Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LASIX/80MG/BULK

Facility

$3.00

Hospital Charge Code	60634643
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LASIX/80MG/TAB

Facility

$3.00

Hospital Charge Code	60633272
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LASIX/80MG/TAB

Facility

$3.00

Hospital Charge Code	60633272
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

LASSO ATX SUTURE 90 AR4065905

Facility

$967.25

Hospital Charge Code	270627514
Hospital Revenue Code	272
Min. Negotiated Rate	$23.31
Max. Negotiated Rate	$483.62
Rate for Payer: Aetna Commercial	$367.56
Rate for Payer: Aetna Medicare Advantage	$290.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.65
Rate for Payer: Cigna Commercial	$483.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.18
Rate for Payer: Oxford Commercial	$193.45
Rate for Payer: Qualcare PPO/HMO/WC	$145.09
Rate for Payer: UnitedHealthcare Commercial	$193.45
Rate for Payer: UnitedHealthcare Community & State	$23.31
Rate for Payer: Wellpoint Medicaid Managed Care	$25.63

LASSO ATX SUTURE 90 AR4065905

Facility

$967.25

Hospital Charge Code	270627514
Hospital Revenue Code	272
Min. Negotiated Rate	$145.09
Max. Negotiated Rate	$145.09
Rate for Payer: Qualcare PPO/HMO/WC	$145.09

LASSO QUICKPASS CURVE LEFT 45

Facility

$1,145.00

Hospital Charge Code	270667328
Hospital Revenue Code	270
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$572.50
Rate for Payer: Aetna Commercial	$435.10
Rate for Payer: Aetna Medicare Advantage	$343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.98
Rate for Payer: Cigna Commercial	$572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.50
Rate for Payer: Oxford Commercial	$229.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.75
Rate for Payer: UnitedHealthcare Commercial	$229.00
Rate for Payer: UnitedHealthcare Community & State	$27.59
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

LASSO QUICKPASS CURVE LEFT 45

Facility

$1,145.00

Hospital Charge Code	270667328
Hospital Revenue Code	270
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

LASSO QUICKPASS RIGHT 25 DEG

Facility

$1,145.00

Hospital Charge Code	270667327
Hospital Revenue Code	270
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

LASSO QUICKPASS RIGHT 25 DEG

Facility

$1,145.00

Hospital Charge Code	270667327
Hospital Revenue Code	270
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$572.50
Rate for Payer: Aetna Commercial	$435.10
Rate for Payer: Aetna Medicare Advantage	$343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.98
Rate for Payer: Cigna Commercial	$572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.50
Rate for Payer: Oxford Commercial	$229.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.75
Rate for Payer: UnitedHealthcare Commercial	$229.00
Rate for Payer: UnitedHealthcare Community & State	$27.59
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

LASSO SUTURE 45 DEGREE

Facility

$967.25

Hospital Charge Code	270636100
Hospital Revenue Code	272
Min. Negotiated Rate	$23.31
Max. Negotiated Rate	$483.62
Rate for Payer: Aetna Commercial	$367.56
Rate for Payer: Aetna Medicare Advantage	$290.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.65
Rate for Payer: Cigna Commercial	$483.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.18
Rate for Payer: Oxford Commercial	$193.45
Rate for Payer: Qualcare PPO/HMO/WC	$145.09
Rate for Payer: UnitedHealthcare Commercial	$193.45
Rate for Payer: UnitedHealthcare Community & State	$23.31
Rate for Payer: Wellpoint Medicaid Managed Care	$25.63

LASSO SUTURE 45 DEGREE

Facility

$967.25

Hospital Charge Code	270636100
Hospital Revenue Code	272
Min. Negotiated Rate	$145.09
Max. Negotiated Rate	$145.09
Rate for Payer: Qualcare PPO/HMO/WC	$145.09

LATANOPROST 2.5 ML SOL

Facility

$1,043.59

Service Code	NDC 13830304
Hospital Charge Code	60628089
Hospital Revenue Code	250
Min. Negotiated Rate	$156.54
Max. Negotiated Rate	$156.54
Rate for Payer: Qualcare PPO/HMO/WC	$156.54

