Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ONDANSETRON 8 MG TAB

Facility

$276.44

Service Code	NDC 51079052520
Hospital Charge Code	6008718
Hospital Revenue Code	250
Min. Negotiated Rate	$41.47
Max. Negotiated Rate	$41.47
Rate for Payer: Qualcare PPO/HMO/WC	$41.47

ONDANSETRON 8 MG TAB

Facility

$276.44

Service Code	NDC 51079052520
Hospital Charge Code	6008718
Hospital Revenue Code	250
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$138.22
Rate for Payer: Aetna Commercial	$105.05
Rate for Payer: Aetna Medicare Advantage	$82.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.49
Rate for Payer: Cigna Commercial	$138.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.93
Rate for Payer: Oxford Commercial	$55.29
Rate for Payer: Qualcare PPO/HMO/WC	$41.47
Rate for Payer: UnitedHealthcare Commercial	$55.29
Rate for Payer: UnitedHealthcare Community & State	$6.66
Rate for Payer: Wellpoint Medicaid Managed Care	$7.33

ONDANSETRON HYDROCHLORIDE 40MG

Facility

$34.73

Hospital Charge Code	6063943223
Hospital Revenue Code	636
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$8.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.21

ONDANSETRON HYDROCHLORIDE 40MG

Facility

$34.73

Hospital Charge Code	6063943223
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.36
Rate for Payer: Aetna Commercial	$13.20
Rate for Payer: Aetna Medicare Advantage	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.86
Rate for Payer: Cigna Commercial	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.21
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

ONDANSETRON IV 32MG/50ML .9NS

Facility

$376.35

Hospital Charge Code	60628145
Hospital Revenue Code	636
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$91.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.08
Rate for Payer: Qualcare PPO/HMO/WC	$56.45

ONDANSETRON IV 32MG/50ML .9NS

Facility

$376.35

Hospital Charge Code	60628145
Hospital Revenue Code	636
Min. Negotiated Rate	$9.07
Max. Negotiated Rate	$188.18
Rate for Payer: Aetna Commercial	$143.01
Rate for Payer: Aetna Medicare Advantage	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.97
Rate for Payer: Cigna Commercial	$188.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.08
Rate for Payer: Qualcare PPO/HMO/WC	$56.45
Rate for Payer: UnitedHealthcare Community & State	$9.07
Rate for Payer: Wellpoint Medicaid Managed Care	$9.97

ONDANSTRN ORL SOL 4MG/5ML

Facility

$160.13

Service Code	HCPCS Q0162
Hospital Charge Code	60635699
Hospital Revenue Code	636
Min. Negotiated Rate	$24.02
Max. Negotiated Rate	$38.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.02

ONDANSTRN ORL SOL 4MG/5ML

Facility

$160.13

Service Code	HCPCS Q0162
Hospital Charge Code	60635699
Hospital Revenue Code	636
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$80.06
Rate for Payer: Aetna Commercial	$60.85
Rate for Payer: Aetna Medicare Advantage	$48.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.83
Rate for Payer: Cigna Commercial	$80.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.02
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

ONE STEP CATH 5FR. 10CM

Facility

$450.00

Hospital Charge Code	270665909
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ONE STEP CATH 5FR. 10CM

Facility

$450.00

Hospital Charge Code	270665909
Hospital Revenue Code	278
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) NJ Health	$90.00
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	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

ONE STEP CATH 5FR. 15CM

Facility

$450.00

Hospital Charge Code	270665910
Hospital Revenue Code	278
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) NJ Health	$90.00
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	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

ONE STEP CATH 5FR. 15CM

Facility

$450.00

Hospital Charge Code	270665910
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ONE STEP CENTESIS CATHETER

Facility

$82.40

Hospital Charge Code	270653940
Hospital Revenue Code	270
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$31.31
Rate for Payer: Aetna Medicare Advantage	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.01
Rate for Payer: Cigna Commercial	$41.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.72
Rate for Payer: Oxford Commercial	$16.48
Rate for Payer: Qualcare PPO/HMO/WC	$12.36
Rate for Payer: UnitedHealthcare Commercial	$16.48
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.18

ONE STEP CENTESIS CATHETER

Facility

$82.40

Hospital Charge Code	270653940
Hospital Revenue Code	270
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$12.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.36

ONLAY TIBIAL INSERT SZ 1 10MM

Facility

$3,935.00

Hospital Charge Code	270668783
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 1 10MM

Facility

$3,935.00

Hospital Charge Code	270668783
Hospital Revenue Code	278
Min. Negotiated Rate	$94.83
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$94.83
Rate for Payer: Wellpoint Medicaid Managed Care	$104.28

ONLAY TIBIAL INSERT SZ 1 12MM

Facility

$3,935.00

Hospital Charge Code	270668784
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 1 12MM

Facility

$3,935.00

Hospital Charge Code	270668784
Hospital Revenue Code	278
Min. Negotiated Rate	$94.83
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$94.83
Rate for Payer: Wellpoint Medicaid Managed Care	$104.28

ONLAY TIBIAL INSERT SZ 1 8MM

Facility

$3,935.00

Hospital Charge Code	270668781
Hospital Revenue Code	278
Min. Negotiated Rate	$94.83
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$94.83
Rate for Payer: Wellpoint Medicaid Managed Care	$104.28

ONLAY TIBIAL INSERT SZ 1 8MM

Facility

$3,935.00

Hospital Charge Code	270668781
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 1 9MM

Facility

$3,935.00

Hospital Charge Code	270668782
Hospital Revenue Code	278
Min. Negotiated Rate	$94.83
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$94.83
Rate for Payer: Wellpoint Medicaid Managed Care	$104.28

ONLAY TIBIAL INSERT SZ 1 9MM

Facility

$3,935.00

Hospital Charge Code	270668782
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 2 10MM

Facility

$3,935.00

Hospital Charge Code	270668786
Hospital Revenue Code	278
Min. Negotiated Rate	$94.83
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$94.83
Rate for Payer: Wellpoint Medicaid Managed Care	$104.28

ONLAY TIBIAL INSERT SZ 2 10MM

Facility

$3,935.00

Hospital Charge Code	270668786
Hospital Revenue Code	278
Min. Negotiated Rate	$590.25
Max. Negotiated Rate	$952.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25

ONLAY TIBIAL INSERT SZ 2 12MM

Facility

$3,935.00

Hospital Charge Code	270668787
Hospital Revenue Code	278
Min. Negotiated Rate	$94.83
Max. Negotiated Rate	$1,967.50
Rate for Payer: Aetna Commercial	$1,495.30
Rate for Payer: Aetna Medicare Advantage	$1,180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,003.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,003.42
Rate for Payer: Cigna Commercial	$1,967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$952.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$865.70
Rate for Payer: Qualcare PPO/HMO/WC	$590.25
Rate for Payer: UnitedHealthcare Community & State	$94.83
Rate for Payer: Wellpoint Medicaid Managed Care	$104.28

Know your out-of-pocket cost for care.

All Charges