Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RIABNI 500MG/50ML VIAL

Facility

$28,815.36

Service Code	HCPCS Q5123
Hospital Charge Code	606390461
Hospital Revenue Code	636
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$6,973.32
Rate for Payer: Aetna Commercial	$55.11
Rate for Payer: Aetna Medicare Advantage	$65.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.13
Rate for Payer: Cigna Medicare Advantage	$20.26
Rate for Payer: Clover Medicare Advantage	$19.25
Rate for Payer: EmblemHealth Commercial	$60.78
Rate for Payer: Humana Medicare Advantage	$20.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,973.32
Rate for Payer: Qualcare PPO/HMO/WC	$4,322.30
Rate for Payer: UnitedHealthcare Community & State	$694.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.26
Rate for Payer: Wellcare Medicare Advantage	$20.26
Rate for Payer: Wellpoint Medicaid Managed Care	$763.61

RIABNI 500MG/50ML VIAL

Facility

$28,815.36

Service Code	HCPCS Q5123
Hospital Charge Code	606390461
Hospital Revenue Code	636
Min. Negotiated Rate	$4,322.30
Max. Negotiated Rate	$6,973.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,973.32
Rate for Payer: Qualcare PPO/HMO/WC	$4,322.30

RI AB W/RFL TITER,WB

Facility

$390.00

Service Code	HCPCS 86255
Hospital Charge Code	39900368
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RI AB W/RFL TITER,WB

Facility

$390.00

Service Code	HCPCS 86255
Hospital Charge Code	39900368
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

RI AUTOANTIBODY

Facility

$1,866.45

Service Code	HCPCS 84182
Hospital Charge Code	3009997
Hospital Revenue Code	301
Min. Negotiated Rate	$279.97
Max. Negotiated Rate	$279.97
Rate for Payer: Qualcare PPO/HMO/WC	$279.97

RI AUTOANTIBODY

Facility

$1,866.45

Service Code	HCPCS 84182
Hospital Charge Code	3009997
Hospital Revenue Code	301
Min. Negotiated Rate	$23.37
Max. Negotiated Rate	$933.23
Rate for Payer: Aetna Commercial	$79.45
Rate for Payer: Aetna Medicare Advantage	$94.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.44
Rate for Payer: Cigna Commercial	$933.23
Rate for Payer: Cigna Medicare Advantage	$29.21
Rate for Payer: Clover Medicare Advantage	$27.75
Rate for Payer: EmblemHealth Commercial	$87.63
Rate for Payer: Humana Medicare Advantage	$30.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$279.97
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$23.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.21
Rate for Payer: Wellcare Medicare Advantage	$29.21
Rate for Payer: Wellpoint Medicaid Managed Care	$49.46

RIBAVIRIN 200MG

Facility

$66.53

Service Code	NDC 68382026012
Hospital Charge Code	606390326
Hospital Revenue Code	250
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$9.98
Rate for Payer: Qualcare PPO/HMO/WC	$9.98

RIBAVIRIN 200MG

Facility

$66.53

Service Code	NDC 68382026012
Hospital Charge Code	606390326
Hospital Revenue Code	250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.27
Rate for Payer: Aetna Commercial	$25.28
Rate for Payer: Aetna Medicare Advantage	$19.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.97
Rate for Payer: Cigna Commercial	$33.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.96
Rate for Payer: Oxford Commercial	$13.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.98
Rate for Payer: UnitedHealthcare Commercial	$13.31
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

RIBAVIRIN 6GMS/100ML

Facility

$6,730.25

Hospital Charge Code	6004808
Hospital Revenue Code	250
Min. Negotiated Rate	$162.20
Max. Negotiated Rate	$3,365.12
Rate for Payer: Aetna Commercial	$2,557.49
Rate for Payer: Aetna Medicare Advantage	$2,019.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,716.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,716.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,716.21
Rate for Payer: Cigna Commercial	$3,365.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,019.08
Rate for Payer: Oxford Commercial	$1,346.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.54
Rate for Payer: UnitedHealthcare Commercial	$1,346.05
Rate for Payer: UnitedHealthcare Community & State	$162.20
Rate for Payer: Wellpoint Medicaid Managed Care	$178.35

RIBAVIRIN 6GMS/100ML

Facility

$6,730.25

Hospital Charge Code	6004808
Hospital Revenue Code	250
Min. Negotiated Rate	$1,009.54
Max. Negotiated Rate	$1,009.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.54

RIBBON PRINTER SMALL

Facility

$45.00

Hospital Charge Code	270647901
Hospital Revenue Code	270
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

RIBBON PRINTER SMALL

Facility

$45.00

Hospital Charge Code	270647901
Hospital Revenue Code	270
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

RIBOFLAVIN TAB 100MG

Facility

$1.95

Hospital Charge Code	60628698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

RIBOFLAVIN TAB 100MG

Facility

$1.95

Hospital Charge Code	60628698
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

RIBOFLAVIN(VIT B2 100MG)

Facility

$2.00

Hospital Charge Code	60635392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

RIBOFLAVIN(VIT B2 100MG)

Facility

$2.00

Hospital Charge Code	60635392
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

RIBOSOMAL ANTIBODIES

Facility

$312.00

Service Code	HCPCS 86235
Hospital Charge Code	38476063
Hospital Revenue Code	302
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$156.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$8.27

RIBOSOMAL ANTIBODIES

Facility

$312.00

Service Code	HCPCS 86235
Hospital Charge Code	38476063
Hospital Revenue Code	302
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$46.80
Rate for Payer: Qualcare PPO/HMO/WC	$46.80

RIBOSOMAL P AB ELISA

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3006880
Hospital Revenue Code	301
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$126.72
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$126.72
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.03
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.02
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.72

RIBOSOMAL P AB ELISA

Facility

$253.45

Service Code	HCPCS 83520
Hospital Charge Code	3006880
Hospital Revenue Code	301
Min. Negotiated Rate	$38.02
Max. Negotiated Rate	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$38.02

RIBOSOMAL P ANTIBODY

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	3038542
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

RIBOSOMAL P ANTIBODY

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	3038542
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RIBS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 71100LT
Hospital Charge Code	94061265
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

RIBS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 71100LT
Hospital Charge Code	94061265
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

RIBS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 71100RT
Hospital Charge Code	94061267
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges