Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LIPOSYN II 20%/500ML

Facility

$44.00

Hospital Charge Code	60634540
Hospital Revenue Code	250
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

LIPOSYN II 20%/500ML

Facility

$44.00

Hospital Charge Code	60634540
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.20
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

LIPROPR0TEIN ELECTROPHORESIS

Facility

$1,028.49

Hospital Charge Code	3001849
Hospital Revenue Code	301
Min. Negotiated Rate	$154.27
Max. Negotiated Rate	$154.27
Rate for Payer: Qualcare PPO/HMO/WC	$154.27

LIPROPR0TEIN ELECTROPHORESIS

Facility

$1,028.49

Hospital Charge Code	3001849
Hospital Revenue Code	301
Min. Negotiated Rate	$24.79
Max. Negotiated Rate	$514.25
Rate for Payer: Aetna Commercial	$390.83
Rate for Payer: Aetna Medicare Advantage	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.26
Rate for Payer: Cigna Commercial	$514.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.27
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$24.79
Rate for Payer: Wellpoint Medicaid Managed Care	$27.25

LIPROPR0TEIN ELECTROPHORESIS I

Facility

$133.65

Service Code	HCPCS 83700
Hospital Charge Code	3001849B
Hospital Revenue Code	301
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$20.05

LIPROPR0TEIN ELECTROPHORESIS I

Facility

$894.84

Service Code	HCPCS 80061
Hospital Charge Code	3001849A
Hospital Revenue Code	301
Min. Negotiated Rate	$134.23
Max. Negotiated Rate	$134.23
Rate for Payer: Qualcare PPO/HMO/WC	$134.23

LIPROPR0TEIN ELECTROPHORESIS I

Facility

$133.65

Service Code	HCPCS 83700
Hospital Charge Code	3001849B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$30.63
Rate for Payer: Aetna Medicare Advantage	$36.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.65
Rate for Payer: Cigna Commercial	$66.83
Rate for Payer: Cigna Medicare Advantage	$11.26
Rate for Payer: Clover Medicare Advantage	$10.70
Rate for Payer: EmblemHealth Commercial	$33.78
Rate for Payer: Humana Medicare Advantage	$11.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.26
Rate for Payer: Wellcare Medicare Advantage	$11.26
Rate for Payer: Wellpoint Medicaid Managed Care	$3.54

LIPROPR0TEIN ELECTROPHORESIS I

Facility

$894.84

Service Code	HCPCS 80061
Hospital Charge Code	3001849A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$447.42
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	$447.42
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	$268.45
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.23
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	$23.71

LIQUID ADHESIVE

Facility

$15.75

Service Code	NDC 496052348
Hospital Charge Code	60628531
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.88
Rate for Payer: Aetna Commercial	$5.99
Rate for Payer: Aetna Medicare Advantage	$4.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.02
Rate for Payer: Cigna Commercial	$7.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.72
Rate for Payer: Oxford Commercial	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$2.36
Rate for Payer: UnitedHealthcare Commercial	$3.15
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

LIQUID ADHESIVE

Facility

$15.75

Service Code	NDC 496052348
Hospital Charge Code	60628531
Hospital Revenue Code	250
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$2.36
Rate for Payer: Qualcare PPO/HMO/WC	$2.36

Liquid PolibarPlus 1900ml 105%

Facility

$192.55

Hospital Charge Code	6000431
Hospital Revenue Code	250
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$96.28
Rate for Payer: Aetna Commercial	$73.17
Rate for Payer: Aetna Medicare Advantage	$57.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.10
Rate for Payer: Cigna Commercial	$96.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.77
Rate for Payer: Oxford Commercial	$38.51
Rate for Payer: Qualcare PPO/HMO/WC	$28.88
Rate for Payer: UnitedHealthcare Commercial	$38.51
Rate for Payer: UnitedHealthcare Community & State	$4.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.10

Liquid PolibarPlus 1900ml 105%

Facility

$192.55

Hospital Charge Code	6000431
Hospital Revenue Code	250
Min. Negotiated Rate	$28.88
Max. Negotiated Rate	$28.88
Rate for Payer: Qualcare PPO/HMO/WC	$28.88

LIQUID UA CONTROL L III

Facility

$306.45

Hospital Charge Code	270605270
Hospital Revenue Code	272
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$153.22
Rate for Payer: Aetna Commercial	$116.45
Rate for Payer: Aetna Medicare Advantage	$91.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.14
Rate for Payer: Cigna Commercial	$153.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.94
Rate for Payer: Oxford Commercial	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$45.97
Rate for Payer: UnitedHealthcare Commercial	$61.29
Rate for Payer: UnitedHealthcare Community & State	$7.39
Rate for Payer: Wellpoint Medicaid Managed Care	$8.12

