Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONTRAST OMNIPAQUE 300mg 100ml

Facility

$71.95

Hospital Charge Code	270643912C
Hospital Revenue Code	255
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$35.98
Rate for Payer: Aetna Commercial	$27.34
Rate for Payer: Aetna Medicare Advantage	$21.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.35
Rate for Payer: Cigna Commercial	$35.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.59
Rate for Payer: Oxford Commercial	$14.39
Rate for Payer: Qualcare PPO/HMO/WC	$10.79
Rate for Payer: UnitedHealthcare Commercial	$14.39
Rate for Payer: UnitedHealthcare Community & State	$1.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

CONTRAST OMNIPAQUE 320MG/1ML

Facility

$3.75

Hospital Charge Code	270605512C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Qualcare PPO/HMO/WC	$0.56

CONTRAST OMNIPAQUE 320MG/1ML

Facility

$3.75

Hospital Charge Code	270605512C
Hospital Revenue Code	255
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.43
Rate for Payer: Aetna Medicare Advantage	$1.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.96
Rate for Payer: Cigna Commercial	$1.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.56
Rate for Payer: UnitedHealthcare Commercial	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

CONTRAST OMNIPAQUE 75cc BOTTLE

Facility

$147.25

Hospital Charge Code	605512
Hospital Revenue Code	636
Min. Negotiated Rate	$22.09
Max. Negotiated Rate	$35.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.63
Rate for Payer: Qualcare PPO/HMO/WC	$22.09

CONTRAST OMNIPAQUE 75cc BOTTLE

Facility

$147.25

Hospital Charge Code	605512
Hospital Revenue Code	636
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$44.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.55
Rate for Payer: Cigna Commercial	$73.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.63
Rate for Payer: Qualcare PPO/HMO/WC	$22.09
Rate for Payer: UnitedHealthcare Community & State	$3.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

CONTRAST OMNIPAQUE B 125CC

Facility

$228.85

Hospital Charge Code	270605514
Hospital Revenue Code	636
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$114.42
Rate for Payer: Aetna Commercial	$86.96
Rate for Payer: Aetna Medicare Advantage	$68.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.36
Rate for Payer: Cigna Commercial	$114.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.38
Rate for Payer: Qualcare PPO/HMO/WC	$34.33
Rate for Payer: UnitedHealthcare Community & State	$5.52
Rate for Payer: Wellpoint Medicaid Managed Care	$6.06

CONTRAST OMNIPAQUE B 125CC

Facility

$228.85

Hospital Charge Code	270605514
Hospital Revenue Code	636
Min. Negotiated Rate	$34.33
Max. Negotiated Rate	$55.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.38
Rate for Payer: Qualcare PPO/HMO/WC	$34.33

CONTRAST OMNIPAQUE B 75CC

Facility

$147.25

Hospital Charge Code	270605512
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$55.95
Rate for Payer: Aetna Medicare Advantage	$44.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.55
Rate for Payer: Cigna Commercial	$73.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.17
Rate for Payer: Oxford Commercial	$29.45
Rate for Payer: Qualcare PPO/HMO/WC	$22.09
Rate for Payer: UnitedHealthcare Commercial	$29.45
Rate for Payer: UnitedHealthcare Community & State	$3.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

CONTRAST OMNIPAQUE B 75CC

Facility

$147.25

Hospital Charge Code	270605512
Hospital Revenue Code	272
Min. Negotiated Rate	$22.09
Max. Negotiated Rate	$22.09
Rate for Payer: Qualcare PPO/HMO/WC	$22.09

CONTRAST SAVER

Facility

$56.50

Hospital Charge Code	270663919N
Hospital Revenue Code	272
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$28.25
Rate for Payer: Aetna Commercial	$21.47
Rate for Payer: Aetna Medicare Advantage	$16.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.41
Rate for Payer: Cigna Commercial	$28.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.95
Rate for Payer: Oxford Commercial	$11.30
Rate for Payer: Qualcare PPO/HMO/WC	$8.47
Rate for Payer: UnitedHealthcare Commercial	$11.30
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

CONTRAST SAVER

Facility

$55.00

Hospital Charge Code	270663919
Hospital Revenue Code	272
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

CONTRAST SAVER

Facility

$55.00

Hospital Charge Code	270663919
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$11.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

CONTRAST SAVER

Facility

$56.50

Hospital Charge Code	270663919N
Hospital Revenue Code	272
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$8.47

CONTRAST VISIPAQUE 100CC

Facility

$225.35

Hospital Charge Code	626139
Hospital Revenue Code	636
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$54.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.53
Rate for Payer: Qualcare PPO/HMO/WC	$33.80

