Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LACTULOSE 10 G REC UD

Facility

$8.65

Hospital Charge Code	60629948
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

LACTULOSE 10 G REC UD

Facility

$8.65

Hospital Charge Code	60629948
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.33
Rate for Payer: Aetna Commercial	$3.29
Rate for Payer: Aetna Medicare Advantage	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.21
Rate for Payer: Cigna Commercial	$4.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$1.73
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

LACTULOSE 15ML U/D

Facility

$7.00

Hospital Charge Code	60635186
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

LACTULOSE 15ML U/D

Facility

$7.00

Hospital Charge Code	60635186
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LACTULOSE SOL 30ML

Facility

$9.00

Hospital Charge Code	6014153
Hospital Revenue Code	251
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

LACTULOSE SOL 30ML

Facility

$9.00

Hospital Charge Code	6014153
Hospital Revenue Code	251
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

LAGB W HIATAL HERNIA REPAIR

Facility

$53,712.80

Hospital Charge Code	1600161
Hospital Revenue Code	360
Min. Negotiated Rate	$1,294.48
Max. Negotiated Rate	$26,856.40
Rate for Payer: Aetna Commercial	$20,410.86
Rate for Payer: Aetna Medicare Advantage	$16,113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,696.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,696.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,696.76
Rate for Payer: Cigna Commercial	$26,856.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,113.84
Rate for Payer: Qualcare PPO/HMO/WC	$8,056.92
Rate for Payer: UnitedHealthcare Community & State	$1,294.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1,423.39

LAGB W HIATAL HERNIA REPAIR

Facility

$53,712.80

Hospital Charge Code	1600161
Hospital Revenue Code	360
Min. Negotiated Rate	$8,056.92
Max. Negotiated Rate	$8,056.92
Rate for Payer: Qualcare PPO/HMO/WC	$8,056.92

LAG SCREW 10.5MMX115MM

Facility

$4,478.50

Service Code	HCPCS C1713
Hospital Charge Code	270705155
Hospital Revenue Code	278
Min. Negotiated Rate	$671.77
Max. Negotiated Rate	$1,083.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,083.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$985.27
Rate for Payer: Qualcare PPO/HMO/WC	$671.77

LAG SCREW 10.5MMX115MM

Facility

$4,478.50

Service Code	HCPCS C1713
Hospital Charge Code	270705155
Hospital Revenue Code	278
Min. Negotiated Rate	$107.93
Max. Negotiated Rate	$2,239.25
Rate for Payer: Aetna Commercial	$1,701.83
Rate for Payer: Aetna Medicare Advantage	$1,343.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,142.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,142.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,142.02
Rate for Payer: Cigna Commercial	$2,239.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,083.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$985.27
Rate for Payer: Qualcare PPO/HMO/WC	$671.77
Rate for Payer: UnitedHealthcare Community & State	$107.93
Rate for Payer: Wellpoint Medicaid Managed Care	$118.68

LAG SCREW 10.5X110MM

Facility

$4,478.50

Service Code	HCPCS C1713
Hospital Charge Code	270705861
Hospital Revenue Code	278
Min. Negotiated Rate	$107.93
Max. Negotiated Rate	$2,239.25
Rate for Payer: Aetna Commercial	$1,701.83
Rate for Payer: Aetna Medicare Advantage	$1,343.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,142.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,142.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,142.02
Rate for Payer: Cigna Commercial	$2,239.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,083.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$985.27
Rate for Payer: Qualcare PPO/HMO/WC	$671.77
Rate for Payer: UnitedHealthcare Community & State	$107.93
Rate for Payer: Wellpoint Medicaid Managed Care	$118.68

LAG SCREW 10.5X110MM

Facility

$4,478.50

Service Code	HCPCS C1713
Hospital Charge Code	270705861
Hospital Revenue Code	278
Min. Negotiated Rate	$671.77
Max. Negotiated Rate	$1,083.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,083.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$985.27
Rate for Payer: Qualcare PPO/HMO/WC	$671.77

LAG SCREW 10.5X90MM

Facility

$4,478.50

Service Code	HCPCS C1713
Hospital Charge Code	270705681
Hospital Revenue Code	278
Min. Negotiated Rate	$671.77
Max. Negotiated Rate	$1,083.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,083.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$985.27
Rate for Payer: Qualcare PPO/HMO/WC	$671.77

LAG SCREW 10.5X90MM

Facility

$4,478.50

Service Code	HCPCS C1713
Hospital Charge Code	270705681
Hospital Revenue Code	278
Min. Negotiated Rate	$107.93
Max. Negotiated Rate	$2,239.25
Rate for Payer: Aetna Commercial	$1,701.83
Rate for Payer: Aetna Medicare Advantage	$1,343.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,142.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,142.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,142.02
Rate for Payer: Cigna Commercial	$2,239.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,083.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$985.27
Rate for Payer: Qualcare PPO/HMO/WC	$671.77
Rate for Payer: UnitedHealthcare Community & State	$107.93
Rate for Payer: Wellpoint Medicaid Managed Care	$118.68

LAG SCREW 10.5X95MM

Facility

$3,685.00

Hospital Charge Code	270664026
Hospital Revenue Code	278
Min. Negotiated Rate	$552.75
Max. Negotiated Rate	$891.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$737.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$891.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$810.70
Rate for Payer: Qualcare PPO/HMO/WC	$552.75

LAG SCREW 10.5X95MM

Facility

$3,685.00

Hospital Charge Code	270664026
Hospital Revenue Code	278
Min. Negotiated Rate	$88.81
Max. Negotiated Rate	$1,842.50
Rate for Payer: Aetna Commercial	$1,400.30
Rate for Payer: Aetna Medicare Advantage	$1,105.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$737.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.67
Rate for Payer: Cigna Commercial	$1,842.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$891.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$810.70
Rate for Payer: Qualcare PPO/HMO/WC	$552.75
Rate for Payer: UnitedHealthcare Community & State	$88.81
Rate for Payer: Wellpoint Medicaid Managed Care	$97.65

LAG SCREW CANN 2x12MM

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270675635
Hospital Revenue Code	278
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$22.89
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

LAG SCREW CANN 2x12MM

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270675635
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

LAG SCREW CANN CANC 4x24MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270673714
Hospital Revenue Code	278
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

LAG SCREW CANN CANC 4x24MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270673714
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

LAG SCREW CANN CANC 4x32MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270673655
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

LAG SCREW CANN CANC 4x32MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270673655
Hospital Revenue Code	278
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

LAG SCREW CANN CANC 4x34MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270673656
Hospital Revenue Code	278
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

LAG SCREW CANN CANC 4x34MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270673656
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

LAG SCREW CANN CANC 4x36MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270673657
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

Know your out-of-pocket cost for care.

All Charges