Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ARICEPT 10MG TAB BULK

Facility

$17.00

Hospital Charge Code	60635190
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$6.46
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.40
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

ARICEPT 10MG TAB BULK

Facility

$17.00

Hospital Charge Code	60635190
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

ARICEPT 5MG TAB BULK

Facility

$17.00

Hospital Charge Code	60635191
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.50
Rate for Payer: Aetna Commercial	$6.46
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.10
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.40
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

ARICEPT 5MG TAB BULK

Facility

$17.00

Hospital Charge Code	60635191
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

ARIPIPRAZOL 2 MG TAB

Facility

$85.65

Hospital Charge Code	60630047
Hospital Revenue Code	250
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$12.85
Rate for Payer: Qualcare PPO/HMO/WC	$12.85

ARIPIPRAZOL 2 MG TAB

Facility

$85.65

Hospital Charge Code	60630047
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$42.83
Rate for Payer: Aetna Commercial	$32.55
Rate for Payer: Aetna Medicare Advantage	$25.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.84
Rate for Payer: Cigna Commercial	$42.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.70
Rate for Payer: Oxford Commercial	$17.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.85
Rate for Payer: UnitedHealthcare Commercial	$17.13
Rate for Payer: UnitedHealthcare Community & State	$2.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

ARIPIPRAZOLE 10 MG TAB

Facility

$239.06

Service Code	NDC 59148000813
Hospital Charge Code	60629312
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$119.53
Rate for Payer: Aetna Commercial	$90.84
Rate for Payer: Aetna Medicare Advantage	$71.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.96
Rate for Payer: Cigna Commercial	$119.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.72
Rate for Payer: Oxford Commercial	$47.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.86
Rate for Payer: UnitedHealthcare Commercial	$47.81
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.34

ARIPIPRAZOLE 10 MG TAB

Facility

$239.06

Service Code	NDC 59148000813
Hospital Charge Code	60629312
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$35.86
Rate for Payer: Qualcare PPO/HMO/WC	$35.86

ARIPIPRAZOLE 15 MG TAB

Facility

$239.06

Service Code	NDC 59148000913
Hospital Charge Code	60629294
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$35.86
Rate for Payer: Qualcare PPO/HMO/WC	$35.86

ARIPIPRAZOLE 15 MG TAB

Facility

$239.06

Service Code	NDC 59148000913
Hospital Charge Code	60629294
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$119.53
Rate for Payer: Aetna Commercial	$90.84
Rate for Payer: Aetna Medicare Advantage	$71.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.96
Rate for Payer: Cigna Commercial	$119.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.72
Rate for Payer: Oxford Commercial	$47.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.86
Rate for Payer: UnitedHealthcare Commercial	$47.81
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.34

ARIPIPRAZOLE 2MG TAB

Facility

$239.06

Service Code	NDC 59148000613
Hospital Charge Code	60632227
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$119.53
Rate for Payer: Aetna Commercial	$90.84
Rate for Payer: Aetna Medicare Advantage	$71.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.96
Rate for Payer: Cigna Commercial	$119.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.72
Rate for Payer: Oxford Commercial	$47.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.86
Rate for Payer: UnitedHealthcare Commercial	$47.81
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.34

ARIPIPRAZOLE 2MG TAB

Facility

$239.06

Service Code	NDC 59148000613
Hospital Charge Code	60632227
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$35.86
Rate for Payer: Qualcare PPO/HMO/WC	$35.86

ARIPIPRAZOLE 5MG TAB

Facility

$239.06

Service Code	NDC 59148000713
Hospital Charge Code	60630004
Hospital Revenue Code	250
Min. Negotiated Rate	$35.86
Max. Negotiated Rate	$35.86
Rate for Payer: Qualcare PPO/HMO/WC	$35.86

ARIPIPRAZOLE 5MG TAB

Facility

$239.06

Service Code	NDC 59148000713
Hospital Charge Code	60630004
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$119.53
Rate for Payer: Aetna Commercial	$90.84
Rate for Payer: Aetna Medicare Advantage	$71.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.96
Rate for Payer: Cigna Commercial	$119.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.72
Rate for Payer: Oxford Commercial	$47.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.86
Rate for Payer: UnitedHealthcare Commercial	$47.81
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.34

