Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN E 100 UNITS CAP

Facility

$2.45

Hospital Charge Code	60628723
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

VITAMIN E 100 UNITS CAP

Facility

$2.45

Hospital Charge Code	60628723
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

VITAMIN E/400U/CAP

Facility

$1.00

Hospital Charge Code	60634307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

VITAMIN E/400U/CAP

Facility

$1.00

Hospital Charge Code	60634307
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

VITAMIN E 400 UNITS CAP

Facility

$4.00

Service Code	NDC 62107006401
Hospital Charge Code	60628724
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

VITAMIN E 400 UNITS CAP

Facility

$4.00

Service Code	NDC 62107006401
Hospital Charge Code	60628724
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VITAMIN E (A-TOCOPHEROL)

Facility

$175.25

Service Code	HCPCS 84446
Hospital Charge Code	3002789
Hospital Revenue Code	301
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$26.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.29

VITAMIN E (A-TOCOPHEROL)

Facility

$175.25

Service Code	HCPCS 84446
Hospital Charge Code	3002789
Hospital Revenue Code	301
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.57
Rate for Payer: Aetna Medicare Advantage	$45.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.19
Rate for Payer: Cigna Commercial	$87.62
Rate for Payer: Cigna Medicare Advantage	$14.18
Rate for Payer: Clover Medicare Advantage	$13.47
Rate for Payer: EmblemHealth Commercial	$42.54
Rate for Payer: Humana Medicare Advantage	$14.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.58
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.29
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.18
Rate for Payer: Wellcare Medicare Advantage	$14.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

VITAMIN E LQ 50IU/ML 60ML

Facility

$113.30

Hospital Charge Code	6005698
Hospital Revenue Code	251
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

VITAMIN E LQ 50IU/ML 60ML

Facility

$113.30

Hospital Charge Code	6005698
Hospital Revenue Code	251
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$56.65
Rate for Payer: Aetna Commercial	$43.05
Rate for Payer: Aetna Medicare Advantage	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.89
Rate for Payer: Cigna Commercial	$56.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.99
Rate for Payer: Oxford Commercial	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$22.66
Rate for Payer: UnitedHealthcare Community & State	$2.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

VITAMIN K

Facility

$390.00

Service Code	HCPCS 84597
Hospital Charge Code	39900151
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN K

Facility

$638.45

Service Code	HCPCS 84597
Hospital Charge Code	3032372
Hospital Revenue Code	301
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$95.77
Rate for Payer: Qualcare PPO/HMO/WC	$95.77

VITAMIN K

Facility

$638.45

Service Code	HCPCS 84597
Hospital Charge Code	3032372
Hospital Revenue Code	301
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$319.23
Rate for Payer: Aetna Commercial	$37.32
Rate for Payer: Aetna Medicare Advantage	$44.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.53
Rate for Payer: Cigna Commercial	$319.23
Rate for Payer: Cigna Medicare Advantage	$13.72
Rate for Payer: Clover Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$41.16
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.72
Rate for Payer: Wellcare Medicare Advantage	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$16.92

VITAMIN K

Facility

$97.10

Service Code	HCPCS 84597
Hospital Charge Code	38477118
Hospital Revenue Code	301
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$37.32
Rate for Payer: Aetna Medicare Advantage	$44.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.53
Rate for Payer: Cigna Commercial	$48.55
Rate for Payer: Cigna Medicare Advantage	$13.72
Rate for Payer: Clover Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$41.16
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.13
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.56
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.72
Rate for Payer: Wellcare Medicare Advantage	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

VITAMIN K

Facility

$97.10

Service Code	HCPCS 84597
Hospital Charge Code	38477118
Hospital Revenue Code	301
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$14.56
Rate for Payer: Qualcare PPO/HMO/WC	$14.56

VITAMIN K

Facility

$390.00

Service Code	HCPCS 84597
Hospital Charge Code	39900151
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.32
Rate for Payer: Aetna Medicare Advantage	$44.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.72
Rate for Payer: Clover Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$41.16
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.72
Rate for Payer: Wellcare Medicare Advantage	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

VITAMIN K 10MG/VIAL

Facility

$37.80

Hospital Charge Code	6010193
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

VITAMIN K 10MG/VIAL

Facility

$37.80

Hospital Charge Code	6010193
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

VITAMIN MULTI INJ VL 50ML

Facility

$53.80

Hospital Charge Code	6009138
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

VITAMIN MULTI INJ VL 50ML

Facility

$53.80

Hospital Charge Code	6009138
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

VITAMIN MULTI MVI-12 INJ

Facility

$15.40

Hospital Charge Code	6009120
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

VITAMIN MULTI MVI-12 INJ

Facility

$15.40

Hospital Charge Code	6009120
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$5.85
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.62
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

VITAMIN, NOS

Facility

$82.00

Service Code	HCPCS 84591
Hospital Charge Code	38477102
Hospital Revenue Code	301
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

VITAMIN, NOS

Facility

$82.00

Service Code	HCPCS 84591
Hospital Charge Code	38477102
Hospital Revenue Code	301
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$46.40
Rate for Payer: Aetna Medicare Advantage	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.58
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: Cigna Medicare Advantage	$17.06
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.06
Rate for Payer: Wellcare Medicare Advantage	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

VITAMINS A, D OINT UD

Facility

$4.00

Service Code	NDC 168003545
Hospital Charge Code	60628432
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