Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LANSOPRAZOLE CAP EC 15MG

Facility

$21.80

Hospital Charge Code	60628159
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

LANSOPRAZOLE CAP EC 15MG

Facility

$21.80

Hospital Charge Code	60628159
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$10.90
Rate for Payer: Aetna Commercial	$8.28
Rate for Payer: Aetna Medicare Advantage	$6.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.56
Rate for Payer: Cigna Commercial	$10.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.54
Rate for Payer: Oxford Commercial	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$4.36
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

LANSOPRAZOLE CAP EC 30MG

Facility

$27.25

Hospital Charge Code	60628160
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

LANSOPRAZOLE CAP EC 30MG

Facility

$27.25

Hospital Charge Code	60628160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.62
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna Medicare Advantage	$8.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.95
Rate for Payer: Cigna Commercial	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.18
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$5.45
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

LANTHANUM CARBONATE1000MG CTAB

Facility

$75.17

Service Code	NDC 54092025490
Hospital Charge Code	60630028
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.59
Rate for Payer: Aetna Commercial	$28.56
Rate for Payer: Aetna Medicare Advantage	$22.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.17
Rate for Payer: Cigna Commercial	$37.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.55
Rate for Payer: Oxford Commercial	$15.03
Rate for Payer: Qualcare PPO/HMO/WC	$11.28
Rate for Payer: UnitedHealthcare Commercial	$15.03
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

LANTHANUM CARBONATE1000MG CTAB

Facility

$75.17

Service Code	NDC 54092025490
Hospital Charge Code	60630028
Hospital Revenue Code	250
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$11.28
Rate for Payer: Qualcare PPO/HMO/WC	$11.28

LANTHANUM CARBONATE 500MG CTAB

Facility

$75.17

Service Code	NDC 54092025290
Hospital Charge Code	60630026
Hospital Revenue Code	250
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$11.28
Rate for Payer: Qualcare PPO/HMO/WC	$11.28

LANTHANUM CARBONATE 500MG CTAB

Facility

$75.17

Service Code	NDC 54092025290
Hospital Charge Code	60630026
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.59
Rate for Payer: Aetna Commercial	$28.56
Rate for Payer: Aetna Medicare Advantage	$22.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.17
Rate for Payer: Cigna Commercial	$37.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.55
Rate for Payer: Oxford Commercial	$15.03
Rate for Payer: Qualcare PPO/HMO/WC	$11.28
Rate for Payer: UnitedHealthcare Commercial	$15.03
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

LANTHANUM CARBONATE 750MG CTAB

Facility

$39.00

Hospital Charge Code	60630027
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

LANTHANUM CARBONATE 750MG CTAB

Facility

$39.00

Hospital Charge Code	60630027
Hospital Revenue Code	250
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

LANTUS INSULIN 10ML VIAL

Facility

$539.22

Service Code	HCPCS J1815
Hospital Charge Code	606390414
Hospital Revenue Code	636
Min. Negotiated Rate	$80.88
Max. Negotiated Rate	$130.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.49
Rate for Payer: Qualcare PPO/HMO/WC	$80.88

LANTUS INSULIN 10ML VIAL

Facility

$539.22

Service Code	HCPCS J1815
Hospital Charge Code	606390414
Hospital Revenue Code	636
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$269.61
Rate for Payer: Aetna Commercial	$204.90
Rate for Payer: Aetna Medicare Advantage	$161.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.50
Rate for Payer: Cigna Commercial	$269.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.49
Rate for Payer: Qualcare PPO/HMO/WC	$80.88
Rate for Payer: UnitedHealthcare Community & State	$13.00
Rate for Payer: Wellpoint Medicaid Managed Care	$14.29

LANTUS VIAL PER 50 UNITS

Facility

$4.00

Service Code	NDC 88222033
Hospital Charge Code	60632262
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

LANTUS VIAL PER 50 UNITS

Facility

$4.00

Service Code	NDC 88222033
Hospital Charge Code	60632262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LAP ABD PERIT OMTUM W DRAINAGE

Facility

$35,550.90

Service Code	HCPCS 49323
Hospital Charge Code	1600000405
Hospital Revenue Code	360
Min. Negotiated Rate	$856.78
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,665.27
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,332.64
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$856.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$942.10

