Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VITMIN B3 (SERUM)

Facility

$178.88

Service Code	HCPCS 84591
Hospital Charge Code	397080020
Hospital Revenue Code	301
Min. Negotiated Rate	$4.74
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	$89.44
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	$53.66
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.83
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	$4.74

VITMIN B3 (SERUM)

Facility

$178.88

Service Code	HCPCS 84591
Hospital Charge Code	397080020
Hospital Revenue Code	301
Min. Negotiated Rate	$26.83
Max. Negotiated Rate	$26.83
Rate for Payer: Qualcare PPO/HMO/WC	$26.83

VITOSS 2.5 CC BA2X

Facility

$6,345.00

Hospital Charge Code	270656574
Hospital Revenue Code	278
Min. Negotiated Rate	$951.75
Max. Negotiated Rate	$1,535.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,395.90
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

VITOSS 2.5 CC BA2X

Facility

$6,345.00

Hospital Charge Code	270656574
Hospital Revenue Code	278
Min. Negotiated Rate	$152.91
Max. Negotiated Rate	$3,172.50
Rate for Payer: Aetna Commercial	$2,411.10
Rate for Payer: Aetna Medicare Advantage	$1,903.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,617.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,617.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,617.97
Rate for Payer: Cigna Commercial	$3,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,395.90
Rate for Payer: Qualcare PPO/HMO/WC	$951.75
Rate for Payer: UnitedHealthcare Community & State	$152.91
Rate for Payer: Wellpoint Medicaid Managed Care	$168.14

VITOSS BA2X FOAM PACK 10CC

Facility

$19,922.35

Service Code	HCPCS C1713
Hospital Charge Code	270656479
Hospital Revenue Code	278
Min. Negotiated Rate	$2,988.35
Max. Negotiated Rate	$4,821.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,984.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,821.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,382.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,988.35

VITOSS BA2X FOAM PACK 10CC

Facility

$19,922.35

Service Code	HCPCS C1713
Hospital Charge Code	270656479
Hospital Revenue Code	278
Min. Negotiated Rate	$480.13
Max. Negotiated Rate	$9,961.17
Rate for Payer: Aetna Commercial	$7,570.49
Rate for Payer: Aetna Medicare Advantage	$5,976.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,080.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,080.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,984.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,080.20
Rate for Payer: Cigna Commercial	$9,961.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,821.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,382.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,988.35
Rate for Payer: UnitedHealthcare Community & State	$480.13
Rate for Payer: Wellpoint Medicaid Managed Care	$527.94

VITOSS BB FOAM PACK 5 CC

Facility

$11,100.40

Service Code	HCPCS C1713
Hospital Charge Code	270680168
Hospital Revenue Code	278
Min. Negotiated Rate	$1,665.06
Max. Negotiated Rate	$2,686.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,220.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,686.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,442.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,665.06

VITOSS BB FOAM PACK 5 CC

Facility

$11,100.40

Service Code	HCPCS C1713
Hospital Charge Code	270680168
Hospital Revenue Code	278
Min. Negotiated Rate	$267.52
Max. Negotiated Rate	$5,550.20
Rate for Payer: Aetna Commercial	$4,218.15
Rate for Payer: Aetna Medicare Advantage	$3,330.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,830.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,830.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,220.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,830.60
Rate for Payer: Cigna Commercial	$5,550.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,686.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,442.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,665.06
Rate for Payer: UnitedHealthcare Community & State	$267.52
Rate for Payer: Wellpoint Medicaid Managed Care	$294.16

VITOSS BB TRAUMA FOAM PACK

Facility

$5,920.20

Service Code	HCPCS C1713
Hospital Charge Code	270671169
Hospital Revenue Code	278
Min. Negotiated Rate	$888.03
Max. Negotiated Rate	$1,432.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,184.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,432.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,302.44
Rate for Payer: Qualcare PPO/HMO/WC	$888.03

