Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OMNISCAN 287MG INJ 20ML VIAL

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	60630198
Hospital Revenue Code	255
Min. Negotiated Rate	$105.53
Max. Negotiated Rate	$105.53
Rate for Payer: Qualcare PPO/HMO/WC	$105.53

OMNISCAN 5ml

Facility

$69.50

Service Code	HCPCS A9579
Hospital Charge Code	601530
Hospital Revenue Code	255
Min. Negotiated Rate	$10.43
Max. Negotiated Rate	$10.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.43

OMNISCAN 5ml

Facility

$69.50

Service Code	HCPCS A9579
Hospital Charge Code	601530
Hospital Revenue Code	255
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$34.75
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$20.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.72
Rate for Payer: Cigna Commercial	$34.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.85
Rate for Payer: Oxford Commercial	$13.90
Rate for Payer: Qualcare PPO/HMO/WC	$10.43
Rate for Payer: UnitedHealthcare Commercial	$13.90
Rate for Payer: UnitedHealthcare Community & State	$1.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1.84

OMNI SPAN 0 DEG

Facility

$1,750.00

Hospital Charge Code	270664472
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

OMNI SPAN 0 DEG

Facility

$1,750.00

Hospital Charge Code	270664472
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

ONCO 2 PROTEINS

Facility

$2,348.00

Service Code	HCPCS 81500
Hospital Charge Code	401081500
Hospital Revenue Code	301
Min. Negotiated Rate	$62.22
Max. Negotiated Rate	$1,174.00
Rate for Payer: Aetna Commercial	$708.56
Rate for Payer: Aetna Medicare Advantage	$844.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$940.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$940.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$940.33
Rate for Payer: Cigna Commercial	$1,174.00
Rate for Payer: Cigna Medicare Advantage	$260.50
Rate for Payer: Clover Medicare Advantage	$247.47
Rate for Payer: EmblemHealth Commercial	$781.50
Rate for Payer: Humana Medicare Advantage	$268.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$208.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.50
Rate for Payer: Wellcare Medicare Advantage	$260.50
Rate for Payer: Wellpoint Medicaid Managed Care	$62.22

ONCO 2 PROTEINS

Facility

$2,348.00

Service Code	HCPCS 81500
Hospital Charge Code	401081500
Hospital Revenue Code	301
Min. Negotiated Rate	$352.20
Max. Negotiated Rate	$352.20
Rate for Payer: Qualcare PPO/HMO/WC	$352.20

ONCOPROTEIN DCP

Facility

$290.79

Service Code	HCPCS 83951
Hospital Charge Code	401183951
Hospital Revenue Code	301
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: Aetna Medicare Advantage	$208.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.50
Rate for Payer: Cigna Commercial	$145.40
Rate for Payer: Cigna Medicare Advantage	$64.41
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.24
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Medicare Advantage	$64.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

ONCOPROTEIN DCP

Facility

$290.79

Service Code	HCPCS 83951
Hospital Charge Code	401183951
Hospital Revenue Code	301
Min. Negotiated Rate	$43.62
Max. Negotiated Rate	$43.62
Rate for Payer: Qualcare PPO/HMO/WC	$43.62

ONCOVIN/1MG/1ML

Facility

$213.00

Hospital Charge Code	60633574
Hospital Revenue Code	250
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$106.50
Rate for Payer: Aetna Commercial	$80.94
Rate for Payer: Aetna Medicare Advantage	$63.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.31
Rate for Payer: Cigna Commercial	$106.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: Oxford Commercial	$42.60
Rate for Payer: Qualcare PPO/HMO/WC	$31.95
Rate for Payer: UnitedHealthcare Commercial	$42.60
Rate for Payer: UnitedHealthcare Community & State	$5.13
Rate for Payer: Wellpoint Medicaid Managed Care	$5.64

ONCOVIN/1MG/1ML

Facility

$450.00

Hospital Charge Code	60633573
Hospital Revenue Code	250
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

ONCOVIN/1MG/1ML

Facility

$450.00

Hospital Charge Code	60633573
Hospital Revenue Code	250
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ONCOVIN/1MG/1ML

Facility

$213.00

Hospital Charge Code	60633574
Hospital Revenue Code	250
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$31.95
Rate for Payer: Qualcare PPO/HMO/WC	$31.95

ONDANETRON HYDROCHL8MG UD

Facility

$69.00

Hospital Charge Code	60634879
Hospital Revenue Code	250
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

ONDANETRON HYDROCHL8MG UD

Facility

$69.00

Hospital Charge Code	60634879
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.59
Rate for Payer: Cigna Commercial	$34.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.70
Rate for Payer: Oxford Commercial	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Commercial	$13.80
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

ONDANSETRON 32 MG/50 ML SOL

Facility

$1,032.05

Hospital Charge Code	60628144
Hospital Revenue Code	636
Min. Negotiated Rate	$154.81
Max. Negotiated Rate	$249.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.76
Rate for Payer: Qualcare PPO/HMO/WC	$154.81

ONDANSETRON 32 MG/50 ML SOL

Facility

$1,032.05

Hospital Charge Code	60628144
Hospital Revenue Code	636
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$516.02
Rate for Payer: Aetna Commercial	$392.18
Rate for Payer: Aetna Medicare Advantage	$309.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.17
Rate for Payer: Cigna Commercial	$516.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.76
Rate for Payer: Qualcare PPO/HMO/WC	$154.81
Rate for Payer: UnitedHealthcare Community & State	$24.87
Rate for Payer: Wellpoint Medicaid Managed Care	$27.35

ONDANSETRON 4MG/2ML INJ

Facility

$6.70

Service Code	HCPCS J2405
Hospital Charge Code	60628669
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

ONDANSETRON 4MG/2ML INJ

Facility

$6.70

Service Code	HCPCS J2405
Hospital Charge Code	60628669
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.01
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	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

ONDANSETRON 4 MG DISINTEG. TAB

Facility

$26.80

Service Code	NDC 62756024064
Hospital Charge Code	60630085
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

ONDANSETRON 4 MG DISINTEG. TAB

Facility

$26.80

Service Code	NDC 62756024064
Hospital Charge Code	60630085
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

ONDANSETRON 4 MG TAB

Facility

$166.03

Service Code	NDC 63304045830
Hospital Charge Code	60628146
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.02
Rate for Payer: Aetna Commercial	$63.09
Rate for Payer: Aetna Medicare Advantage	$49.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.34
Rate for Payer: Cigna Commercial	$83.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.81
Rate for Payer: Oxford Commercial	$33.21
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.21
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

ONDANSETRON 4 MG TAB

Facility

$166.03

Service Code	NDC 63304045830
Hospital Charge Code	60628146
Hospital Revenue Code	250
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

ONDANSETRON 8 MG DISINTEG. TAB

Facility

$30.08

Service Code	NDC 54868574900
Hospital Charge Code	60630086
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.04
Rate for Payer: Aetna Commercial	$11.43
Rate for Payer: Aetna Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.67
Rate for Payer: Cigna Commercial	$15.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.02
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

ONDANSETRON 8 MG DISINTEG. TAB

Facility

$30.08

Service Code	NDC 54868574900
Hospital Charge Code	60630086
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

Know your out-of-pocket cost for care.

All Charges