Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LEVOXINE/0.3MG/TAB

Facility

$7.30

Service Code	NDC 378182177
Hospital Charge Code	60633293
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

LEVOXINE/500MCG

Facility

$152.00

Hospital Charge Code	60633295
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna Commercial	$57.76
Rate for Payer: Aetna Medicare Advantage	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.76
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.60
Rate for Payer: Oxford Commercial	$30.40
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$30.40
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

LEVOXINE/500MCG

Facility

$152.00

Hospital Charge Code	60633295
Hospital Revenue Code	250
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LEVSTATIN INJ/10MG/ML

Facility

$2,209.00

Hospital Charge Code	60634927
Hospital Revenue Code	636
Min. Negotiated Rate	$331.35
Max. Negotiated Rate	$534.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.58
Rate for Payer: Qualcare PPO/HMO/WC	$331.35

LEVSTATIN INJ/10MG/ML

Facility

$2,209.00

Hospital Charge Code	60634927
Hospital Revenue Code	636
Min. Negotiated Rate	$53.24
Max. Negotiated Rate	$1,104.50
Rate for Payer: Aetna Commercial	$839.42
Rate for Payer: Aetna Medicare Advantage	$662.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.29
Rate for Payer: Cigna Commercial	$1,104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.58
Rate for Payer: Qualcare PPO/HMO/WC	$331.35
Rate for Payer: UnitedHealthcare Community & State	$53.24
Rate for Payer: Wellpoint Medicaid Managed Care	$58.54

LEXAPRO 20MG

Facility

$14.00

Hospital Charge Code	60635552
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

LEXAPRO 20MG

Facility

$14.00

Hospital Charge Code	60635552
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

LEXIVA, 700MG, TAB

Facility

$134.47

Service Code	NDC 49702020718
Hospital Charge Code	60635465
Hospital Revenue Code	250
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$20.17
Rate for Payer: Qualcare PPO/HMO/WC	$20.17

LEXIVA, 700MG, TAB

Facility

$134.47

Service Code	NDC 49702020718
Hospital Charge Code	60635465
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$67.23
Rate for Payer: Aetna Commercial	$51.10
Rate for Payer: Aetna Medicare Advantage	$40.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.29
Rate for Payer: Cigna Commercial	$67.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.34
Rate for Payer: Oxford Commercial	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.17
Rate for Payer: UnitedHealthcare Commercial	$26.89
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$3.56

LFAN TAB 2MG

Facility

$7.00

Hospital Charge Code	6009286
Hospital Revenue Code	251
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LFAN TAB 2MG

Facility

$7.00

Hospital Charge Code	6009286
Hospital Revenue Code	251
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

LFIT V50 FEMORAL HEAD

Facility

$5,880.00

Hospital Charge Code	270656529
Hospital Revenue Code	278
Min. Negotiated Rate	$141.71
Max. Negotiated Rate	$2,940.00
Rate for Payer: Aetna Commercial	$2,234.40
Rate for Payer: Aetna Medicare Advantage	$1,764.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,499.40
Rate for Payer: Cigna Commercial	$2,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,293.60
Rate for Payer: Qualcare PPO/HMO/WC	$882.00
Rate for Payer: UnitedHealthcare Community & State	$141.71
Rate for Payer: Wellpoint Medicaid Managed Care	$155.82

LFIT V50 FEMORAL HEAD

Facility

$5,880.00

Hospital Charge Code	270656529
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,422.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,293.60
Rate for Payer: Qualcare PPO/HMO/WC	$882.00

LG11 AUTOANTIBODY TEST

Facility

$2,575.00

Service Code	HCPCS 86255
Hospital Charge Code	3038555
Hospital Revenue Code	302
Min. Negotiated Rate	$386.25
Max. Negotiated Rate	$386.25
Rate for Payer: Qualcare PPO/HMO/WC	$386.25

LG11 AUTOANTIBODY TEST

Facility

$2,575.00

Service Code	HCPCS 86255
Hospital Charge Code	3038555
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$1,287.50
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$1,287.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$772.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$386.25
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$68.24

LG HYBRID GLENOID BASE 4MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687721
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LG HYBRID GLENOID BASE 4MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687721
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

LGN CEMENT STEM 14MMX160MMSTRT

Facility

$12,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270686901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,921.50
Max. Negotiated Rate	$3,100.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,562.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,100.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,818.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,921.50

LGN CEMENT STEM 14MMX160MMSTRT

Facility

$12,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270686901
Hospital Revenue Code	278
Min. Negotiated Rate	$308.72
Max. Negotiated Rate	$6,405.00
Rate for Payer: Aetna Commercial	$4,867.80
Rate for Payer: Aetna Medicare Advantage	$3,843.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,266.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,266.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,562.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,266.55
Rate for Payer: Cigna Commercial	$6,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,100.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,818.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,921.50
Rate for Payer: UnitedHealthcare Community & State	$308.72
Rate for Payer: Wellpoint Medicaid Managed Care	$339.46

LGN OX CONSTRAINED FEM 5 RT

Facility

$63,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270686900
Hospital Revenue Code	278
Min. Negotiated Rate	$9,515.25
Max. Negotiated Rate	$15,351.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,687.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,351.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,955.70
Rate for Payer: Qualcare PPO/HMO/WC	$9,515.25

LGN OX CONSTRAINED FEM 5 RT

Facility

$63,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270686900
Hospital Revenue Code	278
Min. Negotiated Rate	$1,528.78
Max. Negotiated Rate	$31,717.50
Rate for Payer: Aetna Commercial	$24,105.30
Rate for Payer: Aetna Medicare Advantage	$19,030.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,175.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,175.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,175.92
Rate for Payer: Cigna Commercial	$31,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,351.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,955.70
Rate for Payer: Qualcare PPO/HMO/WC	$9,515.25
Rate for Payer: UnitedHealthcare Community & State	$1,528.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1,681.03

LGTIN/BAND ANGIOACCESS AV FSTL

Facility

$25,406.80

Service Code	HCPCS 37607
Hospital Charge Code	16000954
Hospital Revenue Code	360
Min. Negotiated Rate	$612.30
Max. Negotiated Rate	$13,540.60
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,540.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,540.60
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,622.04
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$612.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$673.28

LGTIN/BAND ANGIOACCESS AV FSTL

Facility

$25,406.80

Service Code	HCPCS 37607
Hospital Charge Code	16000954
Hospital Revenue Code	360
Min. Negotiated Rate	$3,811.02
Max. Negotiated Rate	$3,811.02
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02

LGX 15CM 72404256

Facility

$39,115.00

Hospital Charge Code	270659251
Hospital Revenue Code	278
Min. Negotiated Rate	$5,867.25
Max. Negotiated Rate	$9,465.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,823.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,465.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,605.30
Rate for Payer: Qualcare PPO/HMO/WC	$5,867.25

LGX 15CM 72404256

Facility

$39,115.00

Hospital Charge Code	270659251
Hospital Revenue Code	278
Min. Negotiated Rate	$942.67
Max. Negotiated Rate	$19,557.50
Rate for Payer: Aetna Commercial	$14,863.70
Rate for Payer: Aetna Medicare Advantage	$11,734.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,974.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,974.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,823.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,974.33
Rate for Payer: Cigna Commercial	$19,557.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,465.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,605.30
Rate for Payer: Qualcare PPO/HMO/WC	$5,867.25
Rate for Payer: UnitedHealthcare Community & State	$942.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1,036.55

Know your out-of-pocket cost for care.

All Charges