Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RIVAROXABAN 15MG TAB

Facility

$53.05

Hospital Charge Code	60635910
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.52
Rate for Payer: Aetna Commercial	$20.16
Rate for Payer: Aetna Medicare Advantage	$15.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.53
Rate for Payer: Cigna Commercial	$26.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.91
Rate for Payer: Oxford Commercial	$10.61
Rate for Payer: Qualcare PPO/HMO/WC	$7.96
Rate for Payer: UnitedHealthcare Commercial	$10.61
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

RIVAROXABAN 2.5MG TAB

Facility

$35.58

Service Code	NDC 50458057710
Hospital Charge Code	606390289
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.79
Rate for Payer: Aetna Commercial	$13.52
Rate for Payer: Aetna Medicare Advantage	$10.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.07
Rate for Payer: Cigna Commercial	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.67
Rate for Payer: Oxford Commercial	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$7.12
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

RIVAROXABAN 2.5MG TAB

Facility

$35.58

Service Code	NDC 50458057710
Hospital Charge Code	606390289
Hospital Revenue Code	250
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

RIVASTIGMINE 1.5 MG CAP

Facility

$28.41

Service Code	NDC 781261460
Hospital Charge Code	60629076
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.21
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: Aetna Medicare Advantage	$8.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.24
Rate for Payer: Cigna Commercial	$14.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.52
Rate for Payer: Oxford Commercial	$5.68
Rate for Payer: Qualcare PPO/HMO/WC	$4.26
Rate for Payer: UnitedHealthcare Commercial	$5.68
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

RIVASTIGMINE 1.5 MG CAP

Facility

$28.41

Service Code	NDC 781261460
Hospital Charge Code	60629076
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$4.26
Rate for Payer: Qualcare PPO/HMO/WC	$4.26

RIVASTIGMINE 3 MG CAP

Facility

$28.41

Service Code	NDC 781261560
Hospital Charge Code	60629182
Hospital Revenue Code	250
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$4.26
Rate for Payer: Qualcare PPO/HMO/WC	$4.26

RIVASTIGMINE 3 MG CAP

Facility

$28.41

Service Code	NDC 781261560
Hospital Charge Code	60629182
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.21
Rate for Payer: Aetna Commercial	$10.80
Rate for Payer: Aetna Medicare Advantage	$8.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.24
Rate for Payer: Cigna Commercial	$14.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.52
Rate for Payer: Oxford Commercial	$5.68
Rate for Payer: Qualcare PPO/HMO/WC	$4.26
Rate for Payer: UnitedHealthcare Commercial	$5.68
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

RIVASTIGMINE 4.6 MG PATCH

Facility

$100.70

Service Code	NDC 78050115
Hospital Charge Code	60630006
Hospital Revenue Code	250
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$15.11
Rate for Payer: Qualcare PPO/HMO/WC	$15.11

RIVASTIGMINE 4.6 MG PATCH

Facility

$100.70

Service Code	NDC 78050115
Hospital Charge Code	60630006
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.35
Rate for Payer: Aetna Commercial	$38.27
Rate for Payer: Aetna Medicare Advantage	$30.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.68
Rate for Payer: Cigna Commercial	$50.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.21
Rate for Payer: Oxford Commercial	$20.14
Rate for Payer: Qualcare PPO/HMO/WC	$15.11
Rate for Payer: UnitedHealthcare Commercial	$20.14
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

RIVASTIGMINE 9.5 MG PATCH

Facility

$100.70

Service Code	NDC 78050215
Hospital Charge Code	60630007
Hospital Revenue Code	250
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$15.11
Rate for Payer: Qualcare PPO/HMO/WC	$15.11

RIVASTIGMINE 9.5 MG PATCH

Facility

$100.70

Service Code	NDC 78050215
Hospital Charge Code	60630007
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.35
Rate for Payer: Aetna Commercial	$38.27
Rate for Payer: Aetna Medicare Advantage	$30.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.68
Rate for Payer: Cigna Commercial	$50.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.21
Rate for Payer: Oxford Commercial	$20.14
Rate for Payer: Qualcare PPO/HMO/WC	$15.11
Rate for Payer: UnitedHealthcare Commercial	$20.14
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

RIVET ATK POP LACTOSORB 905800

Facility

$1,740.00

Hospital Charge Code	270617180
Hospital Revenue Code	272
Min. Negotiated Rate	$261.00
Max. Negotiated Rate	$261.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.00

RIVET ATK POP LACTOSORB 905800

Facility

$1,740.00

Hospital Charge Code	270617180
Hospital Revenue Code	272
Min. Negotiated Rate	$41.93
Max. Negotiated Rate	$870.00
Rate for Payer: Aetna Commercial	$661.20
Rate for Payer: Aetna Medicare Advantage	$522.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$443.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$443.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$443.70
Rate for Payer: Cigna Commercial	$870.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$522.00
Rate for Payer: Oxford Commercial	$348.00
Rate for Payer: Qualcare PPO/HMO/WC	$261.00
Rate for Payer: UnitedHealthcare Commercial	$348.00
Rate for Payer: UnitedHealthcare Community & State	$41.93
Rate for Payer: Wellpoint Medicaid Managed Care	$46.11

RL 3000ML***********

Facility

$23.00

Hospital Charge Code	1608249
Hospital Revenue Code	272
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

RL 3000ML***********

Facility

$23.00

Hospital Charge Code	1608249
Hospital Revenue Code	272
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

R&L HRT ART/GRAFT ANGIO

Facility

$16,190.00

Service Code	HCPCS 93461
Hospital Charge Code	74110070
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

R&L HRT ART/GRAFT ANGIO

Facility

$16,190.00

Service Code	HCPCS 93461
Hospital Charge Code	5100669
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

R&L HRT ART/GRAFT ANGIO

Facility

$16,190.00

Service Code	HCPCS 93461
Hospital Charge Code	5100669
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

R&L HRT ART/GRAFT ANGIO

Facility

$16,190.00

Service Code	HCPCS 93461
Hospital Charge Code	74110070
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

R&L HRT ART/VENTRICLE ANGIO

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	74110069
Hospital Revenue Code	481
Min. Negotiated Rate	$620.27
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	$7,721.15
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	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$620.27
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	$682.03

R&L HRT ART/VENTRICLE ANGIO

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	74110069
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

R&L HRT ART W OR W/O LV

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	5100668
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

R&L HRT ART W OR W/O LV

Facility

$25,737.16

Service Code	HCPCS 93460
Hospital Charge Code	5100668
Hospital Revenue Code	481
Min. Negotiated Rate	$620.27
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	$7,721.15
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	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$620.27
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	$682.03

R&L HRT CATH CHD ABNL NT CNJ

Facility

$25,737.16

Service Code	HCPCS 93597
Hospital Charge Code	411093597
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

R&L HRT CATH CHD ABNL NT CNJ

Facility

$25,737.16

Service Code	HCPCS 93597
Hospital Charge Code	411093597
Hospital Revenue Code	481
Min. Negotiated Rate	$620.27
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	$7,721.15
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	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$620.27
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	$682.03

Know your out-of-pocket cost for care.

All Charges