LIQUID UA CONTROL L III

Facility

$306.45

Hospital Charge Code	270605270
Hospital Revenue Code	272
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$45.97
Rate for Payer: Qualcare PPO/HMO/WC	$45.97

LISDEXAMFETAMINE DIMESYLATE 20

Facility

$38.19

Service Code	NDC 59417010210
Hospital Charge Code	6063943214
Hospital Revenue Code	250
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$5.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.73

LISDEXAMFETAMINE DIMESYLATE 20

Facility

$38.19

Service Code	NDC 59417010210
Hospital Charge Code	6063943214
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.09
Rate for Payer: Aetna Commercial	$14.51
Rate for Payer: Aetna Medicare Advantage	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.74
Rate for Payer: Cigna Commercial	$19.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.46
Rate for Payer: Oxford Commercial	$7.64
Rate for Payer: Qualcare PPO/HMO/WC	$5.73
Rate for Payer: UnitedHealthcare Commercial	$7.64
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

LISDEXAMFETAMINE DIMESYLATE 30

Facility

$38.19

Service Code	NDC 59417010310
Hospital Charge Code	6063943215
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.09
Rate for Payer: Aetna Commercial	$14.51
Rate for Payer: Aetna Medicare Advantage	$11.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.74
Rate for Payer: Cigna Commercial	$19.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.46
Rate for Payer: Oxford Commercial	$7.64
Rate for Payer: Qualcare PPO/HMO/WC	$5.73
Rate for Payer: UnitedHealthcare Commercial	$7.64
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

LISDEXAMFETAMINE DIMESYLATE 30

Facility

$38.19

Service Code	NDC 59417010310
Hospital Charge Code	6063943215
Hospital Revenue Code	250
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$5.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.73

LISFRANC PLATE LG LEFT

Facility

$4,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270702068
Hospital Revenue Code	278
Min. Negotiated Rate	$99.29
Max. Negotiated Rate	$2,060.00
Rate for Payer: Aetna Commercial	$1,565.60
Rate for Payer: Aetna Medicare Advantage	$1,236.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,050.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$824.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,050.60
Rate for Payer: Cigna Commercial	$2,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$997.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$906.40
Rate for Payer: Qualcare PPO/HMO/WC	$618.00
Rate for Payer: UnitedHealthcare Community & State	$99.29
Rate for Payer: Wellpoint Medicaid Managed Care	$109.18

LISFRANC PLATE LG LEFT

Facility

$4,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270702068
Hospital Revenue Code	278
Min. Negotiated Rate	$618.00
Max. Negotiated Rate	$997.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$824.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$997.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$906.40
Rate for Payer: Qualcare PPO/HMO/WC	$618.00

LISINOPRIL 10 MG TAB

Facility

$6.30

Service Code	NDC 51079098220
Hospital Charge Code	60627572
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.15
Rate for Payer: Aetna Commercial	$2.39
Rate for Payer: Aetna Medicare Advantage	$1.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.61
Rate for Payer: Cigna Commercial	$3.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.89
Rate for Payer: Oxford Commercial	$1.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.95
Rate for Payer: UnitedHealthcare Commercial	$1.26
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

LISINOPRIL 10 MG TAB

Facility

$6.30

Service Code	NDC 51079098220
Hospital Charge Code	60627572
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.95

LISINOPRIL 20 MG TAB

Facility

$6.77

Service Code	NDC 51079098320
Hospital Charge Code	60627573
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

LISINOPRIL 20 MG TAB

Facility

$6.77

Service Code	NDC 51079098320
Hospital Charge Code	60627573
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$2.57
Rate for Payer: Aetna Medicare Advantage	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.73
Rate for Payer: Cigna Commercial	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.03
Rate for Payer: Oxford Commercial	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

LISINOPRIL 2.5 MG TAB

Facility

$4.36

Service Code	NDC 68180051201
Hospital Charge Code	60629826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.66
Rate for Payer: Aetna Medicare Advantage	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.11
Rate for Payer: Cigna Commercial	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.31
Rate for Payer: Oxford Commercial	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.65
Rate for Payer: UnitedHealthcare Commercial	$0.87
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

Know your out-of-pocket cost for care.

All Charges