Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LACTATE DEHYDROGENASE (LD/LDH)

Facility

$282.00

Service Code	HCPCS 83615
Hospital Charge Code	38472437
Hospital Revenue Code	301
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$141.00
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$19.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.80
Rate for Payer: Cigna Commercial	$141.00
Rate for Payer: Cigna Medicare Advantage	$6.04
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Medicare Advantage	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$7.47

LACTATE DEHYDROGENASE (LD/LDH)

Facility

$282.00

Service Code	HCPCS 83615
Hospital Charge Code	38472437
Hospital Revenue Code	301
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Qualcare PPO/HMO/WC	$42.30

LACTATED RINGERS 1000cc

Facility

$5.72

Hospital Charge Code	270650053
Hospital Revenue Code	258
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

LACTATED RINGERS 1000cc

Facility

$5.72

Hospital Charge Code	270650053
Hospital Revenue Code	258
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.86
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$1.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.46
Rate for Payer: Cigna Commercial	$2.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.72
Rate for Payer: Oxford Commercial	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.14
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

LACTATED RINGER'S 1000 ML SOL

Facility

$16.48

Service Code	NDC 338011704
Hospital Charge Code	60627910
Hospital Revenue Code	258
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$6.26
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$3.30
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

LACTATED RINGER'S 1000 ML SOL

Facility

$16.48

Service Code	NDC 338011704
Hospital Charge Code	60627910
Hospital Revenue Code	258
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

LACTATED RINGERS 500ml

Facility

$5.60

Hospital Charge Code	270649837
Hospital Revenue Code	258
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.80
Rate for Payer: Aetna Commercial	$2.13
Rate for Payer: Aetna Medicare Advantage	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.43
Rate for Payer: Cigna Commercial	$2.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.68
Rate for Payer: Oxford Commercial	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.12
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

LACTATED RINGERS 500ml

Facility

$5.60

Hospital Charge Code	270649837
Hospital Revenue Code	258
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

LACTIC ACID

Facility

$191.00

Service Code	HCPCS 83605
Hospital Charge Code	38472443
Hospital Revenue Code	301
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.47
Rate for Payer: Aetna Medicare Advantage	$37.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.76
Rate for Payer: Cigna Commercial	$95.50
Rate for Payer: Cigna Medicare Advantage	$11.57
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.65
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Medicare Advantage	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

LACTIC ACID

Facility

$191.00

Service Code	HCPCS 83605
Hospital Charge Code	38472443
Hospital Revenue Code	301
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$28.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

LACTIC ACID, ALL SOURCES

Facility

$636.05

Service Code	HCPCS 83605
Hospital Charge Code	3008380
Hospital Revenue Code	301
Min. Negotiated Rate	$95.41
Max. Negotiated Rate	$95.41
Rate for Payer: Qualcare PPO/HMO/WC	$95.41

LACTIC ACID, ALL SOURCES

Facility

$636.05

Service Code	HCPCS 83605
Hospital Charge Code	3008380
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$318.02
Rate for Payer: Aetna Commercial	$31.47
Rate for Payer: Aetna Medicare Advantage	$37.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.76
Rate for Payer: Cigna Commercial	$318.02
Rate for Payer: Cigna Medicare Advantage	$11.57
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.81
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.41
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Medicare Advantage	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$16.86

LACTIC ACID CSF

Facility

$113.65

Service Code	HCPCS 83605
Hospital Charge Code	3000708
Hospital Revenue Code	301
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.47
Rate for Payer: Aetna Medicare Advantage	$37.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.76
Rate for Payer: Cigna Commercial	$56.83
Rate for Payer: Cigna Medicare Advantage	$11.57
Rate for Payer: Clover Medicare Advantage	$10.99
Rate for Payer: EmblemHealth Commercial	$34.71
Rate for Payer: Humana Medicare Advantage	$11.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.57
Rate for Payer: Wellcare Medicare Advantage	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

LACTIC ACID CSF

Facility

$113.65

Service Code	HCPCS 83605
Hospital Charge Code	3000708
Hospital Revenue Code	301
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

LACTIC ACID DEHYDRGNSE LDH RPT

Facility

$419.12

Service Code	HCPCS 8361591
Hospital Charge Code	3001757R
Hospital Revenue Code	301
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$209.56
Rate for Payer: Aetna Commercial	$159.27
Rate for Payer: Aetna Medicare Advantage	$125.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.88
Rate for Payer: Cigna Commercial	$209.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.87
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.10
Rate for Payer: Wellpoint Medicaid Managed Care	$11.11

LACTIC ACID DEHYDRGNSE LDH RPT

Facility

$419.12

Service Code	HCPCS 8361591
Hospital Charge Code	3001757R
Hospital Revenue Code	301
Min. Negotiated Rate	$62.87
Max. Negotiated Rate	$62.87
Rate for Payer: Qualcare PPO/HMO/WC	$62.87

LACTIC ACID DEHYDROGENASE LDH

Facility

$717.44

Service Code	HCPCS 83615
Hospital Charge Code	3001757
Hospital Revenue Code	301
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$358.72
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$19.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.80
Rate for Payer: Cigna Commercial	$358.72
Rate for Payer: Cigna Medicare Advantage	$6.04
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.23
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.62
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Medicare Advantage	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$19.01

LACTIC ACID DEHYDROGENASE LDH

Facility

$717.44

Service Code	HCPCS 83615
Hospital Charge Code	3001757
Hospital Revenue Code	301
Min. Negotiated Rate	$107.62
Max. Negotiated Rate	$107.62
Rate for Payer: Qualcare PPO/HMO/WC	$107.62

LACTIC ACID DEHY - LDH PANEL**

Facility

$6.00

Service Code	HCPCS 83615
Hospital Charge Code	3001757P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

LACTIC ACID DEHY - LDH PANEL**

Facility

$6.00

Service Code	HCPCS 83615
Hospital Charge Code	3001757P
Hospital Revenue Code	301
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$19.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.80
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: Cigna Medicare Advantage	$6.04
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Medicare Advantage	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

LACTOBACILLUS ACID CAP

Facility

$3.20

Hospital Charge Code	6027122
Hospital Revenue Code	251
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

LACTOBACILLUS ACID CAP

Facility

$3.20

Hospital Charge Code	6027122
Hospital Revenue Code	251
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

LACTOBACILLUS ACIDPH CAP 500MG

Facility

$4.00

Service Code	NDC 904660861
Hospital Charge Code	60628158
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LACTOBACILLUS ACIDPH CAP 500MG

Facility

$4.00

Service Code	NDC 904660861
Hospital Charge Code	60628158
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LACTOFERRIN QNT STOOL

Facility

$390.00

Service Code	HCPCS 83631
Hospital Charge Code	38479742
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges