Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LAMICTAL-LAMOTRIGINE SERUM****

Facility

$297.00

Service Code	HCPCS 80299
Hospital Charge Code	3009989
Hospital Revenue Code	301
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$148.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.87

LAMICTAL-LAMOTRIGINE SERUM****

Facility

$297.00

Service Code	HCPCS 80299
Hospital Charge Code	3009989
Hospital Revenue Code	301
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$44.55
Rate for Payer: Qualcare PPO/HMO/WC	$44.55

LAMICTRAL 100MG

Facility

$13.00

Hospital Charge Code	60635086
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

LAMICTRAL 100MG

Facility

$13.00

Hospital Charge Code	60635086
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

LAMICTRAL 150MG

Facility

$40.07

Service Code	NDC 51079086520
Hospital Charge Code	60635087
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$6.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01

LAMICTRAL 150MG

Facility

$40.07

Service Code	NDC 51079086520
Hospital Charge Code	60635087
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$20.04
Rate for Payer: Aetna Commercial	$15.23
Rate for Payer: Aetna Medicare Advantage	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.22
Rate for Payer: Cigna Commercial	$20.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.02
Rate for Payer: Oxford Commercial	$8.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01
Rate for Payer: UnitedHealthcare Commercial	$8.01
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

LAMICTRAL 200MG

Facility

$43.62

Service Code	NDC 51079086620
Hospital Charge Code	60635088
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.81
Rate for Payer: Aetna Commercial	$16.58
Rate for Payer: Aetna Medicare Advantage	$13.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.12
Rate for Payer: Cigna Commercial	$21.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.09
Rate for Payer: Oxford Commercial	$8.72
Rate for Payer: Qualcare PPO/HMO/WC	$6.54
Rate for Payer: UnitedHealthcare Commercial	$8.72
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

LAMICTRAL 200MG

Facility

$43.62

Service Code	NDC 51079086620
Hospital Charge Code	60635088
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$6.54
Rate for Payer: Qualcare PPO/HMO/WC	$6.54

LAMICTRAL 25MG

Facility

$15.00

Hospital Charge Code	60635089
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

LAMICTRAL 25MG

Facility

$15.00

Hospital Charge Code	60635089
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

LAMINA IQ

Facility

$455.40

Hospital Charge Code	270653896
Hospital Revenue Code	272
Min. Negotiated Rate	$68.31
Max. Negotiated Rate	$68.31
Rate for Payer: Qualcare PPO/HMO/WC	$68.31

LAMINA IQ

Facility

$455.40

Hospital Charge Code	270653896
Hospital Revenue Code	272
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$227.70
Rate for Payer: Aetna Commercial	$173.05
Rate for Payer: Aetna Medicare Advantage	$136.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.13
Rate for Payer: Cigna Commercial	$227.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.62
Rate for Payer: Oxford Commercial	$91.08
Rate for Payer: Qualcare PPO/HMO/WC	$68.31
Rate for Payer: UnitedHealthcare Commercial	$91.08
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

LAMINCT IMPL NS ELCTRDS,EPIDRL

Facility

$88,183.60

Service Code	HCPCS 63655
Hospital Charge Code	1600000858
Hospital Revenue Code	360
Min. Negotiated Rate	$13,227.54
Max. Negotiated Rate	$13,227.54
Rate for Payer: Qualcare PPO/HMO/WC	$13,227.54

LAMINCT IMPL NS ELCTRDS,EPIDRL

Facility

$88,183.60

Service Code	HCPCS 63655
Hospital Charge Code	1600000858
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$83,195.82
Rate for Payer: Aetna Commercial	$62,690.15
Rate for Payer: Aetna Medicare Advantage	$74,675.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83,195.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83,195.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,047.85
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	$83,195.82
Rate for Payer: Cigna Commercial	$46,199.32
Rate for Payer: Cigna Medicare Advantage	$23,047.85
Rate for Payer: Clover Medicare Advantage	$21,895.46
Rate for Payer: EmblemHealth Commercial	$69,143.55
Rate for Payer: Humana Medicare Advantage	$23,739.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,047.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,455.08
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$13,227.54
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$2,125.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,047.85
Rate for Payer: Wellcare Medicare Advantage	$23,047.85
Rate for Payer: Wellpoint Medicaid Managed Care	$2,336.87

