Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VIVACTIL/10MG/TAB

Facility

$3.00

Hospital Charge Code	60634409
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

VIVACTIL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634408
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

VIVACTIL/5MG/TAB

Facility

$3.00

Hospital Charge Code	60634408
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

VIVATROL ER INJ 380MG

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390234
Hospital Revenue Code	636
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$2,472.96
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.34
Rate for Payer: Cigna Medicare Advantage	$4.25
Rate for Payer: Clover Medicare Advantage	$4.04
Rate for Payer: EmblemHealth Commercial	$12.75
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83
Rate for Payer: UnitedHealthcare Community & State	$246.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.25
Rate for Payer: Wellcare Medicare Advantage	$4.25
Rate for Payer: Wellpoint Medicaid Managed Care	$270.80

VIVATROL ER INJ 380MG

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390234
Hospital Revenue Code	636
Min. Negotiated Rate	$1,532.83
Max. Negotiated Rate	$2,472.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83

VI VENOUS ANGIOPLASTY

Facility

$5,659.55

Service Code	HCPCS 35476
Hospital Charge Code	5600004
Hospital Revenue Code	361
Min. Negotiated Rate	$848.93
Max. Negotiated Rate	$848.93
Rate for Payer: Qualcare PPO/HMO/WC	$848.93

VI VENOUS ANGIOPLASTY

Facility

$5,659.55

Service Code	HCPCS 35476
Hospital Charge Code	5600004
Hospital Revenue Code	361
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$2,829.78
Rate for Payer: Aetna Commercial	$2,150.63
Rate for Payer: Aetna Medicare Advantage	$1,697.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.19
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	$1,443.19
Rate for Payer: Cigna Commercial	$2,829.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,697.87
Rate for Payer: Qualcare PPO/HMO/WC	$848.93
Rate for Payer: UnitedHealthcare Community & State	$136.40
Rate for Payer: Wellpoint Medicaid Managed Care	$149.98

VIVIGEN GRAFT 1CC

Facility

$2,855.00

Service Code	HCPCS C1762
Hospital Charge Code	270685524
Hospital Revenue Code	278
Min. Negotiated Rate	$428.25
Max. Negotiated Rate	$690.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$628.10
Rate for Payer: Qualcare PPO/HMO/WC	$428.25

VIVIGEN GRAFT 1CC

Facility

$2,855.00

Service Code	HCPCS C1762
Hospital Charge Code	270685524
Hospital Revenue Code	278
Min. Negotiated Rate	$68.81
Max. Negotiated Rate	$1,427.50
Rate for Payer: Aetna Commercial	$1,084.90
Rate for Payer: Aetna Medicare Advantage	$856.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$728.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$728.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$728.02
Rate for Payer: Cigna Commercial	$1,427.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$628.10
Rate for Payer: Qualcare PPO/HMO/WC	$428.25
Rate for Payer: UnitedHealthcare Community & State	$68.81
Rate for Payer: Wellpoint Medicaid Managed Care	$75.66

VIVIGEN GRAFT 1CC

Facility

$2,715.00

Service Code	HCPCS C1762
Hospital Charge Code	270679087
Hospital Revenue Code	278
Min. Negotiated Rate	$407.25
Max. Negotiated Rate	$657.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$597.30
Rate for Payer: Qualcare PPO/HMO/WC	$407.25

VIVIGEN GRAFT 1CC

Facility

$2,715.00

Service Code	HCPCS C1762
Hospital Charge Code	270679087
Hospital Revenue Code	278
Min. Negotiated Rate	$65.43
Max. Negotiated Rate	$1,357.50
Rate for Payer: Aetna Commercial	$1,031.70
Rate for Payer: Aetna Medicare Advantage	$814.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.33
Rate for Payer: Cigna Commercial	$1,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$597.30
Rate for Payer: Qualcare PPO/HMO/WC	$407.25
Rate for Payer: UnitedHealthcare Community & State	$65.43
Rate for Payer: Wellpoint Medicaid Managed Care	$71.95

VIVIGEN GRAFT 5CC

Facility

$12,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270679086
Hospital Revenue Code	278
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