CONTRAST VISIPAQUE 100CC

Facility

$225.35

Hospital Charge Code	626139
Hospital Revenue Code	636
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$112.67
Rate for Payer: Aetna Commercial	$85.63
Rate for Payer: Aetna Medicare Advantage	$67.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.46
Rate for Payer: Cigna Commercial	$112.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.53
Rate for Payer: Qualcare PPO/HMO/WC	$33.80
Rate for Payer: UnitedHealthcare Community & State	$5.43
Rate for Payer: Wellpoint Medicaid Managed Care	$5.97

CONTRAST VISIPAQUE 200CC

Facility

$379.25

Hospital Charge Code	628529
Hospital Revenue Code	636
Min. Negotiated Rate	$56.89
Max. Negotiated Rate	$91.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.78
Rate for Payer: Qualcare PPO/HMO/WC	$56.89

CONTRAST VISIPAQUE 200CC

Facility

$379.25

Hospital Charge Code	628529
Hospital Revenue Code	636
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$189.62
Rate for Payer: Aetna Commercial	$144.12
Rate for Payer: Aetna Medicare Advantage	$113.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.71
Rate for Payer: Cigna Commercial	$189.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.78
Rate for Payer: Qualcare PPO/HMO/WC	$56.89
Rate for Payer: UnitedHealthcare Community & State	$9.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.05

CONTRAST VISIPAQUE 320 150CC

Facility

$483.25

Hospital Charge Code	270600716
Hospital Revenue Code	636
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$241.62
Rate for Payer: Aetna Commercial	$183.63
Rate for Payer: Aetna Medicare Advantage	$144.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.23
Rate for Payer: Cigna Commercial	$241.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.95
Rate for Payer: Qualcare PPO/HMO/WC	$72.49
Rate for Payer: UnitedHealthcare Community & State	$11.65
Rate for Payer: Wellpoint Medicaid Managed Care	$12.81

CONTRAST VISIPAQUE 320 150CC

Facility

$483.25

Hospital Charge Code	270600716
Hospital Revenue Code	636
Min. Negotiated Rate	$72.49
Max. Negotiated Rate	$116.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.95
Rate for Payer: Qualcare PPO/HMO/WC	$72.49

CONTRAST VISIPAQUE 320 200cc

Facility

$379.25

Hospital Charge Code	270628529
Hospital Revenue Code	636
Min. Negotiated Rate	$56.89
Max. Negotiated Rate	$91.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.78
Rate for Payer: Qualcare PPO/HMO/WC	$56.89

CONTRAST VISIPAQUE 320 200cc

Facility

$379.25

Hospital Charge Code	270628529
Hospital Revenue Code	636
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$189.62
Rate for Payer: Aetna Commercial	$144.12
Rate for Payer: Aetna Medicare Advantage	$113.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.71
Rate for Payer: Cigna Commercial	$189.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.78
Rate for Payer: Qualcare PPO/HMO/WC	$56.89
Rate for Payer: UnitedHealthcare Community & State	$9.14
Rate for Payer: Wellpoint Medicaid Managed Care	$10.05

CONTRAST VISIPAQUE 320 50CC

Facility

$161.65

Hospital Charge Code	270600715
Hospital Revenue Code	636
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$80.83
Rate for Payer: Aetna Commercial	$61.43
Rate for Payer: Aetna Medicare Advantage	$48.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.22
Rate for Payer: Cigna Commercial	$80.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.12
Rate for Payer: Qualcare PPO/HMO/WC	$24.25
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.28

CONTRAST VISIPAQUE 320 50CC

Facility

$161.65

Hospital Charge Code	270600715
Hospital Revenue Code	636
Min. Negotiated Rate	$24.25
Max. Negotiated Rate	$39.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.12
Rate for Payer: Qualcare PPO/HMO/WC	$24.25

CONTRAST VISIPAQUE 320mg 100cc

Facility

$286.51

Hospital Charge Code	270642101
Hospital Revenue Code	255
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$143.25
Rate for Payer: Aetna Commercial	$108.87
Rate for Payer: Aetna Medicare Advantage	$85.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.06
Rate for Payer: Cigna Commercial	$143.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.95
Rate for Payer: Oxford Commercial	$57.30
Rate for Payer: Qualcare PPO/HMO/WC	$42.98
Rate for Payer: UnitedHealthcare Commercial	$57.30
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.59

CONTRAST VISIPAQUE 320mg 100cc

Facility

$286.51

Hospital Charge Code	270642101
Hospital Revenue Code	255
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$42.98
Rate for Payer: Qualcare PPO/HMO/WC	$42.98

Know your out-of-pocket cost for care.

All Charges