Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VIDEX EC 250 MG CAPS

Facility

$73.77

Service Code	NDC 87667317
Hospital Charge Code	60635345
Hospital Revenue Code	250
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$11.07
Rate for Payer: Qualcare PPO/HMO/WC	$11.07

VIDEX EC 250 MG CAPS

Facility

$73.77

Service Code	NDC 87667317
Hospital Charge Code	60635345
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$36.88
Rate for Payer: Aetna Commercial	$28.03
Rate for Payer: Aetna Medicare Advantage	$22.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.81
Rate for Payer: Cigna Commercial	$36.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.13
Rate for Payer: Oxford Commercial	$14.75
Rate for Payer: Qualcare PPO/HMO/WC	$11.07
Rate for Payer: UnitedHealthcare Commercial	$14.75
Rate for Payer: UnitedHealthcare Community & State	$1.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.95

VIDEX EC CAPS 400 MG

Facility

$115.17

Service Code	NDC 87667417
Hospital Charge Code	60635320
Hospital Revenue Code	250
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$17.28
Rate for Payer: Qualcare PPO/HMO/WC	$17.28

VIDEX EC CAPS 400 MG

Facility

$115.17

Service Code	NDC 87667417
Hospital Charge Code	60635320
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$57.59
Rate for Payer: Aetna Commercial	$43.76
Rate for Payer: Aetna Medicare Advantage	$34.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.37
Rate for Payer: Cigna Commercial	$57.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.55
Rate for Payer: Oxford Commercial	$23.03
Rate for Payer: Qualcare PPO/HMO/WC	$17.28
Rate for Payer: UnitedHealthcare Commercial	$23.03
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

VID SMOKING/HUMAN PHYS GN-16

Facility

$450.00

Hospital Charge Code	270632335
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

VID SMOKING/HUMAN PHYS GN-16

Facility

$450.00

Hospital Charge Code	270632335
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

VI EMOBLIZATION (NON NEURO)

Facility

$40,990.35

Hospital Charge Code	5600002
Hospital Revenue Code	361
Min. Negotiated Rate	$987.87
Max. Negotiated Rate	$20,495.17
Rate for Payer: Aetna Commercial	$15,576.33
Rate for Payer: Aetna Medicare Advantage	$12,297.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.54
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	$10,452.54
Rate for Payer: Cigna Commercial	$20,495.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,297.10
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55
Rate for Payer: UnitedHealthcare Community & State	$987.87
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.24

VI EMOBLIZATION (NON NEURO)

Facility

$40,990.35

Hospital Charge Code	5600002
Hospital Revenue Code	361
Min. Negotiated Rate	$6,148.55
Max. Negotiated Rate	$6,148.55
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.55

VI ILIAC ANGIOSPLASTY

Facility

$21,962.30

Hospital Charge Code	5600005
Hospital Revenue Code	361
Min. Negotiated Rate	$529.29
Max. Negotiated Rate	$10,981.15
Rate for Payer: Aetna Commercial	$8,345.67
Rate for Payer: Aetna Medicare Advantage	$6,588.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,600.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,600.39
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	$5,600.39
Rate for Payer: Cigna Commercial	$10,981.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,588.69
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34
Rate for Payer: UnitedHealthcare Community & State	$529.29
Rate for Payer: Wellpoint Medicaid Managed Care	$582.00

VI ILIAC ANGIOSPLASTY

Facility

$21,962.30

Hospital Charge Code	5600005
Hospital Revenue Code	361
Min. Negotiated Rate	$3,294.34
Max. Negotiated Rate	$3,294.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,294.34

VI INT EXT BILIARY DRAINAGE

Facility

$2,687.25

Service Code	HCPCS 75982
Hospital Charge Code	5600015
Hospital Revenue Code	323
Min. Negotiated Rate	$64.76
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,021.15
Rate for Payer: Aetna Medicare Advantage	$806.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$685.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$685.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$685.25
Rate for Payer: Cigna Commercial	$1,343.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$806.17
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$403.09
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$64.76
Rate for Payer: Wellpoint Medicaid Managed Care	$71.21

