Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LAMIVUDINE 150 MG TAB

Facility

$54.74

Service Code	NDC 68084057821
Hospital Charge Code	6016539
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.37
Rate for Payer: Aetna Commercial	$20.80
Rate for Payer: Aetna Medicare Advantage	$16.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.96
Rate for Payer: Cigna Commercial	$27.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.42
Rate for Payer: Oxford Commercial	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$8.21
Rate for Payer: UnitedHealthcare Commercial	$10.95
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

LAMIVUDINE ELIX 10MG/ML 240ML

Facility

$34.10

Service Code	NDC 49702020548
Hospital Charge Code	60628772
Hospital Revenue Code	250
Min. Negotiated Rate	$5.12
Max. Negotiated Rate	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.12

LAMIVUDINE ELIX 10MG/ML 240ML

Facility

$34.10

Service Code	NDC 49702020548
Hospital Charge Code	60628772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.05
Rate for Payer: Aetna Commercial	$12.96
Rate for Payer: Aetna Medicare Advantage	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.70
Rate for Payer: Cigna Commercial	$17.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.23
Rate for Payer: Oxford Commercial	$6.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.12
Rate for Payer: UnitedHealthcare Commercial	$6.82
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

LAMIVUDINE/ZIDOVUDINE 1 TAB

Facility

$104.05

Service Code	NDC 378518091
Hospital Charge Code	60629151
Hospital Revenue Code	250
Min. Negotiated Rate	$15.61
Max. Negotiated Rate	$15.61
Rate for Payer: Qualcare PPO/HMO/WC	$15.61

LAMIVUDINE/ZIDOVUDINE 1 TAB

Facility

$104.05

Service Code	NDC 378518091
Hospital Charge Code	60629151
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.02
Rate for Payer: Aetna Commercial	$39.54
Rate for Payer: Aetna Medicare Advantage	$31.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.53
Rate for Payer: Cigna Commercial	$52.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.21
Rate for Payer: Oxford Commercial	$20.81
Rate for Payer: Qualcare PPO/HMO/WC	$15.61
Rate for Payer: UnitedHealthcare Commercial	$20.81
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

LAMOTRIGINE

Facility

$390.00

Service Code	HCPCS 80175
Hospital Charge Code	39900318
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LAMOTRIGINE

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472309
Hospital Revenue Code	301
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

LAMOTRIGINE

Facility

$390.00

Service Code	HCPCS 80175
Hospital Charge Code	39900318
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.83
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LAMOTRIGINE

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3007565
Hospital Revenue Code	301
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.96
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

LAMOTRIGINE

Facility

$181.65

Service Code	HCPCS 82542
Hospital Charge Code	3007565
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

LAMOTRIGINE

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472309
Hospital Revenue Code	301
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$124.00
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	$37.50
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	$22.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
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	$1.99

LAMOTRIGINE 100 MG TAB

Facility

$26.80

Service Code	NDC 173064255
Hospital Charge Code	60628826
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

LAMOTRIGINE 100 MG TAB

Facility

$26.80

Service Code	NDC 173064255
Hospital Charge Code	60628826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.04
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

LAMOTRIGINE 25 MG TAB

Facility

$26.80

Service Code	NDC 173063302
Hospital Charge Code	60628827
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.04
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

LAMOTRIGINE 25 MG TAB

Facility

$26.80

Service Code	NDC 173063302
Hospital Charge Code	60628827
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

LAMP EXAM GOOSE NECK

Facility

$1,538.25

Hospital Charge Code	270658987
Hospital Revenue Code	272
Min. Negotiated Rate	$230.74
Max. Negotiated Rate	$230.74
Rate for Payer: Qualcare PPO/HMO/WC	$230.74

LAMP EXAM GOOSE NECK

Facility

$1,538.25

Hospital Charge Code	270658987
Hospital Revenue Code	272
Min. Negotiated Rate	$37.07
Max. Negotiated Rate	$769.12
Rate for Payer: Aetna Commercial	$584.53
Rate for Payer: Aetna Medicare Advantage	$461.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.25
Rate for Payer: Cigna Commercial	$769.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.48
Rate for Payer: Oxford Commercial	$307.65
Rate for Payer: Qualcare PPO/HMO/WC	$230.74
Rate for Payer: UnitedHealthcare Commercial	$307.65
Rate for Payer: UnitedHealthcare Community & State	$37.07
Rate for Payer: Wellpoint Medicaid Managed Care	$40.76

LAMPRENE/50MG/CAP

Facility

$3.00

Hospital Charge Code	60633259
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LAMPRENE/50MG/CAP

Facility

$3.00

Hospital Charge Code	60633259
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

LANCET AUTOLET FING ST

Facility

$4.00

Hospital Charge Code	270301205
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LANCET AUTOLET FING ST

Facility

$4.00

Hospital Charge Code	270301205
Hospital Revenue Code	270
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

LANG COMP CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9159GN
Hospital Charge Code	84201020
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

LANG COMP CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9159GN
Hospital Charge Code	84201162
Hospital Revenue Code	449
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

LANG COMP CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9159GN
Hospital Charge Code	84201162
Hospital Revenue Code	449
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

LANG COMP CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G9159GN
Hospital Charge Code	84201020
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges