Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VIBRAMYCIN 50MG/5ML SYR

Facility

$82.50

Hospital Charge Code	6063943176
Hospital Revenue Code	250
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

VIBRAMYCIN 50MG/5ML SYR

Facility

$82.50

Hospital Charge Code	6063943176
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna Commercial	$31.35
Rate for Payer: Aetna Medicare Advantage	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.04
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.75
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$16.50
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

VI BRANCHIOCEPHAZIL

Facility

$5,659.55

Service Code	HCPCS 35475
Hospital Charge Code	5600008
Hospital Revenue Code	361
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

VI BRANCHIOCEPHAZIL

Facility

$5,659.55

Service Code	HCPCS 35475
Hospital Charge Code	5600008
Hospital Revenue Code	361
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$2,150.63
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
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	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,697.87
Rate for Payer: Qualcare PPO/HMO/WC	$848.93
Rate for Payer: UnitedHealthcare Community & State	$136.40
Rate for Payer: Wellpoint Medicaid Managed Care	$149.98

VICI Stent 14x120

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270687299
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI Stent 14x120

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270687299
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699S
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699N
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696S
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696N
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697N
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697S
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698S
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698N
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

VICI VENOUS STENT SYS 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICODIN 5/300 MG TAB

Facility

$10.94

Hospital Charge Code	606380011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.47
Rate for Payer: Aetna Commercial	$4.16
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.79
Rate for Payer: Cigna Commercial	$5.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.28
Rate for Payer: Oxford Commercial	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.19
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

VICODIN 5/300 MG TAB

Facility

$10.94

Hospital Charge Code	606380011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

VICODIN/TAB

Facility

$3.00

Hospital Charge Code	60634154
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

Know your out-of-pocket cost for care.

All Charges