Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RING VALTRAC 25X1.5 8082-00**

Facility

$897.00

Hospital Charge Code	1604818
Hospital Revenue Code	272
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$340.86
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.10
Rate for Payer: Oxford Commercial	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$179.40
Rate for Payer: UnitedHealthcare Community & State	$21.62
Rate for Payer: Wellpoint Medicaid Managed Care	$23.77

RING VALTRAC 25X2.0 8083-00***

Facility

$897.00

Hospital Charge Code	1604826
Hospital Revenue Code	272
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$340.86
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.10
Rate for Payer: Oxford Commercial	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$179.40
Rate for Payer: UnitedHealthcare Community & State	$21.62
Rate for Payer: Wellpoint Medicaid Managed Care	$23.77

RING VALTRAC 25X2.0 8083-00***

Facility

$897.00

Hospital Charge Code	1604826
Hospital Revenue Code	272
Min. Negotiated Rate	$134.55
Max. Negotiated Rate	$134.55
Rate for Payer: Qualcare PPO/HMO/WC	$134.55

RING VALTRAC 25X2.5 8084-00***

Facility

$897.00

Hospital Charge Code	1604834
Hospital Revenue Code	272
Min. Negotiated Rate	$134.55
Max. Negotiated Rate	$134.55
Rate for Payer: Qualcare PPO/HMO/WC	$134.55

RING VALTRAC 25X2.5 8084-00***

Facility

$897.00

Hospital Charge Code	1604834
Hospital Revenue Code	272
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$340.86
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.10
Rate for Payer: Oxford Commercial	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$179.40
Rate for Payer: UnitedHealthcare Community & State	$21.62
Rate for Payer: Wellpoint Medicaid Managed Care	$23.77

RING VALTRAC 28X1.5 8087-00***

Facility

$897.00

Hospital Charge Code	1604842
Hospital Revenue Code	272
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$340.86
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.10
Rate for Payer: Oxford Commercial	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$179.40
Rate for Payer: UnitedHealthcare Community & State	$21.62
Rate for Payer: Wellpoint Medicaid Managed Care	$23.77

RING VALTRAC 28X1.5 8087-00***

Facility

$897.00

Hospital Charge Code	1604842
Hospital Revenue Code	272
Min. Negotiated Rate	$134.55
Max. Negotiated Rate	$134.55
Rate for Payer: Qualcare PPO/HMO/WC	$134.55

RING VALTRAC 28X2.0 8088-00***

Facility

$897.00

Hospital Charge Code	1604859
Hospital Revenue Code	272
Min. Negotiated Rate	$134.55
Max. Negotiated Rate	$134.55
Rate for Payer: Qualcare PPO/HMO/WC	$134.55

RING VALTRAC 28X2.0 8088-00***

Facility

$897.00

Hospital Charge Code	1604859
Hospital Revenue Code	272
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$340.86
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.10
Rate for Payer: Oxford Commercial	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$179.40
Rate for Payer: UnitedHealthcare Community & State	$21.62
Rate for Payer: Wellpoint Medicaid Managed Care	$23.77

RING VALTRAC 31X1.5 8089-00**

Facility

$897.00

Hospital Charge Code	1604305
Hospital Revenue Code	272
Min. Negotiated Rate	$134.55
Max. Negotiated Rate	$134.55
Rate for Payer: Qualcare PPO/HMO/WC	$134.55

RING VALTRAC 31X1.5 8089-00**

Facility

$897.00

Hospital Charge Code	1604305
Hospital Revenue Code	272
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$340.86
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.10
Rate for Payer: Oxford Commercial	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$179.40
Rate for Payer: UnitedHealthcare Community & State	$21.62
Rate for Payer: Wellpoint Medicaid Managed Care	$23.77

RING VALTRAC 31X2.0 80900-00**

Facility

$897.00

Hospital Charge Code	1604313
Hospital Revenue Code	272
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$448.50
Rate for Payer: Aetna Commercial	$340.86
Rate for Payer: Aetna Medicare Advantage	$269.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.74
Rate for Payer: Cigna Commercial	$448.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.10
Rate for Payer: Oxford Commercial	$179.40
Rate for Payer: Qualcare PPO/HMO/WC	$134.55
Rate for Payer: UnitedHealthcare Commercial	$179.40
Rate for Payer: UnitedHealthcare Community & State	$21.62
Rate for Payer: Wellpoint Medicaid Managed Care	$23.77

RING VALTRAC 31X2.0 80900-00**

Facility

$897.00

Hospital Charge Code	1604313
Hospital Revenue Code	272
Min. Negotiated Rate	$134.55
Max. Negotiated Rate	$134.55
Rate for Payer: Qualcare PPO/HMO/WC	$134.55

RIOPAN/540MG/5ML

Facility

$3.00

Hospital Charge Code	60633825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

RIOPAN/540MG/5ML

Facility

$3.00

Hospital Charge Code	60633825
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

RIOPAN PLUS

Facility

$6.00

Hospital Charge Code	60634435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

RIOPAN PLUS

Facility

$6.00

Hospital Charge Code	60634435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

RIO SYSTEM IRRIGATION TUBE

Facility

$601.25

Hospital Charge Code	270692852
Hospital Revenue Code	272
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$300.62
Rate for Payer: Aetna Commercial	$228.47
Rate for Payer: Aetna Medicare Advantage	$180.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.32
Rate for Payer: Cigna Commercial	$300.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.38
Rate for Payer: Oxford Commercial	$120.25
Rate for Payer: Qualcare PPO/HMO/WC	$90.19
Rate for Payer: UnitedHealthcare Commercial	$120.25
Rate for Payer: UnitedHealthcare Community & State	$14.49
Rate for Payer: Wellpoint Medicaid Managed Care	$15.93

RIO SYSTEM IRRIGATION TUBE

Facility

$601.25

Hospital Charge Code	270692852
Hospital Revenue Code	272
Min. Negotiated Rate	$90.19
Max. Negotiated Rate	$90.19
Rate for Payer: Qualcare PPO/HMO/WC	$90.19

RISEDRONATE 30 MG TAB

Facility

$28.90

Hospital Charge Code	60629237
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.45
Rate for Payer: Aetna Commercial	$10.98
Rate for Payer: Aetna Medicare Advantage	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.37
Rate for Payer: Cigna Commercial	$14.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.67
Rate for Payer: Oxford Commercial	$5.78
Rate for Payer: Qualcare PPO/HMO/WC	$4.33
Rate for Payer: UnitedHealthcare Commercial	$5.78
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

RISEDRONATE 30 MG TAB

Facility

$28.90

Hospital Charge Code	60629237
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.33

RISEDRONATE 5 MG TAB

Facility

$4.15

Hospital Charge Code	60629171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.58
Rate for Payer: Aetna Medicare Advantage	$1.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.06
Rate for Payer: Cigna Commercial	$2.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$0.83
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

RISEDRONATE 5 MG TAB

Facility

$4.15

Hospital Charge Code	60629171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

RISPERDAL 0.5 MG TAB

Facility

$6.00

Hospital Charge Code	60635317
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

RISPERDAL 0.5 MG TAB

Facility

$6.00

Hospital Charge Code	60635317
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

Know your out-of-pocket cost for care.

All Charges