Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LIORESAL/10MG/TAB

Facility

$4.00

Hospital Charge Code	60633308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LIORESAL 20MGTAB(BACLOFEN

Facility

$1.00

Hospital Charge Code	60635475
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

LIORESAL 20MGTAB(BACLOFEN

Facility

$1.00

Hospital Charge Code	60635475
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

LIOTHYRONINE TAB 25MCG

Facility

$11.93

Service Code	NDC 60793011601
Hospital Charge Code	60628259
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna Commercial	$4.53
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.04
Rate for Payer: Cigna Commercial	$5.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.58
Rate for Payer: Oxford Commercial	$2.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.79
Rate for Payer: UnitedHealthcare Commercial	$2.39
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

LIOTHYRONINE TAB 25MCG

Facility

$11.93

Service Code	NDC 60793011601
Hospital Charge Code	60628259
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.79

LIOTHYRONINE TAB 5MCG

Facility

$9.11

Service Code	NDC 60793011501
Hospital Charge Code	60628260
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Commercial	$3.46
Rate for Payer: Aetna Medicare Advantage	$2.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.32
Rate for Payer: Cigna Commercial	$4.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.73
Rate for Payer: Oxford Commercial	$1.82
Rate for Payer: Qualcare PPO/HMO/WC	$1.37
Rate for Payer: UnitedHealthcare Commercial	$1.82
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

LIOTHYRONINE TAB 5MCG

Facility

$9.11

Service Code	NDC 60793011501
Hospital Charge Code	60628260
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$1.37
Rate for Payer: Qualcare PPO/HMO/WC	$1.37

LIPASE

Facility

$317.80

Service Code	HCPCS 83690
Hospital Charge Code	38472455
Hospital Revenue Code	301
Min. Negotiated Rate	$47.67
Max. Negotiated Rate	$47.67
Rate for Payer: Qualcare PPO/HMO/WC	$47.67

LIPASE

Facility

$317.80

Service Code	HCPCS 83690
Hospital Charge Code	38472455
Hospital Revenue Code	301
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$158.90
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare Advantage	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.87
Rate for Payer: Cigna Commercial	$158.90
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.34
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.67
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Medicare Advantage	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$8.42

LIPASE***

Facility

$25.00

Hospital Charge Code	3011822
Hospital Revenue Code	309
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

LIPASE***

Facility

$25.00

Hospital Charge Code	3011822
Hospital Revenue Code	309
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

LIPASE, JP DRAINAGE

Facility

$47.35

Service Code	HCPCS 83690
Hospital Charge Code	39900103
Hospital Revenue Code	301
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

LIPASE, JP DRAINAGE

Facility

$47.35

Service Code	HCPCS 83690
Hospital Charge Code	39900103
Hospital Revenue Code	301
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare Advantage	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.87
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Medicare Advantage	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

LIPASE, SERUM

Facility

$707.67

Service Code	HCPCS 83690
Hospital Charge Code	3001823
Hospital Revenue Code	301
Min. Negotiated Rate	$106.15
Max. Negotiated Rate	$106.15
Rate for Payer: Qualcare PPO/HMO/WC	$106.15

LIPASE, SERUM

Facility

$707.67

Service Code	HCPCS 83690
Hospital Charge Code	3001823
Hospital Revenue Code	301
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$353.83
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare Advantage	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.87
Rate for Payer: Cigna Commercial	$353.83
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$106.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Medicare Advantage	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$18.75

LIPASE, URINE, 24 HOUR***

Facility

$110.00

Service Code	HCPCS 83690
Hospital Charge Code	3032240
Hospital Revenue Code	309
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

LIPASE, URINE, 24 HOUR***

Facility

$110.00

Service Code	HCPCS 83690
Hospital Charge Code	3032240
Hospital Revenue Code	309
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare Advantage	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.87
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Medicare Advantage	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

LIPID

Facility

$758.80

Service Code	HCPCS 80061
Hospital Charge Code	38472023
Hospital Revenue Code	301
Min. Negotiated Rate	$113.82
Max. Negotiated Rate	$113.82
Rate for Payer: Qualcare PPO/HMO/WC	$113.82

LIPID

Facility

$758.80

Service Code	HCPCS 80061
Hospital Charge Code	38472023
Hospital Revenue Code	301
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$379.40
Rate for Payer: Aetna Commercial	$36.42
Rate for Payer: Aetna Medicare Advantage	$43.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$379.40
Rate for Payer: Cigna Medicare Advantage	$13.39
Rate for Payer: Clover Medicare Advantage	$12.72
Rate for Payer: EmblemHealth Commercial	$40.17
Rate for Payer: Humana Medicare Advantage	$13.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.82
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.39
Rate for Payer: Wellcare Medicare Advantage	$13.39
Rate for Payer: Wellpoint Medicaid Managed Care	$20.11

LIPID

Facility

$758.80

Service Code	HCPCS 80061
Hospital Charge Code	38479458
Hospital Revenue Code	301
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$379.40
Rate for Payer: Aetna Commercial	$36.42
Rate for Payer: Aetna Medicare Advantage	$43.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.33
Rate for Payer: Cigna Commercial	$379.40
Rate for Payer: Cigna Medicare Advantage	$13.39
Rate for Payer: Clover Medicare Advantage	$12.72
Rate for Payer: EmblemHealth Commercial	$40.17
Rate for Payer: Humana Medicare Advantage	$13.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.64
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$113.82
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.39
Rate for Payer: Wellcare Medicare Advantage	$13.39
Rate for Payer: Wellpoint Medicaid Managed Care	$20.11

LIPID

Facility

$758.80

Service Code	HCPCS 80061
Hospital Charge Code	38479458
Hospital Revenue Code	301
Min. Negotiated Rate	$113.82
Max. Negotiated Rate	$113.82
Rate for Payer: Qualcare PPO/HMO/WC	$113.82

LIPID-ASSOCIATED SIALIC ACID

Facility

$153.65

Service Code	HCPCS 84275
Hospital Charge Code	3007580
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

LIPID-ASSOCIATED SIALIC ACID

Facility

$153.65

Service Code	HCPCS 84275
Hospital Charge Code	3007580
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$36.56
Rate for Payer: Aetna Medicare Advantage	$43.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.51
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$13.44
Rate for Payer: Clover Medicare Advantage	$12.77
Rate for Payer: EmblemHealth Commercial	$40.32
Rate for Payer: Humana Medicare Advantage	$13.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.44
Rate for Payer: Wellcare Medicare Advantage	$13.44
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

LIPID PROFILE***

Facility

$87.00

Service Code	HCPCS 82465
Hospital Charge Code	3006384
Hospital Revenue Code	301
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.83
Rate for Payer: Aetna Medicare Advantage	$14.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.70
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: Cigna Medicare Advantage	$4.35
Rate for Payer: Clover Medicare Advantage	$4.13
Rate for Payer: EmblemHealth Commercial	$13.05
Rate for Payer: Humana Medicare Advantage	$4.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.35
Rate for Payer: Wellcare Medicare Advantage	$4.35
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

LIPID PROFILE***

Facility

$87.00

Service Code	HCPCS 82465
Hospital Charge Code	3006384
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

Know your out-of-pocket cost for care.

All Charges