LATANOPROST 2.5 ML SOL

Facility

$1,043.59

Service Code	NDC 13830304
Hospital Charge Code	60628089
Hospital Revenue Code	250
Min. Negotiated Rate	$25.15
Max. Negotiated Rate	$521.79
Rate for Payer: Aetna Commercial	$396.56
Rate for Payer: Aetna Medicare Advantage	$313.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.12
Rate for Payer: Cigna Commercial	$521.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.08
Rate for Payer: Oxford Commercial	$208.72
Rate for Payer: Qualcare PPO/HMO/WC	$156.54
Rate for Payer: UnitedHealthcare Commercial	$208.72
Rate for Payer: UnitedHealthcare Community & State	$25.15
Rate for Payer: Wellpoint Medicaid Managed Care	$27.66

LATERAL ENTRY FEMOR NAIL(10MM)

Facility

$6,645.00

Hospital Charge Code	270656684
Hospital Revenue Code	278
Min. Negotiated Rate	$996.75
Max. Negotiated Rate	$1,608.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,329.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,608.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,461.90
Rate for Payer: Qualcare PPO/HMO/WC	$996.75

LATERAL ENTRY FEMOR NAIL(10MM)

Facility

$6,645.00

Hospital Charge Code	270656684
Hospital Revenue Code	278
Min. Negotiated Rate	$160.14
Max. Negotiated Rate	$3,322.50
Rate for Payer: Aetna Commercial	$2,525.10
Rate for Payer: Aetna Medicare Advantage	$1,993.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,694.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,694.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,329.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,694.47
Rate for Payer: Cigna Commercial	$3,322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,608.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,461.90
Rate for Payer: Qualcare PPO/HMO/WC	$996.75
Rate for Payer: UnitedHealthcare Community & State	$160.14
Rate for Payer: Wellpoint Medicaid Managed Care	$176.09

LATERAL KWIRE

Facility

$1,125.00

Hospital Charge Code	270704025
Hospital Revenue Code	272
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

LATERAL KWIRE

Facility

$1,125.00

Hospital Charge Code	270704025
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

LATERAL PATIENT POSITIONER

Facility

$3,250.00

Hospital Charge Code	270703548
Hospital Revenue Code	272
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

LATERAL PATIENT POSITIONER

Facility

$3,250.00

Hospital Charge Code	270703548
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

LATERAL PLATE 30MM

Facility

$16,341.90

Hospital Charge Code	270702310
Hospital Revenue Code	278
Min. Negotiated Rate	$393.84
Max. Negotiated Rate	$8,170.95
Rate for Payer: Aetna Commercial	$6,209.92
Rate for Payer: Aetna Medicare Advantage	$4,902.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,167.18
Rate for Payer: Cigna Commercial	$8,170.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,595.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28
Rate for Payer: UnitedHealthcare Community & State	$393.84
Rate for Payer: Wellpoint Medicaid Managed Care	$433.06

LATERAL PLATE 30MM

Facility

$16,341.90

Hospital Charge Code	270702310
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.28
Max. Negotiated Rate	$3,954.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,595.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28

LATEX SPECIFIC IGE

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3009985
Hospital Revenue Code	305
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

LATEX SPECIFIC IGE

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3009985
Hospital Revenue Code	305
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

LAT INTERBODY 18X40X10MM 6 DEG

Facility

$21,000.00

Hospital Charge Code	270702451
Hospital Revenue Code	278
Min. Negotiated Rate	$506.10
Max. Negotiated Rate	$10,500.00
Rate for Payer: Aetna Commercial	$7,980.00
Rate for Payer: Aetna Medicare Advantage	$6,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,355.00
Rate for Payer: Cigna Commercial	$10,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,082.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,620.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00
Rate for Payer: UnitedHealthcare Community & State	$506.10
Rate for Payer: Wellpoint Medicaid Managed Care	$556.50

LAT INTERBODY 18X40X10MM 6 DEG

Facility

$21,000.00

Hospital Charge Code	270702451
Hospital Revenue Code	278
Min. Negotiated Rate	$3,150.00
Max. Negotiated Rate	$5,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,082.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,620.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,150.00

Know your out-of-pocket cost for care.

All Charges