Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RISPERIDONE 1 MG TAB

Facility

$66.06

Service Code	NDC 50458030001
Hospital Charge Code	6017651
Hospital Revenue Code	250
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$9.91
Rate for Payer: Qualcare PPO/HMO/WC	$9.91

RISPERIDONE 2MG ODT TAB

Facility

$123.35

Service Code	NDC 50458032528
Hospital Charge Code	6063943173
Hospital Revenue Code	250
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$18.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.50

RISPERIDONE 2MG ODT TAB

Facility

$123.35

Service Code	NDC 50458032528
Hospital Charge Code	6063943173
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$61.67
Rate for Payer: Aetna Commercial	$46.87
Rate for Payer: Aetna Medicare Advantage	$37.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.45
Rate for Payer: Cigna Commercial	$61.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.01
Rate for Payer: Oxford Commercial	$24.67
Rate for Payer: Qualcare PPO/HMO/WC	$18.50
Rate for Payer: UnitedHealthcare Commercial	$24.67
Rate for Payer: UnitedHealthcare Community & State	$2.97
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

RISPERIDONE 2 MG TAB

Facility

$110.42

Service Code	NDC 50458032001
Hospital Charge Code	6017644
Hospital Revenue Code	250
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$55.21
Rate for Payer: Aetna Commercial	$41.96
Rate for Payer: Aetna Medicare Advantage	$33.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.16
Rate for Payer: Cigna Commercial	$55.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.13
Rate for Payer: Oxford Commercial	$22.08
Rate for Payer: Qualcare PPO/HMO/WC	$16.56
Rate for Payer: UnitedHealthcare Commercial	$22.08
Rate for Payer: UnitedHealthcare Community & State	$2.66
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

RISPERIDONE 2 MG TAB

Facility

$110.42

Service Code	NDC 50458032001
Hospital Charge Code	6017644
Hospital Revenue Code	250
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$16.56
Rate for Payer: Qualcare PPO/HMO/WC	$16.56

RISPERIDONE 3 MG TAB

Facility

$129.71

Service Code	NDC 50458033001
Hospital Charge Code	60627817
Hospital Revenue Code	250
Min. Negotiated Rate	$19.46
Max. Negotiated Rate	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.46

RISPERIDONE 3 MG TAB

Facility

$129.71

Service Code	NDC 50458033001
Hospital Charge Code	60627817
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$64.86
Rate for Payer: Aetna Commercial	$49.29
Rate for Payer: Aetna Medicare Advantage	$38.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.08
Rate for Payer: Cigna Commercial	$64.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Oxford Commercial	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$19.46
Rate for Payer: UnitedHealthcare Commercial	$25.94
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

RISPERIDONE & 9-OH-RISPER

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3035111
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

RISPERIDONE & 9-OH-RISPER

Facility

$181.65

Service Code	HCPCS 80299
Hospital Charge Code	3035111
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

RISPERIDONE CONSTA 12.5MG/2ML

Facility

$1,372.50

Service Code	HCPCS J2794
Hospital Charge Code	606390334
Hospital Revenue Code	636
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$332.14
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare Advantage	$34.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Medicare Advantage	$10.80
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.14
Rate for Payer: Qualcare PPO/HMO/WC	$205.88
Rate for Payer: UnitedHealthcare Community & State	$33.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Medicare Advantage	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$36.37

RISPERIDONE CONSTA 12.5MG/2ML

Facility

$1,372.50

Service Code	HCPCS J2794
Hospital Charge Code	606390334
Hospital Revenue Code	636
Min. Negotiated Rate	$205.88
Max. Negotiated Rate	$332.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.14
Rate for Payer: Qualcare PPO/HMO/WC	$205.88

RISPERIDONE CONSTA 12.5MG INJ

Facility

$5,259.90

Hospital Charge Code	6063943174
Hospital Revenue Code	636
Min. Negotiated Rate	$788.99
Max. Negotiated Rate	$1,272.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.90
Rate for Payer: Qualcare PPO/HMO/WC	$788.99

