Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VISIPAQUE 200 TO 249ML

Facility

$2,500.00

Hospital Charge Code	7411313
Hospital Revenue Code	255
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

VISIPAQUE 200 TO 249ML

Facility

$2,500.00

Hospital Charge Code	7411315
Hospital Revenue Code	255
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

VISIPAQUE 200 TO 249ML

Facility

$2,500.00

Hospital Charge Code	7411313
Hospital Revenue Code	255
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

VISIPAQUE 250 TO 299ML

Facility

$3,000.00

Hospital Charge Code	7411311
Hospital Revenue Code	255
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.00
Rate for Payer: Oxford Commercial	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Commercial	$600.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

VISIPAQUE 250 TO 299ML

Facility

$3,000.00

Hospital Charge Code	7411309
Hospital Revenue Code	255
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

VISIPAQUE 250 TO 299ML

Facility

$3,000.00

Hospital Charge Code	7411309
Hospital Revenue Code	255
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.00
Rate for Payer: Oxford Commercial	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Commercial	$600.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

VISIPAQUE 250 TO 299ML

Facility

$3,000.00

Hospital Charge Code	7411311
Hospital Revenue Code	255
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

VISIPAQUE 300 TO 349ML

Facility

$3,500.00

Hospital Charge Code	7411323
Hospital Revenue Code	255
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

VISIPAQUE 300 TO 349ML

Facility

$3,500.00

Hospital Charge Code	7411321
Hospital Revenue Code	255
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

VISIPAQUE 300 TO 349ML

Facility

$3,500.00

Hospital Charge Code	7411323
Hospital Revenue Code	255
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

VISIPAQUE 300 TO 349ML

Facility

$3,500.00

Hospital Charge Code	7411321
Hospital Revenue Code	255
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

VISIPAQUE 320MG 100ML

Facility

$6.72

Hospital Charge Code	4800875
Hospital Revenue Code	255
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$1.01

VISIPAQUE 320MG 100ML

Facility

$6.72

Hospital Charge Code	4800875
Hospital Revenue Code	255
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.36
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.02
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.01
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

VISIPAQUE 320MG/50ML VIAL

Facility

$100.50

Service Code	NDC 407222301
Hospital Charge Code	60635828
Hospital Revenue Code	255
Min. Negotiated Rate	$15.07
Max. Negotiated Rate	$15.07
Rate for Payer: Qualcare PPO/HMO/WC	$15.07

VISIPAQUE 320MG/50ML VIAL

Facility

$100.50

Service Code	NDC 407222301
Hospital Charge Code	60635828
Hospital Revenue Code	255
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$50.25
Rate for Payer: Aetna Commercial	$38.19
Rate for Payer: Aetna Medicare Advantage	$30.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.63
Rate for Payer: Cigna Commercial	$50.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.15
Rate for Payer: Oxford Commercial	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$15.07
Rate for Payer: UnitedHealthcare Commercial	$20.10
Rate for Payer: UnitedHealthcare Community & State	$2.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2.66

VISIPAQUE 320 MGL/ML 200ML

Facility

$283.52

Hospital Charge Code	270CH0134
Hospital Revenue Code	636
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.76
Rate for Payer: Aetna Commercial	$107.74
Rate for Payer: Aetna Medicare Advantage	$85.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.30
Rate for Payer: Cigna Commercial	$141.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.61
Rate for Payer: Qualcare PPO/HMO/WC	$42.53
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

VISIPAQUE 320 MGL/ML 200ML

Facility

$283.52

Hospital Charge Code	270CH0134
Hospital Revenue Code	636
Min. Negotiated Rate	$42.53
Max. Negotiated Rate	$68.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.61
Rate for Payer: Qualcare PPO/HMO/WC	$42.53

VISIPAQUE 320MGL/ML 200ML

Facility

$305.34

Hospital Charge Code	2707500025
Hospital Revenue Code	272
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$45.80
Rate for Payer: Qualcare PPO/HMO/WC	$45.80

VISIPAQUE 320MGL/ML 200ML

Facility

$305.34

Hospital Charge Code	2707500025
Hospital Revenue Code	272
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$152.67
Rate for Payer: Aetna Commercial	$116.03
Rate for Payer: Aetna Medicare Advantage	$91.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.86
Rate for Payer: Cigna Commercial	$152.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.60
Rate for Payer: Oxford Commercial	$61.07
Rate for Payer: Qualcare PPO/HMO/WC	$45.80
Rate for Payer: UnitedHealthcare Commercial	$61.07
Rate for Payer: UnitedHealthcare Community & State	$7.36
Rate for Payer: Wellpoint Medicaid Managed Care	$8.09

VISIPAQUE 320 MG/ML 100ML

Facility

$35.91

Hospital Charge Code	270653788
Hospital Revenue Code	272
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$5.39
Rate for Payer: Qualcare PPO/HMO/WC	$5.39

VISIPAQUE 320 MG/ML 100ML

Facility

$35.91

Hospital Charge Code	270653788
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$17.95
Rate for Payer: Aetna Commercial	$13.65
Rate for Payer: Aetna Medicare Advantage	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.16
Rate for Payer: Cigna Commercial	$17.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.77
Rate for Payer: Oxford Commercial	$7.18
Rate for Payer: Qualcare PPO/HMO/WC	$5.39
Rate for Payer: UnitedHealthcare Commercial	$7.18
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

VISIPAQUE 320 MG/ML 100ML V-56

Facility

$184.33

Hospital Charge Code	270CH0133
Hospital Revenue Code	636
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$44.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.61
Rate for Payer: Qualcare PPO/HMO/WC	$27.65

VISIPAQUE 320 MG/ML 100ML V-56

Facility

$184.33

Hospital Charge Code	270CH0133
Hospital Revenue Code	636
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$92.17
Rate for Payer: Aetna Commercial	$70.05
Rate for Payer: Aetna Medicare Advantage	$55.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.00
Rate for Payer: Cigna Commercial	$92.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.61
Rate for Payer: Qualcare PPO/HMO/WC	$27.65
Rate for Payer: UnitedHealthcare Community & State	$4.44
Rate for Payer: Wellpoint Medicaid Managed Care	$4.88

VISIPAQUE 320MG/ML 100ML V-562

Facility

$184.33

Hospital Charge Code	2707500024
Hospital Revenue Code	272
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$27.65
Rate for Payer: Qualcare PPO/HMO/WC	$27.65

VISIPAQUE 320MG/ML 100ML V-562

Facility

$184.33

Hospital Charge Code	2707500024
Hospital Revenue Code	272
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$92.17
Rate for Payer: Aetna Commercial	$70.05
Rate for Payer: Aetna Medicare Advantage	$55.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.00
Rate for Payer: Cigna Commercial	$92.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.30
Rate for Payer: Oxford Commercial	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$27.65
Rate for Payer: UnitedHealthcare Commercial	$36.87
Rate for Payer: UnitedHealthcare Community & State	$4.44
Rate for Payer: Wellpoint Medicaid Managed Care	$4.88

Know your out-of-pocket cost for care.

All Charges