Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IOPAMIDOL-300 200ML

Facility

$128.31

Service Code	NDC 270131545
Hospital Charge Code	606390366
Hospital Revenue Code	255
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$19.25
Rate for Payer: Qualcare PPO/HMO/WC	$19.25

IOPAMIDOL-300 200ML

Facility

$128.31

Service Code	NDC 270131545
Hospital Charge Code	606390366
Hospital Revenue Code	255
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$64.16
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.72
Rate for Payer: Cigna Commercial	$64.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.49
Rate for Payer: Oxford Commercial	$25.66
Rate for Payer: Qualcare PPO/HMO/WC	$19.25
Rate for Payer: UnitedHealthcare Commercial	$25.66
Rate for Payer: UnitedHealthcare Community & State	$3.09
Rate for Payer: Wellpoint Medicaid Managed Care	$3.40

IOPAMIDOL 300U/50ML ISOVUE-300

Facility

$385.18

Service Code	NDC 270131530
Hospital Charge Code	606390381
Hospital Revenue Code	255
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$192.59
Rate for Payer: Aetna Commercial	$146.37
Rate for Payer: Aetna Medicare Advantage	$115.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.22
Rate for Payer: Cigna Commercial	$192.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.55
Rate for Payer: Oxford Commercial	$77.04
Rate for Payer: Qualcare PPO/HMO/WC	$57.78
Rate for Payer: UnitedHealthcare Commercial	$77.04
Rate for Payer: UnitedHealthcare Community & State	$9.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.21

IOPAMIDOL 300U/50ML ISOVUE-300

Facility

$385.18

Service Code	NDC 270131530
Hospital Charge Code	606390381
Hospital Revenue Code	255
Min. Negotiated Rate	$57.78
Max. Negotiated Rate	$57.78
Rate for Payer: Qualcare PPO/HMO/WC	$57.78

IOPAMIDOL-370 100ML

Facility

$835.42

Service Code	NDC 270131635
Hospital Charge Code	606390364
Hospital Revenue Code	255
Min. Negotiated Rate	$20.13
Max. Negotiated Rate	$417.71
Rate for Payer: Aetna Commercial	$317.46
Rate for Payer: Aetna Medicare Advantage	$250.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.03
Rate for Payer: Cigna Commercial	$417.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.63
Rate for Payer: Oxford Commercial	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$125.31
Rate for Payer: UnitedHealthcare Commercial	$167.08
Rate for Payer: UnitedHealthcare Community & State	$20.13
Rate for Payer: Wellpoint Medicaid Managed Care	$22.14

IOPAMIDOL-370 100ML

Facility

$835.42

Service Code	NDC 270131635
Hospital Charge Code	606390364
Hospital Revenue Code	255
Min. Negotiated Rate	$125.31
Max. Negotiated Rate	$125.31
Rate for Payer: Qualcare PPO/HMO/WC	$125.31

IOPAMIDOL-370 150ML

Facility

$1,155.75

Service Code	NDC 270131637
Hospital Charge Code	606390365
Hospital Revenue Code	255
Min. Negotiated Rate	$173.36
Max. Negotiated Rate	$173.36
Rate for Payer: Qualcare PPO/HMO/WC	$173.36

IOPAMIDOL-370 150ML

Facility

$1,155.75

Service Code	NDC 270131637
Hospital Charge Code	606390365
Hospital Revenue Code	255
Min. Negotiated Rate	$27.85
Max. Negotiated Rate	$577.88
Rate for Payer: Aetna Commercial	$439.19
Rate for Payer: Aetna Medicare Advantage	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.72
Rate for Payer: Cigna Commercial	$577.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Oxford Commercial	$231.15
Rate for Payer: Qualcare PPO/HMO/WC	$173.36
Rate for Payer: UnitedHealthcare Commercial	$231.15
Rate for Payer: UnitedHealthcare Community & State	$27.85
Rate for Payer: Wellpoint Medicaid Managed Care	$30.63

IOPAMIDOL-370 50ML

Facility

$418.75

Service Code	NDC 270131630
Hospital Charge Code	606390363
Hospital Revenue Code	255
Min. Negotiated Rate	$62.81
Max. Negotiated Rate	$62.81
Rate for Payer: Qualcare PPO/HMO/WC	$62.81

IOPAMIDOL-370 50ML

Facility

$418.75

Service Code	NDC 270131630
Hospital Charge Code	606390363
Hospital Revenue Code	255
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$209.38
Rate for Payer: Aetna Commercial	$159.12
Rate for Payer: Aetna Medicare Advantage	$125.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.78
Rate for Payer: Cigna Commercial	$209.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.62
Rate for Payer: Oxford Commercial	$83.75
Rate for Payer: Qualcare PPO/HMO/WC	$62.81
Rate for Payer: UnitedHealthcare Commercial	$83.75
Rate for Payer: UnitedHealthcare Community & State	$10.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.10

IOPAMIDOL INJ 612MG/ML

Facility

$337.95

Hospital Charge Code	6003149
Hospital Revenue Code	250
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$50.69
Rate for Payer: Qualcare PPO/HMO/WC	$50.69

IOPAMIDOL INJ 612MG/ML

Facility

$337.95

Hospital Charge Code	6003149
Hospital Revenue Code	250
Min. Negotiated Rate	$8.14
Max. Negotiated Rate	$168.97
Rate for Payer: Aetna Commercial	$128.42
Rate for Payer: Aetna Medicare Advantage	$101.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.18
Rate for Payer: Cigna Commercial	$168.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.39
Rate for Payer: Oxford Commercial	$67.59
Rate for Payer: Qualcare PPO/HMO/WC	$50.69
Rate for Payer: UnitedHealthcare Commercial	$67.59
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: Wellpoint Medicaid Managed Care	$8.96

IOPHEN/30MG/TAB

Facility

$3.00

Hospital Charge Code	60633191
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IOPHEN/30MG/TAB

Facility

$3.00

Hospital Charge Code	60633191
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

IOPHEN C LIQUID/4OZ

Facility

$6.00

Hospital Charge Code	60634732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

IOPHEN C LIQUID/4OZ

Facility

$6.00

Hospital Charge Code	60634732
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

IOPHEN DM LIQUID/4OZ

Facility

$21.00

Hospital Charge Code	60634731
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

IOPHEN DM LIQUID/4OZ

Facility

$21.00

Hospital Charge Code	60634731
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

IOPHEN ELIX/16OZ

Facility

$13.00

Hospital Charge Code	60634613
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

IOPHEN ELIX/16OZ

Facility

$13.00

Hospital Charge Code	60634613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

IOPHEN (ORGANDIN)/TAB

Facility

$3.00

Hospital Charge Code	60634333
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

IOPHEN (ORGANDIN)/TAB

Facility

$3.00

Hospital Charge Code	60634333
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

IOPHYLLINE LIQUID/16OZ

Facility

$8.00

Hospital Charge Code	60634590
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

IOPHYLLINE LIQUID/16OZ

Facility

$8.00

Hospital Charge Code	60634590
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

IOPIDINE 1% OPHTH SOLN

Facility

$43.00

Hospital Charge Code	60634812
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

Know your out-of-pocket cost for care.

All Charges