41
Rate for Payer: Wellpoint Medicaid Managed Care	$37.84

VEP VISUAL EVOKED POTENTIAL

Facility

$5,700.00

Service Code	HCPCS 95930
Hospital Charge Code	5400080
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

VEP VISUAL EVOKED POTENTIAL

Facility

$5,700.00

Service Code	HCPCS 95930
Hospital Charge Code	5400080
Hospital Revenue Code	922
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,584.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$332.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.96
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,710.00
Rate for Payer: Oxford Commercial	$1,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,584.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$459.87
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

VERAPAMIL

Facility

$291.00

Service Code	HCPCS 80299
Hospital Charge Code	38472046
Hospital Revenue Code	301
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

VERAPAMIL

Facility

$291.00

Service Code	HCPCS 80299
Hospital Charge Code	38472046
Hospital Revenue Code	301
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

VERAPAMIL 120 MG ER TAB

Facility

$15.54

Service Code	NDC 51079089420
Hospital Charge Code	60629028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.77
Rate for Payer: Aetna Commercial	$5.91
Rate for Payer: Aetna Medicare Advantage	$4.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.96
Rate for Payer: Cigna Commercial	$7.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.66
Rate for Payer: Oxford Commercial	$3.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.33
Rate for Payer: UnitedHealthcare Commercial	$3.11
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

VERAPAMIL 120 MG ER TAB

Facility

$15.54

Service Code	NDC 51079089420
Hospital Charge Code	60629028
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$2.33

VERAPAMIL 120 MG TAB

Facility

$5.03

Service Code	NDC 904292461
Hospital Charge Code	60627613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

VERAPAMIL 120 MG TAB

Facility

$5.03

Service Code	NDC 904292461
Hospital Charge Code	60627613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.52
Rate for Payer: Aetna Commercial	$1.91
Rate for Payer: Aetna Medicare Advantage	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.28
Rate for Payer: Cigna Commercial	$2.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.01
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

VERAPAMIL 180 MG ER TAB

Facility

$16.68

Service Code	NDC 51079089920
Hospital Charge Code	60627614
Hospital Revenue Code	250
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.50

VERAPAMIL 180 MG ER TAB

Facility

$16.68

Service Code	NDC 51079089920
Hospital Charge Code	60627614
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.34
Rate for Payer: Aetna Commercial	$6.34
Rate for Payer: Aetna Medicare Advantage	$5.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.25
Rate for Payer: Cigna Commercial	$8.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.00
Rate for Payer: Oxford Commercial	$3.34
Rate for Payer: Qualcare PPO/HMO/WC	$2.50
Rate for Payer: UnitedHealthcare Commercial	$3.34
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

VERAPAMIL 240 MG ER TAB

Facility

$16.95

Service Code	NDC 51079086920
Hospital Charge Code	60627615
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.54

VERAPAMIL 240 MG ER TAB

Facility

$16.95

Service Code	NDC 51079086920
Hospital Charge Code	60627615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.47
Rate for Payer: Aetna Commercial	$6.44
Rate for Payer: Aetna Medicare Advantage	$5.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.32
Rate for Payer: Cigna Commercial	$8.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.08
Rate for Payer: Oxford Commercial	$3.39
Rate for Payer: Qualcare PPO/HMO/WC	$2.54
Rate for Payer: UnitedHealthcare Commercial	$3.39
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

VERAPAMIL/2.5MG/1ML

Facility

$13.00

Hospital Charge Code	60634151
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

VERAPAMIL/2.5MG/1ML

Facility

$18.00

Hospital Charge Code	60634150
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

VERAPAMIL/2.5MG/1ML

Facility

$13.00

Hospital Charge Code	60634152
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

VERAPAMIL/2.5MG/1ML

Facility

$13.00

Hospital Charge Code	60634151
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

VERAPAMIL/2.5MG/1ML

Facility

$13.00

Hospital Charge Code	60634152
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

VERAPAMIL/2.5MG/1ML

Facility

$18.00

Hospital Charge Code	60634150
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

Know your out-of-pocket cost for care.

All Charges