LAMINOTOMY ADDL CERVICAL

Facility

$7,312.94

Service Code	HCPCS 63043
Hospital Charge Code	1600000556
Hospital Revenue Code	360
Min. Negotiated Rate	$176.24
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,778.92
Rate for Payer: Aetna Medicare Advantage	$2,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,864.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,864.80
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	$1,864.80
Rate for Payer: Cigna Commercial	$3,656.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,193.88
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,096.94
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$176.24
Rate for Payer: Wellpoint Medicaid Managed Care	$193.79

LAMINOTOMY ADDL CERVICAL

Facility

$7,312.94

Service Code	HCPCS 63043
Hospital Charge Code	1600000556
Hospital Revenue Code	360
Min. Negotiated Rate	$1,096.94
Max. Negotiated Rate	$1,096.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,096.94

LAMINOTOMY ADDL LUMBAR

Facility

$63,107.55

Service Code	HCPCS 63044
Hospital Charge Code	1600000303
Hospital Revenue Code	360
Min. Negotiated Rate	$9,466.13
Max. Negotiated Rate	$9,466.13
Rate for Payer: Qualcare PPO/HMO/WC	$9,466.13

LAMINOTOMY ADDL LUMBAR

Facility

$63,107.55

Service Code	HCPCS 63044
Hospital Charge Code	1600000303
Hospital Revenue Code	360
Min. Negotiated Rate	$1,520.89
Max. Negotiated Rate	$31,553.78
Rate for Payer: Aetna Commercial	$23,980.87
Rate for Payer: Aetna Medicare Advantage	$18,932.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,092.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,092.43
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	$16,092.43
Rate for Payer: Cigna Commercial	$31,553.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,932.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,466.13
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,520.89
Rate for Payer: Wellpoint Medicaid Managed Care	$1,672.35

LAMINOTOMY SINGLE CERVICAL

Facility

$47,548.90

Service Code	HCPCS 63040
Hospital Charge Code	1600000507
Hospital Revenue Code	360
Min. Negotiated Rate	$1,145.93
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,264.67
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,145.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,260.05

LAMINOTOMY SINGLE CERVICAL

Facility

$47,548.90

Service Code	HCPCS 63040
Hospital Charge Code	1600000507
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

LAMINOTOMY SINGLE LUMBAR-LT

Facility

$63,107.55

Service Code	HCPCS 63042
Hospital Charge Code	16001020
Hospital Revenue Code	360
Min. Negotiated Rate	$1,520.89
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,932.26
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,466.13
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,520.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,672.35

LAMINOTOMY SINGLE LUMBAR-LT

Facility

$63,107.55

Service Code	HCPCS 63042
Hospital Charge Code	16001020
Hospital Revenue Code	360
Min. Negotiated Rate	$9,466.13
Max. Negotiated Rate	$9,466.13
Rate for Payer: Qualcare PPO/HMO/WC	$9,466.13

LAMITRODE TRIPOLE 16 LEAD 60 C

Facility

$29,500.00

Hospital Charge Code	270659614
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.00
Max. Negotiated Rate	$7,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,490.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00

LAMITRODE TRIPOLE 16 LEAD 60 C

Facility

$29,500.00

Hospital Charge Code	270659614
Hospital Revenue Code	278
Min. Negotiated Rate	$710.95
Max. Negotiated Rate	$14,750.00
Rate for Payer: Aetna Commercial	$11,210.00
Rate for Payer: Aetna Medicare Advantage	$8,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,522.50
Rate for Payer: Cigna Commercial	$14,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,490.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00
Rate for Payer: UnitedHealthcare Community & State	$710.95
Rate for Payer: Wellpoint Medicaid Managed Care	$781.75

LAMIVUDINE 150 MG TAB

Facility

$54.74

Service Code	NDC 68084057821
Hospital Charge Code	6016539
Hospital Revenue Code	250
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$8.21
Rate for Payer: Qualcare PPO/HMO/WC	$8.21

Know your out-of-pocket cost for care.

All Charges