Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VIAFILL DEMINE BONE FIBER 3CC

Facility

$3,750.00

Hospital Charge Code	270702355
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

VIAFILL DEMINE BONE FIBER 6CC

Facility

$7,500.00

Hospital Charge Code	270702366
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

VIAFILL DEMINE BONE FIBER 6CC

Facility

$7,500.00

Hospital Charge Code	270702366
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

VIAFLOW 1.0CC AMBIENT TISSUE

Facility

$16,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270697593
Hospital Revenue Code	278
Min. Negotiated Rate	$2,504.25
Max. Negotiated Rate	$4,040.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,040.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,672.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,504.25

VIAFLOW 1.0CC AMBIENT TISSUE

Facility

$16,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270697593
Hospital Revenue Code	278
Min. Negotiated Rate	$402.35
Max. Negotiated Rate	$8,347.50
Rate for Payer: Aetna Commercial	$6,344.10
Rate for Payer: Aetna Medicare Advantage	$5,008.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,257.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,257.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,257.23
Rate for Payer: Cigna Commercial	$8,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,040.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,672.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,504.25
Rate for Payer: UnitedHealthcare Community & State	$402.35
Rate for Payer: Wellpoint Medicaid Managed Care	$442.42

VIAL-O-JET

Facility

$5.13

Hospital Charge Code	270060060
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$1.95
Rate for Payer: Aetna Medicare Advantage	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.31
Rate for Payer: Cigna Commercial	$2.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.54
Rate for Payer: Oxford Commercial	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.03
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

VIAL-O-JET

Facility

$5.13

Hospital Charge Code	270060060
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

VIAL-O-JET

Facility

$26.45

Hospital Charge Code	270060060V
Hospital Revenue Code	761
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

VIAL-O-JET

Facility

$26.45

Hospital Charge Code	270060060V
Hospital Revenue Code	761
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$5.29
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

VIAL STERILE EMPTY

Facility

$7.25

Hospital Charge Code	60628557
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

VIAL STERILE EMPTY

Facility

$7.25

Hospital Charge Code	60628557
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

VIAL STERILE EMPTY

Facility

$5.80

Hospital Charge Code	60628611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.20
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

VIAL STERILE EMPTY

Facility

$5.80

Hospital Charge Code	60628611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

VIASHIELD AMNION DL PTCH 4X8CM

Facility

$25,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270696766
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

VIASHIELD AMNION DL PTCH 4X8CM

Facility

$25,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270696766
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

VIASHLD DUL LYR AMNI PTCH4X8CM

Facility

$15,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270696329
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

VIASHLD DUL LYR AMNI PTCH4X8CM

Facility

$15,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270696329
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

VIATORR ENDOPRT 10x8 PTB108275

Facility

$19,500.00

Hospital Charge Code	270635474V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

VIATORR ENDOPRT 10x8 PTB108275

Facility

$23,770.00

Service Code	HCPCS C1876
Hospital Charge Code	270635474
Hospital Revenue Code	278
Min. Negotiated Rate	$3,565.50
Max. Negotiated Rate	$5,752.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,752.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,229.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,565.50

VIATORR ENDOPRT 10x8 PTB108275

Facility

$19,500.00

Hospital Charge Code	270635474V
Hospital Revenue Code	278
Min. Negotiated Rate	$469.95
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$469.95
Rate for Payer: Wellpoint Medicaid Managed Care	$516.75

VIATORR ENDOPRT 10x8 PTB108275

Facility

$23,770.00

Service Code	HCPCS C1876
Hospital Charge Code	270635474
Hospital Revenue Code	278
Min. Negotiated Rate	$572.86
Max. Negotiated Rate	$11,885.00
Rate for Payer: Aetna Commercial	$9,032.60
Rate for Payer: Aetna Medicare Advantage	$7,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,061.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,061.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,061.35
Rate for Payer: Cigna Commercial	$11,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,752.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,229.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,565.50
Rate for Payer: UnitedHealthcare Community & State	$572.86
Rate for Payer: Wellpoint Medicaid Managed Care	$629.90

VI BILIARY TUBE CHANGE

Facility

$775.25

Hospital Charge Code	5600013
Hospital Revenue Code	320
Min. Negotiated Rate	$116.29
Max. Negotiated Rate	$116.29
Rate for Payer: Qualcare PPO/HMO/WC	$116.29

VI BILIARY TUBE CHANGE

Facility

$775.25

Hospital Charge Code	5600013
Hospital Revenue Code	320
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$294.60
Rate for Payer: Aetna Medicare Advantage	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.69
Rate for Payer: Cigna Commercial	$387.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.57
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.29
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

VIBRAMYCIN 50MG/50ML SYRP

Facility

$4.00

Service Code	NDC 69097065
Hospital Charge Code	60634794
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

VIBRAMYCIN 50MG/50ML SYRP

Facility

$4.00

Service Code	NDC 69097065
Hospital Charge Code	60634794
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges