Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VICODIN/TAB

Facility

$4.00

Hospital Charge Code	60634155
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VICODIN/TAB

Facility

$4.00

Hospital Charge Code	60634155
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

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

VICON C/TAB

Facility

$3.00

Hospital Charge Code	60634309
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

VICON C/TAB

Facility

$3.00

Hospital Charge Code	60634309
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VICON FORTE/TAB

Facility

$3.00

Hospital Charge Code	60634308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VICON FORTE/TAB

Facility

$3.00

Hospital Charge Code	60634308
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

VICRYL MESH KNITTED 6X6

Facility

$527.00

Hospital Charge Code	270334718
Hospital Revenue Code	278
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$127.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.94
Rate for Payer: Qualcare PPO/HMO/WC	$79.05

VICRYL MESH KNITTED 6X6

Facility

$527.00

Hospital Charge Code	270334718
Hospital Revenue Code	278
Min. Negotiated Rate	$12.70
Max. Negotiated Rate	$263.50
Rate for Payer: Aetna Commercial	$200.26
Rate for Payer: Aetna Medicare Advantage	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.38
Rate for Payer: Cigna Commercial	$263.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.94
Rate for Payer: Qualcare PPO/HMO/WC	$79.05
Rate for Payer: UnitedHealthcare Community & State	$12.70
Rate for Payer: Wellpoint Medicaid Managed Care	$13.97

VICRYL PLUS UNDYED 8X27CT-1 CR

Facility

$62.35

Hospital Charge Code	270690394
Hospital Revenue Code	272
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$9.35
Rate for Payer: Qualcare PPO/HMO/WC	$9.35

VICRYL PLUS UNDYED 8X27CT-1 CR

Facility

$62.35

Hospital Charge Code	270690394
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$31.18
Rate for Payer: Aetna Commercial	$23.69
Rate for Payer: Aetna Medicare Advantage	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.90
Rate for Payer: Cigna Commercial	$31.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.70
Rate for Payer: Oxford Commercial	$12.47
Rate for Payer: Qualcare PPO/HMO/WC	$9.35
Rate for Payer: UnitedHealthcare Commercial	$12.47
Rate for Payer: UnitedHealthcare Community & State	$1.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

VIDARABINE OPH OINT 3%

Facility

$212.85

Hospital Charge Code	60628027
Hospital Revenue Code	250
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$106.42
Rate for Payer: Aetna Commercial	$80.88
Rate for Payer: Aetna Medicare Advantage	$63.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.28
Rate for Payer: Cigna Commercial	$106.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.85
Rate for Payer: Oxford Commercial	$42.57
Rate for Payer: Qualcare PPO/HMO/WC	$31.93
Rate for Payer: UnitedHealthcare Commercial	$42.57
Rate for Payer: UnitedHealthcare Community & State	$5.13
Rate for Payer: Wellpoint Medicaid Managed Care	$5.64

VIDARABINE OPH OINT 3%

Facility

$212.85

Hospital Charge Code	60628027
Hospital Revenue Code	250
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$31.93
Rate for Payer: Qualcare PPO/HMO/WC	$31.93

VIDARABINE OPH OINT 3% 3.5GM

Facility

$122.25

Hospital Charge Code	6005656
Hospital Revenue Code	252
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

VIDARABINE OPH OINT 3% 3.5GM

Facility

$122.25

Hospital Charge Code	6005656
Hospital Revenue Code	252
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$46.45
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.67
Rate for Payer: Oxford Commercial	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$24.45
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

VIDEX/100MG/TAB

Facility

$12.00

Hospital Charge Code	60634756
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

VIDEX/100MG/TAB

Facility

$12.00

Hospital Charge Code	60634756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

VIDEX/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634754
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

VIDEX/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VIDEX/50MG/TAB

Facility

$3.00

Hospital Charge Code	60634755
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

VIDEX/50MG/TAB

Facility

$3.00

Hospital Charge Code	60634755
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VIDEX EC 125 MG

Facility

$36.18

Service Code	NDC 87667117
Hospital Charge Code	60632244
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.09
Rate for Payer: Aetna Commercial	$13.75
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.23
Rate for Payer: Cigna Commercial	$18.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.85
Rate for Payer: Oxford Commercial	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$5.43
Rate for Payer: UnitedHealthcare Commercial	$7.24
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

VIDEX EC 125 MG

Facility

$36.18

Service Code	NDC 87667117
Hospital Charge Code	60632244
Hospital Revenue Code	250
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.43

VIDEX EC 200MG CAP

Facility

$57.89

Service Code	NDC 87667217
Hospital Charge Code	60632268
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.68

VIDEX EC 200MG CAP

Facility

$57.89

Service Code	NDC 87667217
Hospital Charge Code	60632268
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$22.00
Rate for Payer: Aetna Medicare Advantage	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.76
Rate for Payer: Cigna Commercial	$28.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.37
Rate for Payer: Oxford Commercial	$11.58
Rate for Payer: Qualcare PPO/HMO/WC	$8.68
Rate for Payer: UnitedHealthcare Commercial	$11.58
Rate for Payer: UnitedHealthcare Community & State	$1.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

Know your out-of-pocket cost for care.

All Charges