Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RITODRINE HCL INJ 10MG/ML 5ML

Facility

$665.00

Hospital Charge Code	6004816
Hospital Revenue Code	250
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$99.75
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

RITODRINE HCL INJ 10MG/ML 5ML

Facility

$665.00

Hospital Charge Code	6004816
Hospital Revenue Code	250
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.50
Rate for Payer: Oxford Commercial	$133.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Commercial	$133.00
Rate for Payer: UnitedHealthcare Community & State	$16.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.62

RITODRINE INJ 10MG/1ML 5ML

Facility

$790.40

Hospital Charge Code	60627468
Hospital Revenue Code	250
Min. Negotiated Rate	$118.56
Max. Negotiated Rate	$118.56
Rate for Payer: Qualcare PPO/HMO/WC	$118.56

RITODRINE INJ 10MG/1ML 5ML

Facility

$790.40

Hospital Charge Code	60627468
Hospital Revenue Code	250
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$395.20
Rate for Payer: Aetna Commercial	$300.35
Rate for Payer: Aetna Medicare Advantage	$237.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.55
Rate for Payer: Cigna Commercial	$395.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.12
Rate for Payer: Oxford Commercial	$158.08
Rate for Payer: Qualcare PPO/HMO/WC	$118.56
Rate for Payer: UnitedHealthcare Commercial	$158.08
Rate for Payer: UnitedHealthcare Community & State	$19.05
Rate for Payer: Wellpoint Medicaid Managed Care	$20.95

RITODRINE INJ/10MG/ML

Facility

$222.00

Hospital Charge Code	60634270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$111.00
Rate for Payer: Aetna Commercial	$84.36
Rate for Payer: Aetna Medicare Advantage	$66.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.61
Rate for Payer: Cigna Commercial	$111.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.60
Rate for Payer: Oxford Commercial	$44.40
Rate for Payer: Qualcare PPO/HMO/WC	$33.30
Rate for Payer: UnitedHealthcare Commercial	$44.40
Rate for Payer: UnitedHealthcare Community & State	$5.35
Rate for Payer: Wellpoint Medicaid Managed Care	$5.88

RITODRINE INJ/10MG/ML

Facility

$222.00

Hospital Charge Code	60634270
Hospital Revenue Code	250
Min. Negotiated Rate	$33.30
Max. Negotiated Rate	$33.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.30

RITONAVIR 100 MG TAB

Facility

$68.94

Service Code	NDC 74234030
Hospital Charge Code	606350993
Hospital Revenue Code	250
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$10.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.34

RITONAVIR 100 MG TAB

Facility

$68.94

Service Code	NDC 74234030
Hospital Charge Code	606350993
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.47
Rate for Payer: Aetna Commercial	$26.20
Rate for Payer: Aetna Medicare Advantage	$20.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.58
Rate for Payer: Cigna Commercial	$34.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.68
Rate for Payer: Oxford Commercial	$13.79
Rate for Payer: Qualcare PPO/HMO/WC	$10.34
Rate for Payer: UnitedHealthcare Commercial	$13.79
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

RITUXAN 500MG/50ML

Facility

$8,195.00

Hospital Charge Code	60635231
Hospital Revenue Code	636
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$4,097.50
Rate for Payer: Aetna Commercial	$3,114.10
Rate for Payer: Aetna Medicare Advantage	$2,458.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,089.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,089.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,089.72
Rate for Payer: Cigna Commercial	$4,097.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$217.17

RITUXAN 500MG/50ML

Facility

$8,195.00

Hospital Charge Code	60635231
Hospital Revenue Code	636
Min. Negotiated Rate	$1,229.25
Max. Negotiated Rate	$1,983.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25

RITUXAN SENSITIVITY (CD20

Facility

$184.00

Service Code	HCPCS 86356
Hospital Charge Code	39900220
Hospital Revenue Code	302
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$72.84
Rate for Payer: Aetna Medicare Advantage	$86.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.67
Rate for Payer: Cigna Commercial	$92.00
Rate for Payer: Cigna Medicare Advantage	$26.78
Rate for Payer: Clover Medicare Advantage	$25.44
Rate for Payer: EmblemHealth Commercial	$80.34
Rate for Payer: Humana Medicare Advantage	$27.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$21.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.78
Rate for Payer: Wellcare Medicare Advantage	$26.78
Rate for Payer: Wellpoint Medicaid Managed Care	$4.88

RITUXAN SENSITIVITY (CD20

Facility

$184.00

Service Code	HCPCS 86356
Hospital Charge Code	39900220
Hospital Revenue Code	302
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$27.60
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

RITUXIMAB 100MG/10 ML INJ.

Facility

$5,186.27

Service Code	HCPCS J9312
Hospital Charge Code	60628699
Hospital Revenue Code	636
Min. Negotiated Rate	$777.94
Max. Negotiated Rate	$1,255.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.08
Rate for Payer: Qualcare PPO/HMO/WC	$777.94

RITUXIMAB 100MG/10 ML INJ.

Facility

$5,186.27

Service Code	HCPCS J9312
Hospital Charge Code	60628699
Hospital Revenue Code	636
Min. Negotiated Rate	$70.45
Max. Negotiated Rate	$1,255.08
Rate for Payer: Aetna Commercial	$201.72
Rate for Payer: Aetna Medicare Advantage	$240.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$74.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.70
Rate for Payer: Cigna Medicare Advantage	$74.16
Rate for Payer: Clover Medicare Advantage	$70.45
Rate for Payer: EmblemHealth Commercial	$222.48
Rate for Payer: Humana Medicare Advantage	$76.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$74.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.08
Rate for Payer: Qualcare PPO/HMO/WC	$777.94
Rate for Payer: UnitedHealthcare Community & State	$124.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.16
Rate for Payer: Wellcare Medicare Advantage	$74.16
Rate for Payer: Wellpoint Medicaid Managed Care	$137.44

RITUXIMAB 500 MG/50 ML INJ.

Facility

$320.50

Hospital Charge Code	60628700
Hospital Revenue Code	636
Min. Negotiated Rate	$48.08
Max. Negotiated Rate	$77.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.56
Rate for Payer: Qualcare PPO/HMO/WC	$48.08

RITUXIMAB 500 MG/50 ML INJ.

Facility

$320.50

Hospital Charge Code	60628700
Hospital Revenue Code	636
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$160.25
Rate for Payer: Aetna Commercial	$121.79
Rate for Payer: Aetna Medicare Advantage	$96.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.73
Rate for Payer: Cigna Commercial	$160.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.56
Rate for Payer: Qualcare PPO/HMO/WC	$48.08
Rate for Payer: UnitedHealthcare Community & State	$7.72
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

RITUXIMAB-ABBS 100MG/10ML

Facility

$679.85

Service Code	HCPCS Q5115
Hospital Charge Code	606390348
Hospital Revenue Code	636
Min. Negotiated Rate	$101.98
Max. Negotiated Rate	$164.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.52
Rate for Payer: Qualcare PPO/HMO/WC	$101.98

RITUXIMAB-ABBS 100MG/10ML

Facility

$679.85

Service Code	HCPCS Q5115
Hospital Charge Code	606390348
Hospital Revenue Code	636
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$164.52
Rate for Payer: Aetna Commercial	$85.08
Rate for Payer: Aetna Medicare Advantage	$101.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.91
Rate for Payer: Cigna Medicare Advantage	$31.28
Rate for Payer: Clover Medicare Advantage	$29.72
Rate for Payer: EmblemHealth Commercial	$93.84
Rate for Payer: Humana Medicare Advantage	$32.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.52
Rate for Payer: Qualcare PPO/HMO/WC	$101.98
Rate for Payer: UnitedHealthcare Community & State	$16.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.28
Rate for Payer: Wellcare Medicare Advantage	$31.28
Rate for Payer: Wellpoint Medicaid Managed Care	$18.02

RITUXIMAB PVVR 10MG/ML

Facility

$3,015.00

Service Code	HCPCS Q5119
Hospital Charge Code	6064943021
Hospital Revenue Code	636
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$729.63
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$44.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.42
Rate for Payer: Cigna Medicare Advantage	$13.69
Rate for Payer: Clover Medicare Advantage	$13.01
Rate for Payer: EmblemHealth Commercial	$41.07
Rate for Payer: Humana Medicare Advantage	$14.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$72.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.69
Rate for Payer: Wellcare Medicare Advantage	$13.69
Rate for Payer: Wellpoint Medicaid Managed Care	$79.90

RITUXIMAB PVVR 10MG/ML

Facility

$3,015.00

Service Code	HCPCS Q5119
Hospital Charge Code	6064943021
Hospital Revenue Code	636
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

RIV4 VACC RECOMBINANT DNA IM

Facility

$222.65

Service Code	HCPCS 90682
Hospital Charge Code	412390682
Hospital Revenue Code	636
Min. Negotiated Rate	$33.40
Max. Negotiated Rate	$53.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Qualcare PPO/HMO/WC	$33.40

RIV4 VACC RECOMBINANT DNA IM

Facility

$222.65

Service Code	HCPCS 90682
Hospital Charge Code	412390682
Hospital Revenue Code	636
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$111.33
Rate for Payer: Aetna Commercial	$84.61
Rate for Payer: Aetna Medicare Advantage	$66.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.78
Rate for Payer: Cigna Commercial	$111.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.88
Rate for Payer: Qualcare PPO/HMO/WC	$33.40
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.90

RIVAL NUCLEAR PROTEIN***

Facility

$259.00

Service Code	HCPCS 86235
Hospital Charge Code	3032406
Hospital Revenue Code	309
Min. Negotiated Rate	$38.85
Max. Negotiated Rate	$38.85
Rate for Payer: Qualcare PPO/HMO/WC	$38.85

RIVAL NUCLEAR PROTEIN***

Facility

$259.00

Service Code	HCPCS 86235
Hospital Charge Code	3032406
Hospital Revenue Code	309
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$129.50
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	$129.50
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	$77.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.85
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	$6.86

RIVAROXABAN 15MG TAB

Facility

$53.05

Hospital Charge Code	60635910
Hospital Revenue Code	250
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$7.96
Rate for Payer: Qualcare PPO/HMO/WC	$7.96

Know your out-of-pocket cost for care.

All Charges