VITOSS BB TRAUMA FOAM PACK

Facility

$5,920.20

Service Code	HCPCS C1713
Hospital Charge Code	270671169
Hospital Revenue Code	278
Min. Negotiated Rate	$142.68
Max. Negotiated Rate	$2,960.10
Rate for Payer: Aetna Commercial	$2,249.68
Rate for Payer: Aetna Medicare Advantage	$1,776.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,509.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,509.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,184.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,509.65
Rate for Payer: Cigna Commercial	$2,960.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,432.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,302.44
Rate for Payer: Qualcare PPO/HMO/WC	$888.03
Rate for Payer: UnitedHealthcare Community & State	$142.68
Rate for Payer: Wellpoint Medicaid Managed Care	$156.89

VITOSS BIMODAL 10CC

Facility

$23,895.30

Service Code	HCPCS C1713
Hospital Charge Code	270697908
Hospital Revenue Code	278
Min. Negotiated Rate	$3,584.30
Max. Negotiated Rate	$5,782.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,779.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,782.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,256.97
Rate for Payer: Qualcare PPO/HMO/WC	$3,584.30

VITOSS BIMODAL 10CC

Facility

$23,895.30

Service Code	HCPCS C1713
Hospital Charge Code	270697908
Hospital Revenue Code	278
Min. Negotiated Rate	$575.88
Max. Negotiated Rate	$11,947.65
Rate for Payer: Aetna Commercial	$9,080.21
Rate for Payer: Aetna Medicare Advantage	$7,168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,093.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,093.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,779.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,093.30
Rate for Payer: Cigna Commercial	$11,947.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,782.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,256.97
Rate for Payer: Qualcare PPO/HMO/WC	$3,584.30
Rate for Payer: UnitedHealthcare Community & State	$575.88
Rate for Payer: Wellpoint Medicaid Managed Care	$633.23

VITOSS BIMODAL 5ML

Facility

$17,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270699423
Hospital Revenue Code	278
Min. Negotiated Rate	$2,643.00
Max. Negotiated Rate	$4,264.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,264.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,876.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.00

VITOSS BIMODAL 5ML

Facility

$17,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270699423
Hospital Revenue Code	278
Min. Negotiated Rate	$424.64
Max. Negotiated Rate	$8,810.00
Rate for Payer: Aetna Commercial	$6,695.60
Rate for Payer: Aetna Medicare Advantage	$5,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,493.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,493.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,493.10
Rate for Payer: Cigna Commercial	$8,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,264.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,876.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.00
Rate for Payer: UnitedHealthcare Community & State	$424.64
Rate for Payer: Wellpoint Medicaid Managed Care	$466.93

VITOSS BONE GRAFT SUB

Facility

$5,250.00

Hospital Charge Code	270656576
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

VITOSS BONE GRAFT SUB

Facility

$5,250.00

Hospital Charge Code	270656576
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

VI TRANSHEPATIC CHOLANGIOGRAM

Facility

$1,631.25

Hospital Charge Code	5600009
Hospital Revenue Code	320
Min. Negotiated Rate	$39.31
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$619.88
Rate for Payer: Aetna Medicare Advantage	$489.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.97
Rate for Payer: Cigna Commercial	$815.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$489.38
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.69
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$39.31
Rate for Payer: Wellpoint Medicaid Managed Care	$43.23

VI TRANSHEPATIC CHOLANGIOGRAM

Facility

$1,631.25

Hospital Charge Code	5600009
Hospital Revenue Code	320
Min. Negotiated Rate	$244.69
Max. Negotiated Rate	$244.69
Rate for Payer: Qualcare PPO/HMO/WC	$244.69

VIVACIT-E DM BEAR LNR 28X42MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689981
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

VIVACIT-E DM BEAR LNR 28X42MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689981
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689592
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689502
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689502
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689592
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

VIVACTIL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634409
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges