Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KEPPRA S/F LIQUID 473 ML

Facility

$22.71

Service Code	NDC 781614116
Hospital Charge Code	606350948
Hospital Revenue Code	250
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$3.41
Rate for Payer: Qualcare PPO/HMO/WC	$3.41

KERALYT/28GM

Facility

$75.00

Hospital Charge Code	60633247
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

KERALYT/28GM

Facility

$75.00

Hospital Charge Code	60633247
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

KERI SCENTED/390ML

Facility

$38.00

Hospital Charge Code	60633248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

KERI SCENTED/390ML

Facility

$38.00

Hospital Charge Code	60633248
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

KERI SKIN OIL

Facility

$21.15

Hospital Charge Code	60628429
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.17

KERI SKIN OIL

Facility

$21.15

Hospital Charge Code	60628429
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.57
Rate for Payer: Aetna Commercial	$8.04
Rate for Payer: Aetna Medicare Advantage	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.39
Rate for Payer: Cigna Commercial	$10.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.34
Rate for Payer: Oxford Commercial	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.17
Rate for Payer: UnitedHealthcare Commercial	$4.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

KETALAR 50ML 10/ML VIAL

Facility

$38.00

Hospital Charge Code	60635179
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

KETALAR 50ML 10/ML VIAL

Facility

$38.00

Hospital Charge Code	60635179
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

KETAMINE 100MG 5ML VIAL

Facility

$13.27

Service Code	NDC 42023011510
Hospital Charge Code	6064943023
Hospital Revenue Code	636
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$3.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.99

KETAMINE 100MG 5ML VIAL

Facility

$13.27

Service Code	NDC 42023011510
Hospital Charge Code	6064943023
Hospital Revenue Code	636
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.63
Rate for Payer: Aetna Commercial	$5.04
Rate for Payer: Aetna Medicare Advantage	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.38
Rate for Payer: Cigna Commercial	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.99
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

KETAMINE 10MG/1ML 20ML INJ

Facility

$132.66

Service Code	NDC 42023011310
Hospital Charge Code	60629284
Hospital Revenue Code	250
Min. Negotiated Rate	$19.90
Max. Negotiated Rate	$19.90
Rate for Payer: Qualcare PPO/HMO/WC	$19.90

KETAMINE 10MG/1ML 20ML INJ

Facility

$132.66

Service Code	NDC 42023011310
Hospital Charge Code	60629284
Hospital Revenue Code	250
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$66.33
Rate for Payer: Aetna Commercial	$50.41
Rate for Payer: Aetna Medicare Advantage	$39.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.83
Rate for Payer: Cigna Commercial	$66.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.80
Rate for Payer: Oxford Commercial	$26.53
Rate for Payer: Qualcare PPO/HMO/WC	$19.90
Rate for Payer: UnitedHealthcare Commercial	$26.53
Rate for Payer: UnitedHealthcare Community & State	$3.20
Rate for Payer: Wellpoint Medicaid Managed Care	$3.52

KETAMINE 200MG/20ML VIAL

Facility

$158.99

Service Code	NDC 65219018420
Hospital Charge Code	6063943400
Hospital Revenue Code	250
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$60.42
Rate for Payer: Aetna Medicare Advantage	$47.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.54
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.70
Rate for Payer: Oxford Commercial	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$31.80
Rate for Payer: UnitedHealthcare Community & State	$3.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.21

KETAMINE 200MG/20ML VIAL

Facility

$158.99

Service Code	NDC 65219018420
Hospital Charge Code	6063943400
Hospital Revenue Code	250
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

KETAMINE 30MG/3ML SYRINGE

Facility

$26.80

Service Code	NDC 69374098233
Hospital Charge Code	606390374
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.04
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

KETAMINE 30MG/3ML SYRINGE

Facility

$26.80

Service Code	NDC 69374098233
Hospital Charge Code	606390374
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

KETAMINE 50MG/ML

Facility

$19.92

Hospital Charge Code	60635817
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.96
Rate for Payer: Aetna Commercial	$7.57
Rate for Payer: Aetna Medicare Advantage	$5.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.08
Rate for Payer: Cigna Commercial	$9.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.98
Rate for Payer: Oxford Commercial	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.99
Rate for Payer: UnitedHealthcare Commercial	$3.98
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

KETAMINE 50MG/ML

Facility

$19.92

Hospital Charge Code	60635817
Hospital Revenue Code	250
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Qualcare PPO/HMO/WC	$2.99

KETAMINE 50MG/ML SYRINGE

Facility

$16.20

Hospital Charge Code	60635770
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.43

KETAMINE 50MG/ML SYRINGE

Facility

$16.20

Hospital Charge Code	60635770
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.10
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Aetna Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.13
Rate for Payer: Cigna Commercial	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.86
Rate for Payer: Oxford Commercial	$3.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.43
Rate for Payer: UnitedHealthcare Commercial	$3.24
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

KETAMINE INJ 10MG

Facility

$70.40

Hospital Charge Code	6009146
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

KETAMINE INJ 10MG

Facility

$70.40

Hospital Charge Code	6009146
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.12
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

KETAMINE INJ 500MG/10ML

Facility

$28.68

Service Code	NDC 409205310
Hospital Charge Code	60627670
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.34
Rate for Payer: Aetna Commercial	$10.90
Rate for Payer: Aetna Medicare Advantage	$8.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.31
Rate for Payer: Cigna Commercial	$14.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.60
Rate for Payer: Oxford Commercial	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$4.30
Rate for Payer: UnitedHealthcare Commercial	$5.74
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

KETAMINE INJ 500MG/10ML

Facility

$28.68

Service Code	NDC 409205310
Hospital Charge Code	60627670
Hospital Revenue Code	250
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$4.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.30

Know your out-of-pocket cost for care.

All Charges