Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KETONES (URINE)****

Facility

$21.00

Hospital Charge Code	3010048
Hospital Revenue Code	301
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$124.00
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	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

KETONES URINE

Facility

$22.45

Service Code	HCPCS 81005
Hospital Charge Code	3000049
Hospital Revenue Code	307
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$5.90
Rate for Payer: Aetna Medicare Advantage	$7.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.83
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: Cigna Medicare Advantage	$2.17
Rate for Payer: Clover Medicare Advantage	$2.06
Rate for Payer: EmblemHealth Commercial	$6.51
Rate for Payer: Humana Medicare Advantage	$2.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.17
Rate for Payer: Wellcare Medicare Advantage	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

KETONES URINE

Facility

$22.45

Service Code	HCPCS 81005
Hospital Charge Code	3000049
Hospital Revenue Code	307
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

KETOPROFEN CAP 25MG

Facility

$7.70

Hospital Charge Code	60627687
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

KETOPROFEN CAP 25MG

Facility

$7.70

Hospital Charge Code	60627687
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

KETOPROFEN CAP 75MG

Facility

$9.00

Hospital Charge Code	60627688
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

KETOPROFEN CAP 75MG

Facility

$9.00

Hospital Charge Code	60627688
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

KETOROLAC 15 MG/ML INJ

Facility

$30.15

Service Code	HCPCS J1885
Hospital Charge Code	6006217
Hospital Revenue Code	636
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$7.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

KETOROLAC 15 MG/ML INJ

Facility

$30.15

Service Code	HCPCS J1885
Hospital Charge Code	6006217
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.30
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Medicare Advantage	$0.40
Rate for Payer: Clover Medicare Advantage	$0.38
Rate for Payer: EmblemHealth Commercial	$1.20
Rate for Payer: Humana Medicare Advantage	$0.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.40
Rate for Payer: Wellcare Medicare Advantage	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

KETOROLAC 30 MG/ML INJ

Facility

$40.20

Service Code	HCPCS J1885
Hospital Charge Code	6006225
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$9.73
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Medicare Advantage	$0.40
Rate for Payer: Clover Medicare Advantage	$0.38
Rate for Payer: EmblemHealth Commercial	$1.20
Rate for Payer: Humana Medicare Advantage	$0.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.40
Rate for Payer: Wellcare Medicare Advantage	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

KETOROLAC 30 MG/ML INJ

Facility

$40.20

Service Code	HCPCS J1885
Hospital Charge Code	6006225
Hospital Revenue Code	636
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$9.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.73
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

KETOROLAC 30MG (TORADOL) VIAL

Facility

$7.00

Hospital Charge Code	83652573
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

KETOROLAC 30MG (TORADOL) VIAL

Facility

$7.00

Hospital Charge Code	83652573
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

KETOROLAC 60MG(TORADOL)VIAL

Facility

$15.00

Hospital Charge Code	83652575
Hospital Revenue Code	636
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	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

KETOROLAC 60MG(TORADOL)VIAL

Facility

$15.00

Hospital Charge Code	83652575
Hospital Revenue Code	636
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$3.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

KETOROLAC INJ 60MG/2ML

Facility

$50.25

Service Code	HCPCS J1885
Hospital Charge Code	60627689
Hospital Revenue Code	636
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$12.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.54

KETOROLAC INJ 60MG/2ML

Facility

$50.25

Service Code	HCPCS J1885
Hospital Charge Code	60627689
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$12.16
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Medicare Advantage	$0.40
Rate for Payer: Clover Medicare Advantage	$0.38
Rate for Payer: EmblemHealth Commercial	$1.20
Rate for Payer: Humana Medicare Advantage	$0.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.54
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.40
Rate for Payer: Wellcare Medicare Advantage	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

KETOROLAC TAB 10MG

Facility

$11.25

Hospital Charge Code	60628862
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

KETOROLAC TAB 10MG

Facility

$11.25

Hospital Charge Code	60628862
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

KETOROLAC TROM 0.5% OPTH

Facility

$326.49

Service Code	NDC 17478020919
Hospital Charge Code	60635778
Hospital Revenue Code	250
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$163.25
Rate for Payer: Aetna Commercial	$124.07
Rate for Payer: Aetna Medicare Advantage	$97.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.25
Rate for Payer: Cigna Commercial	$163.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.95
Rate for Payer: Oxford Commercial	$65.30
Rate for Payer: Qualcare PPO/HMO/WC	$48.97
Rate for Payer: UnitedHealthcare Commercial	$65.30
Rate for Payer: UnitedHealthcare Community & State	$7.87
Rate for Payer: Wellpoint Medicaid Managed Care	$8.65

KETOROLAC TROM 0.5% OPTH

Facility

$326.49

Service Code	NDC 17478020919
Hospital Charge Code	60635778
Hospital Revenue Code	250
Min. Negotiated Rate	$48.97
Max. Negotiated Rate	$48.97
Rate for Payer: Qualcare PPO/HMO/WC	$48.97

KETOSTEROIDS,17(17 KS)FRACTION

Facility

$303.00

Service Code	HCPCS 83593
Hospital Charge Code	38472110
Hospital Revenue Code	301
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

KETOSTEROIDS,17(17 KS)FRACTION

Facility

$303.00

Service Code	HCPCS 83593
Hospital Charge Code	38472110
Hospital Revenue Code	301
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$92.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.88
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: Cigna Medicare Advantage	$28.50
Rate for Payer: Clover Medicare Advantage	$27.07
Rate for Payer: EmblemHealth Commercial	$85.50
Rate for Payer: Humana Medicare Advantage	$29.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$22.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.50
Rate for Payer: Wellcare Medicare Advantage	$28.50
Rate for Payer: Wellpoint Medicaid Managed Care	$8.03

KETROLAC 0.5% OPTHA SOLN

Facility

$66.10

Hospital Charge Code	60628893
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.05
Rate for Payer: Aetna Commercial	$25.12
Rate for Payer: Aetna Medicare Advantage	$19.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.86
Rate for Payer: Cigna Commercial	$33.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.83
Rate for Payer: Oxford Commercial	$13.22
Rate for Payer: Qualcare PPO/HMO/WC	$9.91
Rate for Payer: UnitedHealthcare Commercial	$13.22
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

KETROLAC 0.5% OPTHA SOLN

Facility

$66.10

Hospital Charge Code	60628893
Hospital Revenue Code	250
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$9.91
Rate for Payer: Qualcare PPO/HMO/WC	$9.91

Know your out-of-pocket cost for care.

All Charges