Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RID PURE ALTERNATIVE

Facility

$19.00

Hospital Charge Code	60635478
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

RID PURE ALTERNATIVE

Facility

$19.00

Hospital Charge Code	60635478
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

RID SHAMPOO 2OZ

Facility

$12.00

Hospital Charge Code	60635477
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

RID SHAMPOO 2OZ

Facility

$12.00

Hospital Charge Code	60635477
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

RIFABUTIN 150MG CAP

Facility

$150.48

Service Code	NDC 13530117
Hospital Charge Code	60635380
Hospital Revenue Code	250
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$22.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

RIFABUTIN 150MG CAP

Facility

$150.48

Service Code	NDC 13530117
Hospital Charge Code	60635380
Hospital Revenue Code	250
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$75.24
Rate for Payer: Aetna Commercial	$57.18
Rate for Payer: Aetna Medicare Advantage	$45.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.37
Rate for Payer: Cigna Commercial	$75.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.14
Rate for Payer: Oxford Commercial	$30.10
Rate for Payer: Qualcare PPO/HMO/WC	$22.57
Rate for Payer: UnitedHealthcare Commercial	$30.10
Rate for Payer: UnitedHealthcare Community & State	$3.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

RIFADIN/300MG/CAP

Facility

$8.00

Hospital Charge Code	60633824
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

RIFADIN/300MG/CAP

Facility

$8.00

Hospital Charge Code	60633824
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

RIFAMPIN 150 MG CAP

Facility

$5.00

Hospital Charge Code	60635695
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

RIFAMPIN 150 MG CAP

Facility

$5.00

Hospital Charge Code	60635695
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

RIFAMPIN 15MG CAP

Facility

$13.33

Service Code	NDC 68084035721
Hospital Charge Code	6063943170
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

RIFAMPIN 15MG CAP

Facility

$13.33

Service Code	NDC 68084035721
Hospital Charge Code	6063943170
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$5.07
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.00
Rate for Payer: Oxford Commercial	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$2.67
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

RIFAMPIN 300 MG CAP

Facility

$20.37

Service Code	NDC 51079089020
Hospital Charge Code	6027114
Hospital Revenue Code	251
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.19
Rate for Payer: Aetna Commercial	$7.74
Rate for Payer: Aetna Medicare Advantage	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.19
Rate for Payer: Cigna Commercial	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.11
Rate for Payer: Oxford Commercial	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.06
Rate for Payer: UnitedHealthcare Commercial	$4.07
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

RIFAMPIN 300 MG CAP

Facility

$20.37

Service Code	NDC 51079089020
Hospital Charge Code	6027114
Hospital Revenue Code	251
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.06

RIFAMPIN INJ 600MG/10ML

Facility

$658.60

Hospital Charge Code	6009872
Hospital Revenue Code	250
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$329.30
Rate for Payer: Aetna Commercial	$250.27
Rate for Payer: Aetna Medicare Advantage	$197.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.94
Rate for Payer: Cigna Commercial	$329.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.58
Rate for Payer: Oxford Commercial	$131.72
Rate for Payer: Qualcare PPO/HMO/WC	$98.79
Rate for Payer: UnitedHealthcare Commercial	$131.72
Rate for Payer: UnitedHealthcare Community & State	$15.87
Rate for Payer: Wellpoint Medicaid Managed Care	$17.45

RIFAMPIN INJ 600MG/10ML

Facility

$658.60

Hospital Charge Code	6009872
Hospital Revenue Code	250
Min. Negotiated Rate	$98.79
Max. Negotiated Rate	$98.79
Rate for Payer: Qualcare PPO/HMO/WC	$98.79

RIFATER/TAB

Facility

$8.00

Hospital Charge Code	60634997
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

RIFATER/TAB

Facility

$8.00

Hospital Charge Code	60634997
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.40
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

RIFAXIMIM 550MG TAB

Facility

$206.63

Service Code	NDC 65649030303
Hospital Charge Code	60632220
Hospital Revenue Code	250
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$103.31
Rate for Payer: Aetna Commercial	$78.52
Rate for Payer: Aetna Medicare Advantage	$61.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.69
Rate for Payer: Cigna Commercial	$103.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.99
Rate for Payer: Oxford Commercial	$41.33
Rate for Payer: Qualcare PPO/HMO/WC	$30.99
Rate for Payer: UnitedHealthcare Commercial	$41.33
Rate for Payer: UnitedHealthcare Community & State	$4.98
Rate for Payer: Wellpoint Medicaid Managed Care	$5.48

RIFAXIMIM 550MG TAB

Facility

$206.63

Service Code	NDC 65649030303
Hospital Charge Code	60632220
Hospital Revenue Code	250
Min. Negotiated Rate	$30.99
Max. Negotiated Rate	$30.99
Rate for Payer: Qualcare PPO/HMO/WC	$30.99

RIFAZIMIN 200MG TAB

Facility

$118.19

Service Code	NDC 65649030103
Hospital Charge Code	60630014
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$59.09
Rate for Payer: Aetna Commercial	$44.91
Rate for Payer: Aetna Medicare Advantage	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.14
Rate for Payer: Cigna Commercial	$59.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.46
Rate for Payer: Oxford Commercial	$23.64
Rate for Payer: Qualcare PPO/HMO/WC	$17.73
Rate for Payer: UnitedHealthcare Commercial	$23.64
Rate for Payer: UnitedHealthcare Community & State	$2.85
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

RIFAZIMIN 200MG TAB

Facility

$118.19

Service Code	NDC 65649030103
Hospital Charge Code	60630014
Hospital Revenue Code	250
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$17.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.73

RIGHT HEART CATH

Facility

$11,541.00

Service Code	HCPCS 93451
Hospital Charge Code	366893451
Hospital Revenue Code	481
Min. Negotiated Rate	$278.14
Max. Negotiated Rate	$13,902.76
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,902.76
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,462.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.15
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$278.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$305.84

RIGHT HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93451
Hospital Charge Code	74110009
Hospital Revenue Code	481
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50

RIGHT HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93451
Hospital Charge Code	74110009
Hospital Revenue Code	481
Min. Negotiated Rate	$390.18
Max. Negotiated Rate	$13,902.76
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,902.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,902.76
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,857.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$390.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$429.04

Know your out-of-pocket cost for care.

All Charges