Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VITAMINS A, D OINT UD

Facility

$4.00

Service Code	NDC 168003545
Hospital Charge Code	60628432
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

VIT B12

Facility

$380.80

Service Code	HCPCS 82607
Hospital Charge Code	38479002
Hospital Revenue Code	301
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$190.40
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.43
Rate for Payer: Cigna Commercial	$190.40
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.12
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.09

VIT B12

Facility

$380.80

Service Code	HCPCS 82607
Hospital Charge Code	38479002
Hospital Revenue Code	301
Min. Negotiated Rate	$57.12
Max. Negotiated Rate	$57.12
Rate for Payer: Qualcare PPO/HMO/WC	$57.12

VIT B12 100MCG TAB

Facility

$1.00

Hospital Charge Code	60635388
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

VIT B12 100MCG TAB

Facility

$1.00

Hospital Charge Code	60635388
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

VIT B12 BINDING CAP, UNSAT

Facility

$119.25

Service Code	HCPCS 82608
Hospital Charge Code	3035105
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare Advantage	$46.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.69
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: Cigna Medicare Advantage	$14.32
Rate for Payer: Clover Medicare Advantage	$13.60
Rate for Payer: EmblemHealth Commercial	$42.96
Rate for Payer: Humana Medicare Advantage	$14.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.32
Rate for Payer: Wellcare Medicare Advantage	$14.32
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

VIT B12 BINDING CAP, UNSAT

Facility

$119.25

Service Code	HCPCS 82608
Hospital Charge Code	3035105
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

VIT B12 UNSAT BINDING CAPACITY

Facility

$119.25

Service Code	HCPCS 82608
Hospital Charge Code	3030244
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.95
Rate for Payer: Aetna Medicare Advantage	$46.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.69
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: Cigna Medicare Advantage	$14.32
Rate for Payer: Clover Medicare Advantage	$13.60
Rate for Payer: EmblemHealth Commercial	$42.96
Rate for Payer: Humana Medicare Advantage	$14.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.32
Rate for Payer: Wellcare Medicare Advantage	$14.32
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

VIT B12 UNSAT BINDING CAPACITY

Facility

$119.25

Service Code	HCPCS 82608
Hospital Charge Code	3030244
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

VIT C / FE / B12 CAP

Facility

$2.45

Hospital Charge Code	60629175
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

VIT C / FE / B12 CAP

Facility

$2.45

Hospital Charge Code	60629175
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

VIT D 1 25-DIHYDROXY

Facility

$358.45

Service Code	HCPCS 82652
Hospital Charge Code	8200309RS
Hospital Revenue Code	301
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$179.22
Rate for Payer: Aetna Commercial	$104.72
Rate for Payer: Aetna Medicare Advantage	$124.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$179.22
Rate for Payer: Cigna Medicare Advantage	$38.50
Rate for Payer: Clover Medicare Advantage	$36.58
Rate for Payer: EmblemHealth Commercial	$115.50
Rate for Payer: Humana Medicare Advantage	$39.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.50
Rate for Payer: Wellcare Medicare Advantage	$38.50
Rate for Payer: Wellpoint Medicaid Managed Care	$9.50

VIT D 1 25-DIHYDROXY

Facility

$358.45

Service Code	HCPCS 82652
Hospital Charge Code	8200309RS
Hospital Revenue Code	301
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$53.77
Rate for Payer: Qualcare PPO/HMO/WC	$53.77

VIT D 1,25-DIHYDROXY

Facility

$264.60

Service Code	HCPCS 82652
Hospital Charge Code	39900073
Hospital Revenue Code	301
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$39.69
Rate for Payer: Qualcare PPO/HMO/WC	$39.69

VIT D 1,25-DIHYDROXY

Facility

$264.60

Service Code	HCPCS 82652
Hospital Charge Code	39900073
Hospital Revenue Code	301
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$138.97
Rate for Payer: Aetna Commercial	$104.72
Rate for Payer: Aetna Medicare Advantage	$124.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$132.30
Rate for Payer: Cigna Medicare Advantage	$38.50
Rate for Payer: Clover Medicare Advantage	$36.58
Rate for Payer: EmblemHealth Commercial	$115.50
Rate for Payer: Humana Medicare Advantage	$39.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$30.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.50
Rate for Payer: Wellcare Medicare Advantage	$38.50
Rate for Payer: Wellpoint Medicaid Managed Care	$7.01