LAP ABD PERIT OMTUM W DRAINAGE

Facility

$35,550.90

Service Code	HCPCS 49323
Hospital Charge Code	1600000405
Hospital Revenue Code	360
Min. Negotiated Rate	$5,332.64
Max. Negotiated Rate	$5,332.64
Rate for Payer: Qualcare PPO/HMO/WC	$5,332.64

LAP,ABD PET OMENTUM W BX

Facility

$36,033.50

Service Code	HCPCS 49321
Hospital Charge Code	16000987
Hospital Revenue Code	360
Min. Negotiated Rate	$5,405.02
Max. Negotiated Rate	$5,405.02
Rate for Payer: Qualcare PPO/HMO/WC	$5,405.02

LAP,ABD PET OMENTUM W BX

Facility

$36,033.50

Service Code	HCPCS 49321
Hospital Charge Code	16000987
Hospital Revenue Code	360
Min. Negotiated Rate	$868.41
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,810.05
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,405.02
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$868.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$954.89

LAP,ADB PET OMENUTM W ASP CYST

Facility

$45,838.40

Service Code	HCPCS 49322
Hospital Charge Code	16000645
Hospital Revenue Code	360
Min. Negotiated Rate	$1,104.71
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,751.52
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,875.76
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,104.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,214.72

LAP,ADB PET OMENUTM W ASP CYST

Facility

$45,838.40

Service Code	HCPCS 49322
Hospital Charge Code	16000645
Hospital Revenue Code	360
Min. Negotiated Rate	$6,875.76
Max. Negotiated Rate	$6,875.76
Rate for Payer: Qualcare PPO/HMO/WC	$6,875.76

LAPARAST VAG HYSTRCTMY=<250GM

Facility

$63,727.20

Service Code	HCPCS 58550
Hospital Charge Code	1600000675
Hospital Revenue Code	360
Min. Negotiated Rate	$1,535.83
Max. Negotiated Rate	$25,925.77
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,925.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$25,925.77
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,118.16
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,559.08
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,535.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,688.77

LAPARAST VAG HYSTRCTMY=<250GM

Facility

$63,727.20

Service Code	HCPCS 58550
Hospital Charge Code	1600000675
Hospital Revenue Code	360
Min. Negotiated Rate	$9,559.08
Max. Negotiated Rate	$9,559.08
Rate for Payer: Qualcare PPO/HMO/WC	$9,559.08

LAPAR. FIXATION SYSTEM

Facility

$752.00

Hospital Charge Code	270332703
Hospital Revenue Code	272
Min. Negotiated Rate	$112.80
Max. Negotiated Rate	$112.80
Rate for Payer: Qualcare PPO/HMO/WC	$112.80

LAPAR. FIXATION SYSTEM

Facility

$752.00

Hospital Charge Code	270332703
Hospital Revenue Code	272
Min. Negotiated Rate	$18.12
Max. Negotiated Rate	$376.00
Rate for Payer: Aetna Commercial	$285.76
Rate for Payer: Aetna Medicare Advantage	$225.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.76
Rate for Payer: Cigna Commercial	$376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.60
Rate for Payer: Oxford Commercial	$150.40
Rate for Payer: Qualcare PPO/HMO/WC	$112.80
Rate for Payer: UnitedHealthcare Commercial	$150.40
Rate for Payer: UnitedHealthcare Community & State	$18.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.93

LAPARO ABLATE LIVER TUMOR RF

Facility

$61,304.40

Service Code	HCPCS 47370
Hospital Charge Code	1600000339
Hospital Revenue Code	360
Min. Negotiated Rate	$1,477.44
Max. Negotiated Rate	$45,585.17
Rate for Payer: Aetna Commercial	$34,349.57
Rate for Payer: Aetna Medicare Advantage	$40,916.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45,585.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,628.52
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	$45,585.17
Rate for Payer: Cigna Commercial	$25,313.84
Rate for Payer: Cigna Medicare Advantage	$12,628.52
Rate for Payer: Clover Medicare Advantage	$11,997.09
Rate for Payer: EmblemHealth Commercial	$37,885.56
Rate for Payer: Humana Medicare Advantage	$13,007.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,628.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,391.32
Rate for Payer: Oxford Commercial	$9,689.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,195.66
Rate for Payer: UnitedHealthcare Commercial	$16,605.00
Rate for Payer: UnitedHealthcare Community & State	$1,477.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,628.52
Rate for Payer: Wellcare Medicare Advantage	$12,628.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1,624.57

Know your out-of-pocket cost for care.

All Charges