RISPERIDONE CONSTA 12.5MG INJ

Facility

$5,259.90

Hospital Charge Code	6063943174
Hospital Revenue Code	636
Min. Negotiated Rate	$126.76
Max. Negotiated Rate	$2,629.95
Rate for Payer: Aetna Commercial	$1,998.76
Rate for Payer: Aetna Medicare Advantage	$1,577.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,341.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,341.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,341.27
Rate for Payer: Cigna Commercial	$2,629.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.90
Rate for Payer: Qualcare PPO/HMO/WC	$788.99
Rate for Payer: UnitedHealthcare Community & State	$126.76
Rate for Payer: Wellpoint Medicaid Managed Care	$139.39

RISPERIDONE CONSTA 37.5MG/2 ML

Facility

$4,117.22

Service Code	HCPCS J2794
Hospital Charge Code	60630030
Hospital Revenue Code	636
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$996.37
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare Advantage	$34.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.98
Rate for Payer: Cigna Medicare Advantage	$10.80
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$996.37
Rate for Payer: Qualcare PPO/HMO/WC	$617.58
Rate for Payer: UnitedHealthcare Community & State	$99.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Medicare Advantage	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$109.11

RISPERIDONE CONSTA 37.5MG/2 ML

Facility

$4,117.22

Service Code	HCPCS J2794
Hospital Charge Code	60630030
Hospital Revenue Code	636
Min. Negotiated Rate	$617.58
Max. Negotiated Rate	$996.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$996.37
Rate for Payer: Qualcare PPO/HMO/WC	$617.58

RISPERIDONE TAB 3MG

Facility

$28.80

Hospital Charge Code	6020003
Hospital Revenue Code	252
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$10.94
Rate for Payer: Aetna Medicare Advantage	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.34
Rate for Payer: Cigna Commercial	$14.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.64
Rate for Payer: Oxford Commercial	$5.76
Rate for Payer: Qualcare PPO/HMO/WC	$4.32
Rate for Payer: UnitedHealthcare Commercial	$5.76
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

RISPERIDONE TAB 3MG

Facility

$28.80

Hospital Charge Code	6020003
Hospital Revenue Code	252
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$4.32

RISTOCETIN COFACTOR

Facility

$172.00

Service Code	HCPCS 85245
Hospital Charge Code	38473005
Hospital Revenue Code	305
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

RISTOCETIN COFACTOR

Facility

$172.00

Service Code	HCPCS 85245
Hospital Charge Code	38473005
Hospital Revenue Code	305
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$86.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

RISTOCETIN COFACTOR

Facility

$172.00

Service Code	HCPCS 85245
Hospital Charge Code	38479464
Hospital Revenue Code	305
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

RISTOCETIN COFACTOR

Facility

$172.00

Service Code	HCPCS 85245
Hospital Charge Code	38479464
Hospital Revenue Code	305
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$62.40
Rate for Payer: Aetna Medicare Advantage	$74.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.81
Rate for Payer: Cigna Commercial	$86.00
Rate for Payer: Cigna Medicare Advantage	$22.94
Rate for Payer: Clover Medicare Advantage	$21.79
Rate for Payer: EmblemHealth Commercial	$68.82
Rate for Payer: Humana Medicare Advantage	$23.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$18.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.94
Rate for Payer: Wellcare Medicare Advantage	$22.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

RISTOCETIN COFACTOR***

Facility

$27.00

Hospital Charge Code	3032539
Hospital Revenue Code	309
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

RISTOCETIN COFACTOR***

Facility

$27.00

Hospital Charge Code	3032539
Hospital Revenue Code	309
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

RITALIN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60635879
Hospital Revenue Code	259
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

RITALIN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60635879
Hospital Revenue Code	259
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges