Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OMNIPAQUE 350 150M FLEXPK Y495

Facility

$184.85

Hospital Charge Code	270601302
Hospital Revenue Code	250
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$27.73
Rate for Payer: Qualcare PPO/HMO/WC	$27.73

OMNIPAQUE 350MG/150ML

Facility

$835.00

Hospital Charge Code	60630247
Hospital Revenue Code	255
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$317.30
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.50
Rate for Payer: Oxford Commercial	$167.00
Rate for Payer: Qualcare PPO/HMO/WC	$125.25
Rate for Payer: UnitedHealthcare Commercial	$167.00
Rate for Payer: UnitedHealthcare Community & State	$20.12
Rate for Payer: Wellpoint Medicaid Managed Care	$22.13

OMNIPAQUE 350MG/150ML

Facility

$1,047.34

Service Code	HCPCS Q9967
Hospital Charge Code	60630241
Hospital Revenue Code	255
Min. Negotiated Rate	$157.10
Max. Negotiated Rate	$157.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.10

OMNIPAQUE 350MG/150ML

Facility

$835.00

Hospital Charge Code	60630247
Hospital Revenue Code	255
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$125.25
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

OMNIPAQUE 350MG/150ML

Facility

$1,047.34

Service Code	HCPCS Q9967
Hospital Charge Code	60630241
Hospital Revenue Code	255
Min. Negotiated Rate	$25.24
Max. Negotiated Rate	$523.67
Rate for Payer: Aetna Commercial	$397.99
Rate for Payer: Aetna Medicare Advantage	$314.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.07
Rate for Payer: Cigna Commercial	$523.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.20
Rate for Payer: Oxford Commercial	$209.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.10
Rate for Payer: UnitedHealthcare Commercial	$209.47
Rate for Payer: UnitedHealthcare Community & State	$25.24
Rate for Payer: Wellpoint Medicaid Managed Care	$27.75

OMNIPAQUE 350MG 50ML

Facility

$283.20

Service Code	HCPCS Q9966
Hospital Charge Code	64070010
Hospital Revenue Code	636
Min. Negotiated Rate	$42.48
Max. Negotiated Rate	$68.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.53
Rate for Payer: Qualcare PPO/HMO/WC	$42.48

OMNIPAQUE 350MG 50ML

Facility

$6.11

Hospital Charge Code	4800880
Hospital Revenue Code	255
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

OMNIPAQUE 350MG 50ML

Facility

$283.20

Service Code	HCPCS Q9966
Hospital Charge Code	64070010
Hospital Revenue Code	636
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.60
Rate for Payer: Aetna Commercial	$107.62
Rate for Payer: Aetna Medicare Advantage	$84.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.22
Rate for Payer: Cigna Commercial	$141.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.53
Rate for Payer: Qualcare PPO/HMO/WC	$42.48
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.50

OMNIPAQUE 350MG 50ML

Facility

$6.11

Hospital Charge Code	4800880
Hospital Revenue Code	255
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.06
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare Advantage	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.56
Rate for Payer: Cigna Commercial	$3.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.83
Rate for Payer: Oxford Commercial	$1.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.92
Rate for Payer: UnitedHealthcare Commercial	$1.22
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

OMNIPAQUE 350MG/50ML

Facility

$372.86

Service Code	HCPCS Q9967
Hospital Charge Code	60630240
Hospital Revenue Code	255
Min. Negotiated Rate	$55.93
Max. Negotiated Rate	$55.93
Rate for Payer: Qualcare PPO/HMO/WC	$55.93

OMNIPAQUE 350MG/50ML

Facility

$372.86

Service Code	HCPCS Q9967
Hospital Charge Code	60630240
Hospital Revenue Code	255
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$186.43
Rate for Payer: Aetna Commercial	$141.69
Rate for Payer: Aetna Medicare Advantage	$111.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.08
Rate for Payer: Cigna Commercial	$186.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.86
Rate for Payer: Oxford Commercial	$74.57
Rate for Payer: Qualcare PPO/HMO/WC	$55.93
Rate for Payer: UnitedHealthcare Commercial	$74.57
Rate for Payer: UnitedHealthcare Community & State	$8.99
Rate for Payer: Wellpoint Medicaid Managed Care	$9.88

OMNIPAQUE CONTR 125CC B ******

Facility

$215.00

Hospital Charge Code	271605514
Hospital Revenue Code	272
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.50
Rate for Payer: Oxford Commercial	$43.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$43.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

OMNIPAQUE CONTR 125CC B ******

Facility

$215.00

Hospital Charge Code	271605514
Hospital Revenue Code	272
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

OMNIPEN ADDVANT/1GM

Facility

$24.00

Hospital Charge Code	60634244
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

OMNIPEN ADDVANT/1GM

Facility

$24.00

Hospital Charge Code	60634244
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

OMNIPEN ADDVANT/2GM

Facility

$43.00

Hospital Charge Code	60634245
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

OMNIPEN ADDVANT/2GM

Facility

$43.00

Hospital Charge Code	60634245
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

OMNIPEN ADDVANT/500MG

Facility

$21.00

Hospital Charge Code	60634243
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

OMNIPEN ADDVANT/500MG

Facility

$21.00

Hospital Charge Code	60634243
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

OMNIPEN(AMPICIL)INJ/125MG

Facility

$15.00

Hospital Charge Code	60634240
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

OMNIPEN(AMPICIL)INJ/125MG

Facility

$15.00

Hospital Charge Code	60634240
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

OMNIPEN(AMPICIL)INJ/250MG

Facility

$18.00

Hospital Charge Code	60634241
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

OMNIPEN(AMPICIL)INJ/250MG

Facility

$18.00

Hospital Charge Code	60634241
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

OMNIPEN(AMPICIL)INJ/500MG

Facility

$23.00

Hospital Charge Code	60634242
Hospital Revenue Code	250
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

OMNIPEN(AMPICIL)INJ/500MG

Facility

$23.00

Hospital Charge Code	60634242
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

Know your out-of-pocket cost for care.

All Charges