Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

VISIPAQUE 320MG/ML VIAL(100ML

Facility

$261.30

Service Code	NDC 407222317
Hospital Charge Code	60631593
Hospital Revenue Code	255
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$130.65
Rate for Payer: Aetna Commercial	$99.29
Rate for Payer: Aetna Medicare Advantage	$78.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.63
Rate for Payer: Cigna Commercial	$130.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.39
Rate for Payer: Oxford Commercial	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$39.20
Rate for Payer: UnitedHealthcare Commercial	$52.26
Rate for Payer: UnitedHealthcare Community & State	$6.30
Rate for Payer: Wellpoint Medicaid Managed Care	$6.92

VISIPAQUE 320MG/ML VIAL(100ML

Facility

$261.30

Service Code	NDC 407222317
Hospital Charge Code	60631593
Hospital Revenue Code	255
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$39.20

VISIPAQUE 350 TO 399ML

Facility

$4,000.00

Hospital Charge Code	7411317
Hospital Revenue Code	255
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

VISIPAQUE 350 TO 399ML

Facility

$4,000.00

Hospital Charge Code	7411317
Hospital Revenue Code	255
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Oxford Commercial	$800.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$800.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

VISIPAQUE 350 TO 399ML

Facility

$4,000.00

Hospital Charge Code	7411319
Hospital Revenue Code	255
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,200.00
Rate for Payer: Oxford Commercial	$800.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$800.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

VISIPAQUE 350 TO 399ML

Facility

$4,000.00

Hospital Charge Code	7411319
Hospital Revenue Code	255
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

VISIPAQUE=>400ML

Facility

$4,500.00

Hospital Charge Code	7411297
Hospital Revenue Code	636
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

VISIPAQUE=>400ML

Facility

$4,500.00

Hospital Charge Code	7411299
Hospital Revenue Code	636
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

VISIPAQUE=>400ML

Facility

$4,500.00

Hospital Charge Code	7411297
Hospital Revenue Code	636
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

VISIPAQUE=>400ML

Facility

$4,500.00

Hospital Charge Code	7411299
Hospital Revenue Code	636
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

VISIPAQUE IV CONTRAST 150ML

Facility

$22.10

Hospital Charge Code	270653922
Hospital Revenue Code	272
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.31

VISIPAQUE IV CONTRAST 150ML

Facility

$22.10

Hospital Charge Code	270653922
Hospital Revenue Code	272
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$11.05
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.64
Rate for Payer: Cigna Commercial	$11.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$3.31
Rate for Payer: UnitedHealthcare Commercial	$4.42
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

VISIPORT 10.5MM

Facility

$222.17

Hospital Charge Code	270658732
Hospital Revenue Code	270
Min. Negotiated Rate	$33.33
Max. Negotiated Rate	$33.33
Rate for Payer: Qualcare PPO/HMO/WC	$33.33

VISIPORT 10.5MM

Facility

$222.17

Hospital Charge Code	270658732
Hospital Revenue Code	270
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$111.08
Rate for Payer: Aetna Commercial	$84.42
Rate for Payer: Aetna Medicare Advantage	$66.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.65
Rate for Payer: Cigna Commercial	$111.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.65
Rate for Payer: Oxford Commercial	$44.43
Rate for Payer: Qualcare PPO/HMO/WC	$33.33
Rate for Payer: UnitedHealthcare Commercial	$44.43
Rate for Payer: UnitedHealthcare Community & State	$5.35
Rate for Payer: Wellpoint Medicaid Managed Care	$5.89

VISIPORT OPTICAL TROCAR 5-12MM

Facility

$306.00

Hospital Charge Code	270651839
Hospital Revenue Code	272
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

VISIPORT OPTICAL TROCAR 5-12MM

Facility

$306.00

Hospital Charge Code	270651839
Hospital Revenue Code	272
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$116.28
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.80
Rate for Payer: Oxford Commercial	$61.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$61.20
Rate for Payer: UnitedHealthcare Community & State	$7.37
Rate for Payer: Wellpoint Medicaid Managed Care	$8.11

VISI PRO 7X27 STENT

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270686949S
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

VISI PRO 7X27 STENT

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270686949S
Hospital Revenue Code	278
Min. Negotiated Rate	$125.29
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,975.58
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,143.76
Rate for Payer: Qualcare PPO/HMO/WC	$779.84
Rate for Payer: UnitedHealthcare Community & State	$125.29
Rate for Payer: Wellpoint Medicaid Managed Care	$137.77

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829N
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829
Hospital Revenue Code	278
Min. Negotiated Rate	$156.05
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$2,460.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$156.05
Rate for Payer: Wellpoint Medicaid Managed Care	$171.59

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829N
Hospital Revenue Code	278
Min. Negotiated Rate	$156.05
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$2,460.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,424.50
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$156.05
Rate for Payer: Wellpoint Medicaid Managed Care	$171.59

VISISHOT 2 22G

Facility

$6,215.75

Hospital Charge Code	270703013
Hospital Revenue Code	278
Min. Negotiated Rate	$932.36
Max. Negotiated Rate	$1,504.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,367.46
Rate for Payer: Qualcare PPO/HMO/WC	$932.36

VISISHOT 2 22G

Facility

$6,215.75

Hospital Charge Code	270703013
Hospital Revenue Code	278
Min. Negotiated Rate	$149.80
Max. Negotiated Rate	$3,107.88
Rate for Payer: Aetna Commercial	$2,361.99
Rate for Payer: Aetna Medicare Advantage	$1,864.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,585.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,585.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,585.02
Rate for Payer: Cigna Commercial	$3,107.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,367.46
Rate for Payer: Qualcare PPO/HMO/WC	$932.36
Rate for Payer: UnitedHealthcare Community & State	$149.80
Rate for Payer: Wellpoint Medicaid Managed Care	$164.72

VISISHOT 2 25G

Facility

$6,859.00

Hospital Charge Code	270703015
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.85
Max. Negotiated Rate	$1,659.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,659.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,508.98
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.85

Know your out-of-pocket cost for care.

All Charges