VIVIGEN GRAFT 5CC

Facility

$12,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270679086
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

Vivitrol 380mg inj

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390242
Hospital Revenue Code	636
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$2,472.96
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.34
Rate for Payer: Cigna Medicare Advantage	$4.25
Rate for Payer: Clover Medicare Advantage	$4.04
Rate for Payer: EmblemHealth Commercial	$12.75
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83
Rate for Payer: UnitedHealthcare Community & State	$246.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.25
Rate for Payer: Wellcare Medicare Advantage	$4.25
Rate for Payer: Wellpoint Medicaid Managed Care	$270.80

Vivitrol 380mg inj

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390242
Hospital Revenue Code	636
Min. Negotiated Rate	$1,532.83
Max. Negotiated Rate	$2,472.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83

Vivitrol 380mg Susp Syrg

Facility

$6,600.00

Hospital Charge Code	606380006
Hospital Revenue Code	636
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) 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: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$159.06
Rate for Payer: Wellpoint Medicaid Managed Care	$174.90

Vivitrol 380mg Susp Syrg

Facility

$6,600.00

Hospital Charge Code	606380006
Hospital Revenue Code	636
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

VIVONEX JEJUNOSTOMY KIT

Facility

$389.00

Hospital Charge Code	270332052
Hospital Revenue Code	272
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

VIVONEX JEJUNOSTOMY KIT

Facility

$389.00

Hospital Charge Code	270332052
Hospital Revenue Code	272
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$147.82
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.70
Rate for Payer: Oxford Commercial	$77.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$77.80
Rate for Payer: UnitedHealthcare Community & State	$9.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.31

VIZADISC 2 PK REPLACEMENT KIT

Facility

$170.00

Hospital Charge Code	270668075
Hospital Revenue Code	272
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.00
Rate for Payer: Oxford Commercial	$34.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$34.00
Rate for Payer: UnitedHealthcare Community & State	$4.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

VIZADISC 2 PK REPLACEMENT KIT

Facility

$170.00

Hospital Charge Code	270668075
Hospital Revenue Code	272
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

VIZADISC KNEE TRACE KIT

Facility

$1,140.75

Hospital Charge Code	270668479
Hospital Revenue Code	272
Min. Negotiated Rate	$171.11
Max. Negotiated Rate	$171.11
Rate for Payer: Qualcare PPO/HMO/WC	$171.11

VIZADISC KNEE TRACE KIT

Facility

$1,140.75

Hospital Charge Code	270668479
Hospital Revenue Code	272
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$570.38
Rate for Payer: Aetna Commercial	$433.49
Rate for Payer: Aetna Medicare Advantage	$342.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.89
Rate for Payer: Cigna Commercial	$570.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.23
Rate for Payer: Oxford Commercial	$228.15
Rate for Payer: Qualcare PPO/HMO/WC	$171.11
Rate for Payer: UnitedHealthcare Commercial	$228.15
Rate for Payer: UnitedHealthcare Community & State	$27.49
Rate for Payer: Wellpoint Medicaid Managed Care	$30.23

VIZISHOT FLEX

Facility

$1,586.20

Hospital Charge Code	270678497
Hospital Revenue Code	272
Min. Negotiated Rate	$38.23
Max. Negotiated Rate	$793.10
Rate for Payer: Aetna Commercial	$602.76
Rate for Payer: Aetna Medicare Advantage	$475.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.48
Rate for Payer: Cigna Commercial	$793.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$475.86
Rate for Payer: Oxford Commercial	$317.24
Rate for Payer: Qualcare PPO/HMO/WC	$237.93
Rate for Payer: UnitedHealthcare Commercial	$317.24
Rate for Payer: UnitedHealthcare Community & State	$38.23
Rate for Payer: Wellpoint Medicaid Managed Care	$42.03

VIZISHOT FLEX

Facility

$1,586.20

Hospital Charge Code	270678497
Hospital Revenue Code	272
Min. Negotiated Rate	$237.93
Max. Negotiated Rate	$237.93
Rate for Payer: Qualcare PPO/HMO/WC	$237.93

Know your out-of-pocket cost for care.

All Charges