VITEK CARD GP

Facility

$315.55

Hospital Charge Code	270665946
Hospital Revenue Code	270
Min. Negotiated Rate	$47.33
Max. Negotiated Rate	$47.33
Rate for Payer: Qualcare PPO/HMO/WC	$47.33

VITEK CARD GP

Facility

$315.55

Hospital Charge Code	270665946
Hospital Revenue Code	270
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$157.78
Rate for Payer: Aetna Commercial	$119.91
Rate for Payer: Aetna Medicare Advantage	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.47
Rate for Payer: Cigna Commercial	$157.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.67
Rate for Payer: Oxford Commercial	$63.11
Rate for Payer: Qualcare PPO/HMO/WC	$47.33
Rate for Payer: UnitedHealthcare Commercial	$63.11
Rate for Payer: UnitedHealthcare Community & State	$7.60
Rate for Payer: Wellpoint Medicaid Managed Care	$8.36

VITEK ID CARD GN

Facility

$315.55

Hospital Charge Code	270665948
Hospital Revenue Code	270
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$157.78
Rate for Payer: Aetna Commercial	$119.91
Rate for Payer: Aetna Medicare Advantage	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.47
Rate for Payer: Cigna Commercial	$157.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.67
Rate for Payer: Oxford Commercial	$63.11
Rate for Payer: Qualcare PPO/HMO/WC	$47.33
Rate for Payer: UnitedHealthcare Commercial	$63.11
Rate for Payer: UnitedHealthcare Community & State	$7.60
Rate for Payer: Wellpoint Medicaid Managed Care	$8.36

VITEK ID CARD GN

Facility

$315.55

Hospital Charge Code	270665948
Hospital Revenue Code	270
Min. Negotiated Rate	$47.33
Max. Negotiated Rate	$47.33
Rate for Payer: Qualcare PPO/HMO/WC	$47.33

VITEK SENSI CARD GN71

Facility

$357.90

Hospital Charge Code	270665949
Hospital Revenue Code	270
Min. Negotiated Rate	$53.69
Max. Negotiated Rate	$53.69
Rate for Payer: Qualcare PPO/HMO/WC	$53.69

VITEK SENSI CARD GN71

Facility

$357.90

Hospital Charge Code	270665949
Hospital Revenue Code	270
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$178.95
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare Advantage	$107.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.26
Rate for Payer: Cigna Commercial	$178.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.37
Rate for Payer: Oxford Commercial	$71.58
Rate for Payer: Qualcare PPO/HMO/WC	$53.69
Rate for Payer: UnitedHealthcare Commercial	$71.58
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.48

VITEK SENSI CARD GP67

Facility

$357.90

Hospital Charge Code	270665947
Hospital Revenue Code	270
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$178.95
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare Advantage	$107.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.26
Rate for Payer: Cigna Commercial	$178.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.37
Rate for Payer: Oxford Commercial	$71.58
Rate for Payer: Qualcare PPO/HMO/WC	$53.69
Rate for Payer: UnitedHealthcare Commercial	$71.58
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.48

VITEK SENSI CARD GP67

Facility

$357.90

Hospital Charge Code	270665947
Hospital Revenue Code	270
Min. Negotiated Rate	$53.69
Max. Negotiated Rate	$53.69
Rate for Payer: Qualcare PPO/HMO/WC	$53.69

VI TIBIAL PTA

Facility

$7,952.85

Hospital Charge Code	5600007
Hospital Revenue Code	361
Min. Negotiated Rate	$191.66
Max. Negotiated Rate	$3,976.43
Rate for Payer: Aetna Commercial	$3,022.08
Rate for Payer: Aetna Medicare Advantage	$2,385.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,027.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,027.98
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	$2,027.98
Rate for Payer: Cigna Commercial	$3,976.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,385.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.93
Rate for Payer: UnitedHealthcare Community & State	$191.66
Rate for Payer: Wellpoint Medicaid Managed Care	$210.75

VI TIBIAL PTA

Facility

$7,952.85

Hospital Charge Code	5600007
Hospital Revenue Code	361
Min. Negotiated Rate	$1,192.93
Max. Negotiated Rate	$1,192.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.93

Know your out-of-pocket cost for care.

All Charges