Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LITHIUM CARBONATE 450 MG TER

Facility

$4.00

Service Code	NDC 54002025
Hospital Charge Code	60627862
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LITHIUM CARBONATE 450 MG TER

Facility

$4.00

Service Code	NDC 54002025
Hospital Charge Code	60627862
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LITHIUM CARBONATE TAB 300MG

Facility

$1.95

Hospital Charge Code	60627864
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

LITHIUM CARBONATE TAB 300MG

Facility

$1.95

Hospital Charge Code	60627864
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

LITHIUM CITRATE 300MG/5ML

Facility

$3.00

Hospital Charge Code	60635052
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

LITHIUM CITRATE 300MG/5ML

Facility

$3.00

Hospital Charge Code	60635052
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LITHIUM, SERUM

Facility

$667.59

Service Code	HCPCS 80178
Hospital Charge Code	3001856
Hospital Revenue Code	301
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$17.98
Rate for Payer: Aetna Medicare Advantage	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.86
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.61
Rate for Payer: Clover Medicare Advantage	$6.28
Rate for Payer: EmblemHealth Commercial	$19.83
Rate for Payer: Humana Medicare Advantage	$6.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.61
Rate for Payer: Wellcare Medicare Advantage	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

LITHIUM, SERUM

Facility

$667.59

Service Code	HCPCS 80178
Hospital Charge Code	3001856
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LITHLPXY,IN BLAD&REM FRAG,<2.5

Facility

$23,841.70

Service Code	HCPCS 52317
Hospital Charge Code	160000190
Hospital Revenue Code	360
Min. Negotiated Rate	$574.58
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,152.51
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$574.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$631.81

LITHLPXY,IN BLAD&REM FRAG,<2.5

Facility

$23,841.70

Service Code	HCPCS 52317
Hospital Charge Code	160000190
Hospital Revenue Code	360
Min. Negotiated Rate	$3,576.26
Max. Negotiated Rate	$3,576.26
Rate for Payer: Qualcare PPO/HMO/WC	$3,576.26

LITHOLAPAXY,IN BLAD&REM F>2.5

Facility

$24,549.79

Service Code	HCPCS 52318
Hospital Charge Code	1600000270
Hospital Revenue Code	360
Min. Negotiated Rate	$591.65
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,364.94
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.47
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$591.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$650.57

LITHOLAPAXY,IN BLAD&REM F>2.5

Facility

$24,549.79

Service Code	HCPCS 52318
Hospital Charge Code	1600000270
Hospital Revenue Code	360
Min. Negotiated Rate	$3,682.47
Max. Negotiated Rate	$3,682.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,682.47

LITHOPLASTY BDC 7MM X 40CM

Facility

$16,500.00

Hospital Charge Code	270690506
Hospital Revenue Code	272
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,950.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

LITHOPLASTY BDC 7MM X 40CM

Facility

$16,500.00

Hospital Charge Code	270690506
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

LITHOTRIPSY

Facility

$15,223.29

Service Code	HCPCS 50590
Hospital Charge Code	1300011
Hospital Revenue Code	790
Min. Negotiated Rate	$366.88
Max. Negotiated Rate	$15,116.59
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,116.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,116.59
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,566.99
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,283.49
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$366.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$403.42

LITHOTRIPSY

Facility

$15,223.29

Service Code	HCPCS 50590
Hospital Charge Code	1300011
Hospital Revenue Code	790
Min. Negotiated Rate	$2,283.49
Max. Negotiated Rate	$2,283.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,283.49

LITHOTRIPSY***

Facility

$383.00

Hospital Charge Code	2300234
Hospital Revenue Code	759
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$191.50
Rate for Payer: Aetna Commercial	$145.54
Rate for Payer: Aetna Medicare Advantage	$114.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.67
Rate for Payer: Cigna Commercial	$191.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.90
Rate for Payer: Qualcare PPO/HMO/WC	$57.45
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10.15

LITHOTRIPSY***

Facility

$383.00

Hospital Charge Code	2300234
Hospital Revenue Code	759
Min. Negotiated Rate	$57.45
Max. Negotiated Rate	$57.45
Rate for Payer: Qualcare PPO/HMO/WC	$57.45

LITHOTRIPTER BASKET

Facility

$458.00

Hospital Charge Code	270325613
Hospital Revenue Code	272
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

LITHOTRIPTER BASKET

Facility

$458.00

Hospital Charge Code	270325613
Hospital Revenue Code	272
Min. Negotiated Rate	$11.04
Max. Negotiated Rate	$229.00
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna Medicare Advantage	$137.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.79
Rate for Payer: Cigna Commercial	$229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.40
Rate for Payer: Oxford Commercial	$91.60
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$91.60
Rate for Payer: UnitedHealthcare Community & State	$11.04
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

LITHOTRIPTER MNOLTH 0 MCV 1090

Facility

$2,222.45

Hospital Charge Code	270604774
Hospital Revenue Code	272
Min. Negotiated Rate	$53.56
Max. Negotiated Rate	$1,111.22
Rate for Payer: Aetna Commercial	$844.53
Rate for Payer: Aetna Medicare Advantage	$666.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$566.72
Rate for Payer: Cigna Commercial	$1,111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$666.74
Rate for Payer: Oxford Commercial	$444.49
Rate for Payer: Qualcare PPO/HMO/WC	$333.37
Rate for Payer: UnitedHealthcare Commercial	$444.49
Rate for Payer: UnitedHealthcare Community & State	$53.56
Rate for Payer: Wellpoint Medicaid Managed Care	$58.89

LITHOTRIPTER MNOLTH 0 MCV 1090

Facility

$2,222.45

Hospital Charge Code	270604774
Hospital Revenue Code	272
Min. Negotiated Rate	$333.37
Max. Negotiated Rate	$333.37
Rate for Payer: Qualcare PPO/HMO/WC	$333.37

LITHOTRIPTER MONLTH 2 MCV 1092

Facility

$2,222.45

Hospital Charge Code	270604776
Hospital Revenue Code	270
Min. Negotiated Rate	$53.56
Max. Negotiated Rate	$1,111.22
Rate for Payer: Aetna Commercial	$844.53
Rate for Payer: Aetna Medicare Advantage	$666.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$566.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$566.72
Rate for Payer: Cigna Commercial	$1,111.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$666.74
Rate for Payer: Oxford Commercial	$444.49
Rate for Payer: Qualcare PPO/HMO/WC	$333.37
Rate for Payer: UnitedHealthcare Commercial	$444.49
Rate for Payer: UnitedHealthcare Community & State	$53.56
Rate for Payer: Wellpoint Medicaid Managed Care	$58.89

LITHOTRIPTER MONLTH 2 MCV 1092

Facility

$2,222.45

Hospital Charge Code	270604776
Hospital Revenue Code	270
Min. Negotiated Rate	$333.37
Max. Negotiated Rate	$333.37
Rate for Payer: Qualcare PPO/HMO/WC	$333.37

LIVER ACCESS AND BIOPSY SET

Facility

$2,215.00

Hospital Charge Code	270689191
Hospital Revenue Code	272
Min. Negotiated Rate	$332.25
Max. Negotiated Rate	$332.25
Rate for Payer: Qualcare PPO/HMO/WC	$332.25

Know your out-of-pocket cost for care.

All Charges