ARISTADA 1064MG

Facility

$29,090.80

Service Code	HCPCS J1944
Hospital Charge Code	606390218
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7,039.97
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Medicare Advantage	$3.32
Rate for Payer: Clover Medicare Advantage	$3.15
Rate for Payer: EmblemHealth Commercial	$9.96
Rate for Payer: Humana Medicare Advantage	$3.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,039.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,363.62
Rate for Payer: UnitedHealthcare Community & State	$701.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.32
Rate for Payer: Wellcare Medicare Advantage	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$770.91

ARISTADA 1064MG

Facility

$29,090.80

Service Code	HCPCS J1944
Hospital Charge Code	606390218
Hospital Revenue Code	636
Min. Negotiated Rate	$4,363.62
Max. Negotiated Rate	$7,039.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,039.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,363.62

ARISTADA 441MG

Facility

$12,057.32

Service Code	HCPCS J1944
Hospital Charge Code	606390215
Hospital Revenue Code	636
Min. Negotiated Rate	$1,808.60
Max. Negotiated Rate	$2,917.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.60

ARISTADA 441MG

Facility

$12,057.32

Service Code	HCPCS J1944
Hospital Charge Code	606390215
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$2,917.87
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Medicare Advantage	$3.32
Rate for Payer: Clover Medicare Advantage	$3.15
Rate for Payer: EmblemHealth Commercial	$9.96
Rate for Payer: Humana Medicare Advantage	$3.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.60
Rate for Payer: UnitedHealthcare Community & State	$290.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.32
Rate for Payer: Wellcare Medicare Advantage	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$319.52

ARISTADA 662MG

Facility

$18,099.72

Service Code	HCPCS J1944
Hospital Charge Code	606390216
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$4,380.13
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Medicare Advantage	$3.32
Rate for Payer: Clover Medicare Advantage	$3.15
Rate for Payer: EmblemHealth Commercial	$9.96
Rate for Payer: Humana Medicare Advantage	$3.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,380.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,714.96
Rate for Payer: UnitedHealthcare Community & State	$436.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.32
Rate for Payer: Wellcare Medicare Advantage	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$479.64

ARISTADA 662MG

Facility

$18,099.72

Service Code	HCPCS J1944
Hospital Charge Code	606390216
Hospital Revenue Code	636
Min. Negotiated Rate	$2,714.96
Max. Negotiated Rate	$4,380.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,380.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,714.96

ARISTADA 882MG

Facility

$24,114.64

Service Code	HCPCS J1944
Hospital Charge Code	606390217
Hospital Revenue Code	636
Min. Negotiated Rate	$3,617.20
Max. Negotiated Rate	$5,835.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,835.74
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.20

ARISTADA 882MG

Facility

$24,114.64

Service Code	HCPCS J1944
Hospital Charge Code	606390217
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5,835.74
Rate for Payer: Aetna Commercial	$9.03
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Medicare Advantage	$3.32
Rate for Payer: Clover Medicare Advantage	$3.15
Rate for Payer: EmblemHealth Commercial	$9.96
Rate for Payer: Humana Medicare Advantage	$3.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,835.74
Rate for Payer: Qualcare PPO/HMO/WC	$3,617.20
Rate for Payer: UnitedHealthcare Community & State	$581.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.32
Rate for Payer: Wellcare Medicare Advantage	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$639.04

ARISTADA INITIO 675MG

Facility

$18,455.15

Service Code	HCPCS J1943
Hospital Charge Code	606390214
Hospital Revenue Code	636
Min. Negotiated Rate	$2,768.27
Max. Negotiated Rate	$4,466.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,466.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,768.27

ARISTADA INITIO 675MG

Facility

$18,455.15

Service Code	HCPCS J1943
Hospital Charge Code	606390214
Hospital Revenue Code	636
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$4,466.15
Rate for Payer: Aetna Commercial	$8.84
Rate for Payer: Aetna Medicare Advantage	$10.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Medicare Advantage	$3.25
Rate for Payer: Clover Medicare Advantage	$3.09
Rate for Payer: EmblemHealth Commercial	$9.75
Rate for Payer: Humana Medicare Advantage	$3.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,466.15
Rate for Payer: Qualcare PPO/HMO/WC	$2,768.27
Rate for Payer: UnitedHealthcare Community & State	$444.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.25
Rate for Payer: Wellcare Medicare Advantage	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$489.06

ARISTA HEMOSTAT 1 GRAM

Facility

$407.50

Hospital Charge Code	270687373
Hospital Revenue Code	272
Min. Negotiated Rate	$61.12
Max. Negotiated Rate	$61.12
Rate for Payer: Qualcare PPO/HMO/WC	$61.12

Know your out-of-pocket cost for care.

All Charges