Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEUNG BILARY STENT COTTON 7FR

Facility

$279.00

Hospital Charge Code	270331662
Hospital Revenue Code	278
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$106.02
Rate for Payer: Aetna Medicare Advantage	$83.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.14
Rate for Payer: Cigna Commercial	$139.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.38
Rate for Payer: Qualcare PPO/HMO/WC	$41.85
Rate for Payer: UnitedHealthcare Community & State	$6.72
Rate for Payer: Wellpoint Medicaid Managed Care	$7.39

LEUPROLIDE 3.75MG

Facility

$2,364.80

Hospital Charge Code	6006977
Hospital Revenue Code	636
Min. Negotiated Rate	$56.99
Max. Negotiated Rate	$1,182.40
Rate for Payer: Aetna Commercial	$898.62
Rate for Payer: Aetna Medicare Advantage	$709.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$603.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$603.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$603.02
Rate for Payer: Cigna Commercial	$1,182.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.28
Rate for Payer: Qualcare PPO/HMO/WC	$354.72
Rate for Payer: UnitedHealthcare Community & State	$56.99
Rate for Payer: Wellpoint Medicaid Managed Care	$62.67

LEUPROLIDE 3.75MG

Facility

$2,364.80

Hospital Charge Code	6006977
Hospital Revenue Code	636
Min. Negotiated Rate	$354.72
Max. Negotiated Rate	$572.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.28
Rate for Payer: Qualcare PPO/HMO/WC	$354.72

LEUPROLIDE ACETATE 3.75 MG

Facility

$4,611.48

Service Code	HCPCS J1950
Hospital Charge Code	60627392
Hospital Revenue Code	636
Min. Negotiated Rate	$691.72
Max. Negotiated Rate	$1,115.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.98
Rate for Payer: Qualcare PPO/HMO/WC	$691.72

LEUPROLIDE ACETATE 3.75 MG

Facility

$4,611.48

Service Code	HCPCS J1950
Hospital Charge Code	60627392
Hospital Revenue Code	636
Min. Negotiated Rate	$111.14
Max. Negotiated Rate	$6,373.18
Rate for Payer: Aetna Commercial	$4,802.35
Rate for Payer: Aetna Medicare Advantage	$5,720.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,765.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,871.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.18
Rate for Payer: Cigna Medicare Advantage	$1,765.57
Rate for Payer: Clover Medicare Advantage	$1,677.29
Rate for Payer: EmblemHealth Commercial	$5,296.71
Rate for Payer: Humana Medicare Advantage	$1,818.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,765.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,115.98
Rate for Payer: Qualcare PPO/HMO/WC	$691.72
Rate for Payer: UnitedHealthcare Community & State	$111.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,765.57
Rate for Payer: Wellcare Medicare Advantage	$1,765.57
Rate for Payer: Wellpoint Medicaid Managed Care	$122.20

LEUPROLIDE ACETATE 7.5 MG

Facility

$5,495.41

Service Code	HCPCS J9217
Hospital Charge Code	60627393
Hospital Revenue Code	636
Min. Negotiated Rate	$824.31
Max. Negotiated Rate	$1,329.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,329.89
Rate for Payer: Qualcare PPO/HMO/WC	$824.31

LEUPROLIDE ACETATE 7.5 MG

Facility

$5,495.41

Service Code	HCPCS J9217
Hospital Charge Code	60627393
Hospital Revenue Code	636
Min. Negotiated Rate	$132.44
Max. Negotiated Rate	$1,329.89
Rate for Payer: Aetna Commercial	$479.26
Rate for Payer: Aetna Medicare Advantage	$570.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$636.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$636.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$176.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$186.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$636.03
Rate for Payer: Cigna Medicare Advantage	$176.20
Rate for Payer: Clover Medicare Advantage	$167.39
Rate for Payer: EmblemHealth Commercial	$528.60
Rate for Payer: Humana Medicare Advantage	$181.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$176.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,329.89
Rate for Payer: Qualcare PPO/HMO/WC	$824.31
Rate for Payer: UnitedHealthcare Community & State	$132.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.20
Rate for Payer: Wellcare Medicare Advantage	$176.20
Rate for Payer: Wellpoint Medicaid Managed Care	$145.63

LEUPROLIDE DEPOT INJ 3.75MG

Facility

$4,064.65

Hospital Charge Code	6007264
Hospital Revenue Code	636
Min. Negotiated Rate	$97.96
Max. Negotiated Rate	$2,032.33
Rate for Payer: Aetna Commercial	$1,544.57
Rate for Payer: Aetna Medicare Advantage	$1,219.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,036.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,036.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,036.49
Rate for Payer: Cigna Commercial	$2,032.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.65
Rate for Payer: Qualcare PPO/HMO/WC	$609.70
Rate for Payer: UnitedHealthcare Community & State	$97.96
Rate for Payer: Wellpoint Medicaid Managed Care	$107.71

