Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LOGOL'S SOLN/15ML

Facility

$56.00

Hospital Charge Code	60634571
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

LO IMPLANT, 8x10x25MM

Facility

$29,335.00

Hospital Charge Code	270665931
Hospital Revenue Code	270
Min. Negotiated Rate	$706.97
Max. Negotiated Rate	$14,667.50
Rate for Payer: Aetna Commercial	$11,147.30
Rate for Payer: Aetna Medicare Advantage	$8,800.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,480.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,480.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,480.43
Rate for Payer: Cigna Commercial	$14,667.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,800.50
Rate for Payer: Oxford Commercial	$5,867.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,400.25
Rate for Payer: UnitedHealthcare Commercial	$5,867.00
Rate for Payer: UnitedHealthcare Community & State	$706.97
Rate for Payer: Wellpoint Medicaid Managed Care	$777.38

LO IMPLANT, 8x10x25MM

Facility

$29,335.00

Hospital Charge Code	270665931
Hospital Revenue Code	270
Min. Negotiated Rate	$4,400.25
Max. Negotiated Rate	$4,400.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,400.25

LO IMPLANT 8X10X30MM

Facility

$28,205.00

Hospital Charge Code	270657294
Hospital Revenue Code	278
Min. Negotiated Rate	$4,230.75
Max. Negotiated Rate	$6,825.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,641.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,825.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,205.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,230.75

LO IMPLANT 8X10X30MM

Facility

$28,205.00

Hospital Charge Code	270657294
Hospital Revenue Code	278
Min. Negotiated Rate	$679.74
Max. Negotiated Rate	$14,102.50
Rate for Payer: Aetna Commercial	$10,717.90
Rate for Payer: Aetna Medicare Advantage	$8,461.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,192.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,192.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,641.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,192.27
Rate for Payer: Cigna Commercial	$14,102.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,825.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,205.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,230.75
Rate for Payer: UnitedHealthcare Community & State	$679.74
Rate for Payer: Wellpoint Medicaid Managed Care	$747.43

LO IMPLANT 8X10X30MM

Facility

$29,335.00

Hospital Charge Code	270657291
Hospital Revenue Code	278
Min. Negotiated Rate	$4,400.25
Max. Negotiated Rate	$7,099.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,867.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,099.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,453.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,400.25

LO IMPLANT 8X10X30MM

Facility

$29,335.00

Hospital Charge Code	270657291
Hospital Revenue Code	278
Min. Negotiated Rate	$706.97
Max. Negotiated Rate	$14,667.50
Rate for Payer: Aetna Commercial	$11,147.30
Rate for Payer: Aetna Medicare Advantage	$8,800.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,480.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,480.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,480.43
Rate for Payer: Cigna Commercial	$14,667.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,099.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,453.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,400.25
Rate for Payer: UnitedHealthcare Community & State	$706.97
Rate for Payer: Wellpoint Medicaid Managed Care	$777.38

LOKELMA 10 GM

Facility

$174.20

Service Code	NDC 310111039
Hospital Charge Code	606390285
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$26.13
Rate for Payer: Qualcare PPO/HMO/WC	$26.13

LOKELMA 10 GM

Facility

$174.20

Service Code	NDC 310111039
Hospital Charge Code	606390285
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$87.10
Rate for Payer: Aetna Commercial	$66.20
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.42
Rate for Payer: Cigna Commercial	$87.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.26
Rate for Payer: Oxford Commercial	$34.84
Rate for Payer: Qualcare PPO/HMO/WC	$26.13
Rate for Payer: UnitedHealthcare Commercial	$34.84
Rate for Payer: UnitedHealthcare Community & State	$4.20
Rate for Payer: Wellpoint Medicaid Managed Care	$4.62

LOKELMA 5 GM

Facility

$174.20

Service Code	NDC 310110539
Hospital Charge Code	606390284
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$87.10
Rate for Payer: Aetna Commercial	$66.20
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.42
Rate for Payer: Cigna Commercial	$87.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.26
Rate for Payer: Oxford Commercial	$34.84
Rate for Payer: Qualcare PPO/HMO/WC	$26.13
Rate for Payer: UnitedHealthcare Commercial	$34.84
Rate for Payer: UnitedHealthcare Community & State	$4.20
Rate for Payer: Wellpoint Medicaid Managed Care	$4.62

LOKELMA 5 GM

Facility

$174.20

Service Code	NDC 310110539
Hospital Charge Code	606390284
Hospital Revenue Code	250
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$26.13
Rate for Payer: Qualcare PPO/HMO/WC	$26.13

LOMOTIL/60ML

Facility

$48.00

Hospital Charge Code	60633312
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

LOMOTIL/60ML

Facility

$48.00

Hospital Charge Code	60633312
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

LOMOTIL/TAB

Facility

$4.00

Hospital Charge Code	60633313
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

LOMOTIL/TAB

Facility

$4.00

Hospital Charge Code	60633313
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LOMUSTINE 2 CAP 100MG

Facility

$195.85

Hospital Charge Code	6003354
Hospital Revenue Code	251
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$29.38
Rate for Payer: Qualcare PPO/HMO/WC	$29.38

LOMUSTINE 2 CAP 100MG

Facility

$195.85

Hospital Charge Code	6003354
Hospital Revenue Code	251
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$97.92
Rate for Payer: Aetna Commercial	$74.42
Rate for Payer: Aetna Medicare Advantage	$58.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$97.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.76
Rate for Payer: Oxford Commercial	$39.17
Rate for Payer: Qualcare PPO/HMO/WC	$29.38
Rate for Payer: UnitedHealthcare Commercial	$39.17
Rate for Payer: UnitedHealthcare Community & State	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

LONG ACTING THYROID STIM****

Facility

$148.00

Hospital Charge Code	3011863
Hospital Revenue Code	309
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

LONG ACTING THYROID STIM****

Facility

$148.00

Hospital Charge Code	3011863
Hospital Revenue Code	309
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$56.24
Rate for Payer: Aetna Medicare Advantage	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.74
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

LONG BLADE EXTENDER

Facility

$875.00

Hospital Charge Code	270694230
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

LONG BLADE EXTENDER

Facility

$875.00

Hospital Charge Code	270694230
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

LONG DRILL 4.3

Facility

$800.00

Hospital Charge Code	270657844
Hospital Revenue Code	272
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

LONG DRILL 4.3

Facility

$800.00

Hospital Charge Code	270657844
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

longevity dm bearing 28 x 40mm

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270690807
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

longevity dm bearing 28 x 40mm

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270690807
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

Know your out-of-pocket cost for care.

All Charges