Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VISCOSITY, FLUID

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38473059
Hospital Revenue Code	305
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$209.00
Rate for Payer: Aetna Commercial	$31.74
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.13
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: Cigna Medicare Advantage	$11.67
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Medicare Advantage	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VISCOSITY, FLUID

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38473059
Hospital Revenue Code	305
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

VISCOSITY,SERUM

Facility

$80.20

Service Code	HCPCS 85810
Hospital Charge Code	39900186
Hospital Revenue Code	305
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$12.03
Rate for Payer: Qualcare PPO/HMO/WC	$12.03

VISCOSITY,SERUM

Facility

$80.20

Service Code	HCPCS 85810
Hospital Charge Code	39900186
Hospital Revenue Code	305
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.74
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.13
Rate for Payer: Cigna Commercial	$40.10
Rate for Payer: Cigna Medicare Advantage	$11.67
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.06
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.03
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Medicare Advantage	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

VISCOSITY,SERUM

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38479123
Hospital Revenue Code	305
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

VISCOSITY,SERUM

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38479123
Hospital Revenue Code	305
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$209.00
Rate for Payer: Aetna Commercial	$31.74
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.13
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: Cigna Medicare Advantage	$11.67
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Medicare Advantage	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VISIDRAIN EYE FLUID FLUIDEWICK

Facility

$7.50

Hospital Charge Code	270664106
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

VISIDRAIN EYE FLUID FLUIDEWICK

Facility

$7.50

Hospital Charge Code	270664106
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

VISINE AC/30ML

Facility

$28.00

Hospital Charge Code	60634547
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

VISINE AC/30ML

Facility

$28.00

Hospital Charge Code	60634547
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

VISINE EYE DROPS

Facility

$5.00

Hospital Charge Code	60634830
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

VISINE EYE DROPS

Facility

$5.00

Hospital Charge Code	60634830
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

VISION BLUE .06%

Facility

$383.33

Hospital Charge Code	270659775
Hospital Revenue Code	270
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$57.50
Rate for Payer: Qualcare PPO/HMO/WC	$57.50

VISION BLUE .06%

Facility

$383.33

Hospital Charge Code	270659775
Hospital Revenue Code	270
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$191.66
Rate for Payer: Aetna Commercial	$145.67
Rate for Payer: Aetna Medicare Advantage	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.75
Rate for Payer: Cigna Commercial	$191.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.00
Rate for Payer: Oxford Commercial	$76.67
Rate for Payer: Qualcare PPO/HMO/WC	$57.50
Rate for Payer: UnitedHealthcare Commercial	$76.67
Rate for Payer: UnitedHealthcare Community & State	$9.24
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

VISIPAQUE 150 TO 199ML

Facility

$2,000.00

Hospital Charge Code	7411301
Hospital Revenue Code	255
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

VISIPAQUE 150 TO 199ML

Facility

$2,000.00

Hospital Charge Code	7411301
Hospital Revenue Code	255
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$400.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

VISIPAQUE 150 TO 199ML

Facility

$2,000.00

Hospital Charge Code	7411303
Hospital Revenue Code	255
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

VISIPAQUE 150 TO 199ML

Facility

$2,000.00

Hospital Charge Code	7411303
Hospital Revenue Code	255
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$400.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

VISIPAQUE 1 TO 149ML

Facility

$1,500.00

Hospital Charge Code	7411305
Hospital Revenue Code	255
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

VISIPAQUE 1 TO 149ML

Facility

$1,500.00

Hospital Charge Code	7411307
Hospital Revenue Code	255
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

VISIPAQUE 1 TO 149ML

Facility

$1,500.00

Hospital Charge Code	7411305
Hospital Revenue Code	255
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

VISIPAQUE 1 TO 149ML

Facility

$1,500.00

Hospital Charge Code	7411307
Hospital Revenue Code	255
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

VISIPAQUE 200ML

Facility

$944.70

Service Code	NDC 407222321
Hospital Charge Code	60635838
Hospital Revenue Code	255
Min. Negotiated Rate	$141.71
Max. Negotiated Rate	$141.71
Rate for Payer: Qualcare PPO/HMO/WC	$141.71

VISIPAQUE 200ML

Facility

$944.70

Service Code	NDC 407222321
Hospital Charge Code	60635838
Hospital Revenue Code	255
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$472.35
Rate for Payer: Aetna Commercial	$358.99
Rate for Payer: Aetna Medicare Advantage	$283.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.90
Rate for Payer: Cigna Commercial	$472.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.41
Rate for Payer: Oxford Commercial	$188.94
Rate for Payer: Qualcare PPO/HMO/WC	$141.71
Rate for Payer: UnitedHealthcare Commercial	$188.94
Rate for Payer: UnitedHealthcare Community & State	$22.77
Rate for Payer: Wellpoint Medicaid Managed Care	$25.03

VISIPAQUE 200 TO 249ML

Facility

$2,500.00

Hospital Charge Code	7411315
Hospital Revenue Code	255
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

Know your out-of-pocket cost for care.

All Charges