Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VISISHOT 2 25G

Facility

$6,859.00

Hospital Charge Code	270703015
Hospital Revenue Code	278
Min. Negotiated Rate	$165.30
Max. Negotiated Rate	$3,429.50
Rate for Payer: Aetna Commercial	$2,606.42
Rate for Payer: Aetna Medicare Advantage	$2,057.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,749.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,749.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,749.05
Rate for Payer: Cigna Commercial	$3,429.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,659.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,508.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.85
Rate for Payer: UnitedHealthcare Community & State	$165.30
Rate for Payer: Wellpoint Medicaid Managed Care	$181.76

VISKEN/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634157
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VISKEN/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634157
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

VISKEN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634158
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VISKEN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634158
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

VISTARIL/25MG/CAP

Facility

$6.00

Hospital Charge Code	60634334
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

VISTARIL/25MG/CAP

Facility

$6.00

Hospital Charge Code	60634334
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VISTARIL/50MG/CAP

Facility

$6.00

Hospital Charge Code	60634335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

VISTARIL/50MG/CAP

Facility

$6.00

Hospital Charge Code	60634335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

VISTASEAL 2MM

Facility

$602.75

Hospital Charge Code	270688739
Hospital Revenue Code	272
Min. Negotiated Rate	$90.41
Max. Negotiated Rate	$90.41
Rate for Payer: Qualcare PPO/HMO/WC	$90.41

VISTASEAL 2MM

Facility

$602.75

Hospital Charge Code	270688739
Hospital Revenue Code	272
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$301.38
Rate for Payer: Aetna Commercial	$229.04
Rate for Payer: Aetna Medicare Advantage	$180.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.70
Rate for Payer: Cigna Commercial	$301.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.82
Rate for Payer: Oxford Commercial	$120.55
Rate for Payer: Qualcare PPO/HMO/WC	$90.41
Rate for Payer: UnitedHealthcare Commercial	$120.55
Rate for Payer: UnitedHealthcare Community & State	$14.53
Rate for Payer: Wellpoint Medicaid Managed Care	$15.97

VISTASEAL FIBRIN 4 ML

Facility

$1,116.20

Hospital Charge Code	270688740
Hospital Revenue Code	272
Min. Negotiated Rate	$26.90
Max. Negotiated Rate	$558.10
Rate for Payer: Aetna Commercial	$424.16
Rate for Payer: Aetna Medicare Advantage	$334.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.63
Rate for Payer: Cigna Commercial	$558.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.86
Rate for Payer: Oxford Commercial	$223.24
Rate for Payer: Qualcare PPO/HMO/WC	$167.43
Rate for Payer: UnitedHealthcare Commercial	$223.24
Rate for Payer: UnitedHealthcare Community & State	$26.90
Rate for Payer: Wellpoint Medicaid Managed Care	$29.58

VISTASEAL FIBRIN 4 ML

Facility

$1,116.20

Hospital Charge Code	270688740
Hospital Revenue Code	272
Min. Negotiated Rate	$167.43
Max. Negotiated Rate	$167.43
Rate for Payer: Qualcare PPO/HMO/WC	$167.43

VISTASEAL, FIBRIN SEALANT 10MG

Facility

$2,567.25

Service Code	HCPCS C1765
Hospital Charge Code	270688748
Hospital Revenue Code	278
Min. Negotiated Rate	$385.09
Max. Negotiated Rate	$621.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$564.79
Rate for Payer: Qualcare PPO/HMO/WC	$385.09

VISTASEAL, FIBRIN SEALANT 10MG

Facility

$2,567.25

Service Code	HCPCS C1765
Hospital Charge Code	270688748
Hospital Revenue Code	278
Min. Negotiated Rate	$61.87
Max. Negotiated Rate	$1,283.62
Rate for Payer: Aetna Commercial	$975.55
Rate for Payer: Aetna Medicare Advantage	$770.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$654.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$654.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$654.65
Rate for Payer: Cigna Commercial	$1,283.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$564.79
Rate for Payer: Qualcare PPO/HMO/WC	$385.09
Rate for Payer: UnitedHealthcare Community & State	$61.87
Rate for Payer: Wellpoint Medicaid Managed Care	$68.03

VISTIDE

Facility

$3,249.00

Hospital Charge Code	60635116
Hospital Revenue Code	250
Min. Negotiated Rate	$487.35
Max. Negotiated Rate	$487.35
Rate for Payer: Qualcare PPO/HMO/WC	$487.35

VISTIDE

Facility

$3,249.00

Hospital Charge Code	60635116
Hospital Revenue Code	250
Min. Negotiated Rate	$78.30
Max. Negotiated Rate	$1,624.50
Rate for Payer: Aetna Commercial	$1,234.62
Rate for Payer: Aetna Medicare Advantage	$974.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.50
Rate for Payer: Cigna Commercial	$1,624.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$974.70
Rate for Payer: Oxford Commercial	$649.80
Rate for Payer: Qualcare PPO/HMO/WC	$487.35
Rate for Payer: UnitedHealthcare Commercial	$649.80
Rate for Payer: UnitedHealthcare Community & State	$78.30
Rate for Payer: Wellpoint Medicaid Managed Care	$86.10

VITAFOL LIQUID

Facility

$3.00

Hospital Charge Code	60634980
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

VITAFOL LIQUID

Facility

$3.00

Hospital Charge Code	60634980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VITAGEL SURG.HEMOSTAT 4.5 ML

Facility

$858.00

Hospital Charge Code	270335970
Hospital Revenue Code	272
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$429.00
Rate for Payer: Aetna Commercial	$326.04
Rate for Payer: Aetna Medicare Advantage	$257.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.79
Rate for Payer: Cigna Commercial	$429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.40
Rate for Payer: Oxford Commercial	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$128.70
Rate for Payer: UnitedHealthcare Commercial	$171.60
Rate for Payer: UnitedHealthcare Community & State	$20.68
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

VITAGEL SURG.HEMOSTAT 4.5 ML

Facility

$858.00

Hospital Charge Code	270335970
Hospital Revenue Code	272
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

VITAL UTERINE SCISSON

Facility

$1,845.00

Hospital Charge Code	270665620
Hospital Revenue Code	272
Min. Negotiated Rate	$44.46
Max. Negotiated Rate	$922.50
Rate for Payer: Aetna Commercial	$701.10
Rate for Payer: Aetna Medicare Advantage	$553.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$470.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$470.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$470.48
Rate for Payer: Cigna Commercial	$922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.50
Rate for Payer: Oxford Commercial	$369.00
Rate for Payer: Qualcare PPO/HMO/WC	$276.75
Rate for Payer: UnitedHealthcare Commercial	$369.00
Rate for Payer: UnitedHealthcare Community & State	$44.46
Rate for Payer: Wellpoint Medicaid Managed Care	$48.89

VITAL UTERINE SCISSON

Facility

$1,845.00

Hospital Charge Code	270665620
Hospital Revenue Code	272
Min. Negotiated Rate	$276.75
Max. Negotiated Rate	$276.75
Rate for Payer: Qualcare PPO/HMO/WC	$276.75

VITAL VU DISP TIP ******

Facility

$160.00

Hospital Charge Code	1801158
Hospital Revenue Code	279
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

VITAL VU DISP TIP ******

Facility

$160.00

Hospital Charge Code	1801158
Hospital Revenue Code	279
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.00
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$32.00
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

Know your out-of-pocket cost for care.

All Charges