Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE W/EPINPH VL 1% 30ML

Facility

$7.70

Hospital Charge Code	6014112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

LIDOCAINE W/EPINPH VL 1% 30ML

Facility

$7.70

Hospital Charge Code	6022628
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

LIDOCAINE W/EPINPH VL 1% 30ML

Facility

$7.70

Hospital Charge Code	6014112
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

LIDOCAINE W/EPINPH VL 1% 30ML

Facility

$7.70

Hospital Charge Code	6022628
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

LIDOCAINE W/EPINPH VL 2% 30ML

Facility

$9.00

Hospital Charge Code	6012744
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

LIDOCAINE W/EPINPH VL 2% 30ML

Facility

$9.00

Hospital Charge Code	6012744
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

LIDOCAINE W/GLUC INJ 5%

Facility

$19.85

Hospital Charge Code	6003255
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.93
Rate for Payer: Aetna Commercial	$7.54
Rate for Payer: Aetna Medicare Advantage	$5.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.06
Rate for Payer: Cigna Commercial	$9.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.98
Rate for Payer: UnitedHealthcare Commercial	$3.97
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

LIDOCAINE W/GLUC INJ 5%

Facility

$19.85

Hospital Charge Code	6003255
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.98

LIDOCIANE VIAL 2%

Facility

$3.85

Hospital Charge Code	6014138
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

LIDOCIANE VIAL 2%

Facility

$3.85

Hospital Charge Code	6014138
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.16
Rate for Payer: Oxford Commercial	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Commercial	$0.77
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

LIDO/PRILO CREAM (5GM)

Facility

$53.87

Service Code	NDC 115146860
Hospital Charge Code	6063943126
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.93
Rate for Payer: Aetna Commercial	$20.47
Rate for Payer: Aetna Medicare Advantage	$16.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.74
Rate for Payer: Cigna Commercial	$26.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.16
Rate for Payer: Oxford Commercial	$10.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.08
Rate for Payer: UnitedHealthcare Commercial	$10.77
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

LIDO/PRILO CREAM (5GM)

Facility

$53.87

Service Code	NDC 115146860
Hospital Charge Code	6063943126
Hospital Revenue Code	250
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$8.08
Rate for Payer: Qualcare PPO/HMO/WC	$8.08

LIF AMP BONE SCREW 5.5X45MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270706235
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

LIF AMP BONE SCREW 5.5X45MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270706235
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

LIFAMP ONE SCREW PLATE 04 W CE

Facility

$15,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270706234
Hospital Revenue Code	278
Min. Negotiated Rate	$2,302.50
Max. Negotiated Rate	$3,714.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,714.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,377.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,302.50

LIFAMP ONE SCREW PLATE 04 W CE

Facility

$15,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270706234
Hospital Revenue Code	278
Min. Negotiated Rate	$369.94
Max. Negotiated Rate	$7,675.00
Rate for Payer: Aetna Commercial	$5,833.00
Rate for Payer: Aetna Medicare Advantage	$4,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,914.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,914.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,914.25
Rate for Payer: Cigna Commercial	$7,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,714.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,377.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,302.50
Rate for Payer: UnitedHealthcare Community & State	$369.94
Rate for Payer: Wellpoint Medicaid Managed Care	$406.77

LIFE PORT IMPLANT (BARD)

Facility

$975.00

Service Code	HCPCS C1788
Hospital Charge Code	270658505
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

LIFE PORT IMPLANT (BARD)

Facility

$975.00

Service Code	HCPCS C1788
Hospital Charge Code	270658505
Hospital Revenue Code	278
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

LIFE PORT INFUSION SET

Facility

$14.00

Service Code	HCPCS 99999
Hospital Charge Code	3400199
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

LIFE PORT INFUSION SET

Facility

$14.00

Service Code	HCPCS 99999
Hospital Charge Code	3400199
Hospital Revenue Code	272
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

LIFEPORT INFUSION SET W/Y-SITE

Facility

$38.00

Hospital Charge Code	270331909
Hospital Revenue Code	272
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

LIFEPORT INFUSION SET W/Y-SITE

Facility

$38.00

Hospital Charge Code	270331909
Hospital Revenue Code	272
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

LIFEPORT POWER IMPLANT (BARD)

Facility

$2,010.00

Service Code	HCPCS C1788
Hospital Charge Code	270650771
Hospital Revenue Code	278
Min. Negotiated Rate	$301.50
Max. Negotiated Rate	$486.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$402.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$442.20
Rate for Payer: Qualcare PPO/HMO/WC	$301.50

LIFEPORT POWER IMPLANT (BARD)

Facility

$2,010.00

Service Code	HCPCS C1788
Hospital Charge Code	270650771
Hospital Revenue Code	278
Min. Negotiated Rate	$48.44
Max. Negotiated Rate	$1,005.00
Rate for Payer: Aetna Commercial	$763.80
Rate for Payer: Aetna Medicare Advantage	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$512.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$512.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$402.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$512.55
Rate for Payer: Cigna Commercial	$1,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$442.20
Rate for Payer: Qualcare PPO/HMO/WC	$301.50
Rate for Payer: UnitedHealthcare Community & State	$48.44
Rate for Payer: Wellpoint Medicaid Managed Care	$53.27

LIFEPORT X-PORT ISP

Facility

$1,250.00

Hospital Charge Code	270660381
Hospital Revenue Code	270
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

Know your out-of-pocket cost for care.

All Charges