Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROCURONIUM BROMIDE10MG/ML 10ML

Facility

$252.99

Service Code	NDC 781322070
Hospital Charge Code	606390129
Hospital Revenue Code	250
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.51
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.90
Rate for Payer: Oxford Commercial	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$50.60
Rate for Payer: UnitedHealthcare Community & State	$6.10
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

ROCURONIUM BROMIDE10MG/ML 10ML

Facility

$252.99

Service Code	NDC 781322070
Hospital Charge Code	606390129
Hospital Revenue Code	250
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

ROCURONIUM BROMIDE VL 10MG

Facility

$117.80

Hospital Charge Code	6013197
Hospital Revenue Code	250
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$58.90
Rate for Payer: Aetna Commercial	$44.76
Rate for Payer: Aetna Medicare Advantage	$35.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.04
Rate for Payer: Cigna Commercial	$58.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.34
Rate for Payer: Oxford Commercial	$23.56
Rate for Payer: Qualcare PPO/HMO/WC	$17.67
Rate for Payer: UnitedHealthcare Commercial	$23.56
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

ROCURONIUM BROMIDE VL 10MG

Facility

$117.80

Hospital Charge Code	6013197
Hospital Revenue Code	250
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$17.67
Rate for Payer: Qualcare PPO/HMO/WC	$17.67

ROD

Facility

$1,325.00

Hospital Charge Code	270703489
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

ROD

Facility

$1,325.00

Hospital Charge Code	270703489
Hospital Revenue Code	278
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

ROD

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681172
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

ROD

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681172
Hospital Revenue Code	278
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

ROD 100MM

Facility

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270704447
Hospital Revenue Code	278
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

ROD 100MM

Facility

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270704447
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

ROD 120 MM

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	270684456
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

ROD 120 MM

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	270684456
Hospital Revenue Code	278
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

ROD 120MM

Facility

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270704434
Hospital Revenue Code	278
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

ROD 120MM

Facility

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270704434
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

ROD 12x41cm RT

Facility

$4,797.65

Hospital Charge Code	270626751
Hospital Revenue Code	278
Min. Negotiated Rate	$719.65
Max. Negotiated Rate	$1,161.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,055.48
Rate for Payer: Qualcare PPO/HMO/WC	$719.65

ROD 12x41cm RT

Facility

$4,797.65

Hospital Charge Code	270626751
Hospital Revenue Code	278
Min. Negotiated Rate	$115.62
Max. Negotiated Rate	$2,398.82
Rate for Payer: Aetna Commercial	$1,823.11
Rate for Payer: Aetna Medicare Advantage	$1,439.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,223.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,223.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,223.40
Rate for Payer: Cigna Commercial	$2,398.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,055.48
Rate for Payer: Qualcare PPO/HMO/WC	$719.65
Rate for Payer: UnitedHealthcare Community & State	$115.62
Rate for Payer: Wellpoint Medicaid Managed Care	$127.14

ROD 150MM

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	270684455
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

ROD 150MM

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	270684455
Hospital Revenue Code	278
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

ROD 30MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688862
Hospital Revenue Code	278
Min. Negotiated Rate	$133.68
Max. Negotiated Rate	$215.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.06
Rate for Payer: Qualcare PPO/HMO/WC	$133.68

ROD 30MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688862
Hospital Revenue Code	278
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$445.60
Rate for Payer: Aetna Commercial	$338.66
Rate for Payer: Aetna Medicare Advantage	$267.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.26
Rate for Payer: Cigna Commercial	$445.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.06
Rate for Payer: Qualcare PPO/HMO/WC	$133.68
Rate for Payer: UnitedHealthcare Community & State	$21.48
Rate for Payer: Wellpoint Medicaid Managed Care	$23.62

ROD 35 MM

Facility

$750.00

Hospital Charge Code	270703039
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

ROD 35 MM

Facility

$750.00

Hospital Charge Code	270703039
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

ROD 35MM

Facility

$1,075.00

Service Code	HCPCS C1713
Hospital Charge Code	270689970
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

ROD 35MM

Facility

$1,075.00

Service Code	HCPCS C1713
Hospital Charge Code	270689970
Hospital Revenue Code	278
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

ROD 35MM #11-3035

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705471
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

Know your out-of-pocket cost for care.

All Charges