VI INT EXT BILIARY DRAINAGE

Facility

$2,687.25

Service Code	HCPCS 75982
Hospital Charge Code	5600015
Hospital Revenue Code	323
Min. Negotiated Rate	$403.09
Max. Negotiated Rate	$403.09
Rate for Payer: Qualcare PPO/HMO/WC	$403.09

VI IVC FILTER

Facility

$7,400.85

Service Code	HCPCS 37191
Hospital Charge Code	5600003
Hospital Revenue Code	361
Min. Negotiated Rate	$178.36
Max. Negotiated Rate	$23,862.86
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,862.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
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	$23,862.86
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.26
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.13
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$178.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$196.12

VI IVC FILTER

Facility

$7,400.85

Service Code	HCPCS 37191
Hospital Charge Code	5600003
Hospital Revenue Code	361
Min. Negotiated Rate	$1,110.13
Max. Negotiated Rate	$1,110.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,110.13

VILEX GUIDEWIRE 100MM.09

Facility

$29.75

Hospital Charge Code	270656330
Hospital Revenue Code	278
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.88
Rate for Payer: Aetna Commercial	$11.30
Rate for Payer: Aetna Medicare Advantage	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.59
Rate for Payer: Cigna Commercial	$14.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6.54
Rate for Payer: Qualcare PPO/HMO/WC	$4.46
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

VILEX GUIDEWIRE 100MM.09

Facility

$29.75

Hospital Charge Code	270656330
Hospital Revenue Code	278
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6.54
Rate for Payer: Qualcare PPO/HMO/WC	$4.46

VILEX HOMI IMPLANT 17X15MM

Facility

$7,125.00

Hospital Charge Code	270656769
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

VILEX HOMI IMPLANT 17X15MM

Facility

$7,125.00

Hospital Charge Code	270656769
Hospital Revenue Code	278
Min. Negotiated Rate	$171.71
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75
Rate for Payer: UnitedHealthcare Community & State	$171.71
Rate for Payer: Wellpoint Medicaid Managed Care	$188.81

VIMAX BONE MATRIX CARTRIDGE 10

Facility

$23,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270697258
Hospital Revenue Code	278
Min. Negotiated Rate	$563.94
Max. Negotiated Rate	$11,700.00
Rate for Payer: Aetna Commercial	$8,892.00
Rate for Payer: Aetna Medicare Advantage	$7,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,967.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,967.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,967.00
Rate for Payer: Cigna Commercial	$11,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,662.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,148.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,510.00
Rate for Payer: UnitedHealthcare Community & State	$563.94
Rate for Payer: Wellpoint Medicaid Managed Care	$620.10

VIMAX BONE MATRIX CARTRIDGE 10

Facility

$23,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270697258
Hospital Revenue Code	278
Min. Negotiated Rate	$3,510.00
Max. Negotiated Rate	$5,662.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,662.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,148.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,510.00

VIMAX BONE MATRIX CARTRIDGE 5

Facility

$12,875.00

Service Code	HCPCS C1763
Hospital Charge Code	270697338
Hospital Revenue Code	278
Min. Negotiated Rate	$310.29
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$310.29
Rate for Payer: Wellpoint Medicaid Managed Care	$341.19

VIMAX BONE MATRIX CARTRIDGE 5

Facility

$12,875.00

Service Code	HCPCS C1763
Hospital Charge Code	270697338
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

VIMAX BONE MATRIX VL 2CC

Facility

$6,600.00

Service Code	HCPCS C1763
Hospital Charge Code	270697764
Hospital Revenue Code	278
Min. Negotiated Rate	$159.06
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$159.06
Rate for Payer: Wellpoint Medicaid Managed Care	$174.90

VIMAX BONE MATRIX VL 2CC

Facility

$6,600.00

Service Code	HCPCS C1763
Hospital Charge Code	270697764
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

VINBLASTINE 10 MG INJ

Facility

$110.95

Service Code	HCPCS J9360
Hospital Charge Code	6005664
Hospital Revenue Code	636
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$26.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$16.64

Know your out-of-pocket cost for care.

All Charges