LEUPROLIDE DEPOT INJ 3.75MG

Facility

$4,064.65

Hospital Charge Code	6007264
Hospital Revenue Code	636
Min. Negotiated Rate	$609.70
Max. Negotiated Rate	$983.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.65
Rate for Payer: Qualcare PPO/HMO/WC	$609.70

LEUPROLIDE DEPOT INJ 7.5MG

Facility

$2,955.55

Hospital Charge Code	6007256
Hospital Revenue Code	636
Min. Negotiated Rate	$71.23
Max. Negotiated Rate	$1,477.78
Rate for Payer: Aetna Commercial	$1,123.11
Rate for Payer: Aetna Medicare Advantage	$886.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$753.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$753.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$753.67
Rate for Payer: Cigna Commercial	$1,477.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.24
Rate for Payer: Qualcare PPO/HMO/WC	$443.33
Rate for Payer: UnitedHealthcare Community & State	$71.23
Rate for Payer: Wellpoint Medicaid Managed Care	$78.32

LEUPROLIDE DEPOT INJ 7.5MG

Facility

$2,955.55

Hospital Charge Code	6007256
Hospital Revenue Code	636
Min. Negotiated Rate	$443.33
Max. Negotiated Rate	$715.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.24
Rate for Payer: Qualcare PPO/HMO/WC	$443.33

LEVAFLOXACIN 750MG TABLET

Facility

$111.00

Hospital Charge Code	60635645
Hospital Revenue Code	250
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$16.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.65

LEVAFLOXACIN 750MG TABLET

Facility

$111.00

Hospital Charge Code	60635645
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$55.50
Rate for Payer: Aetna Commercial	$42.18
Rate for Payer: Aetna Medicare Advantage	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.30
Rate for Payer: Cigna Commercial	$55.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.30
Rate for Payer: Oxford Commercial	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$16.65
Rate for Payer: UnitedHealthcare Commercial	$22.20
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

LEVALBUTEROL

Facility

$44.96

Service Code	NDC 378968144
Hospital Charge Code	60628899
Hospital Revenue Code	250
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$6.74
Rate for Payer: Qualcare PPO/HMO/WC	$6.74

LEVALBUTEROL

Facility

$44.96

Service Code	NDC 378968144
Hospital Charge Code	60628899
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.48
Rate for Payer: Aetna Commercial	$17.08
Rate for Payer: Aetna Medicare Advantage	$13.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.46
Rate for Payer: Cigna Commercial	$22.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.49
Rate for Payer: Oxford Commercial	$8.99
Rate for Payer: Qualcare PPO/HMO/WC	$6.74
Rate for Payer: UnitedHealthcare Commercial	$8.99
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

LEVALBUTEROL1.25 MG/3 ML

Facility

$65.79

Service Code	NDC 54569544500
Hospital Charge Code	60628930
Hospital Revenue Code	250
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$9.87
Rate for Payer: Qualcare PPO/HMO/WC	$9.87

LEVALBUTEROL1.25 MG/3 ML

Facility

$65.79

Service Code	NDC 54569544500
Hospital Charge Code	60628930
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$32.90
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Aetna Medicare Advantage	$19.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.78
Rate for Payer: Cigna Commercial	$32.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.74
Rate for Payer: Oxford Commercial	$13.16
Rate for Payer: Qualcare PPO/HMO/WC	$9.87
Rate for Payer: UnitedHealthcare Commercial	$13.16
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

LEVAMISOLE HCL TAB 50MG

Facility

$52.50

Hospital Charge Code	6007439
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

LEVAMISOLE HCL TAB 50MG

Facility

$52.50

Hospital Charge Code	6007439
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.75
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

LEVAMISOLE TAB 50MG

Facility

$35.85

Hospital Charge Code	60628632
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.93
Rate for Payer: Aetna Commercial	$13.62
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.14
Rate for Payer: Cigna Commercial	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.76
Rate for Payer: Oxford Commercial	$7.17
Rate for Payer: Qualcare PPO/HMO/WC	$5.38
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

LEVAMISOLE TAB 50MG

Facility

$35.85

Hospital Charge Code	60628632
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.38

LEVAQUIN 250MG TAB U/D

Facility

$42.00

Hospital Charge Code	60635253
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

LEVAQUIN 250MG TAB U/D

Facility

$42.00

Hospital Charge Code	60635253
Hospital Revenue Code	250
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

LEVAQUIN 500MG TAB U/D

Facility

$51.00

Hospital Charge Code	60635254
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

LEVAQUIN 500MG TAB U/D

Facility

$51.00

Hospital Charge Code	60635254
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

Know your out-of-pocket cost for care.

All Charges