Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LRG BNE OSCLLTNG BLD 63.0X49MM

Facility

$35.00

Hospital Charge Code	270662589
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.50
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

LRG ROCKER SHOE - LNG

Facility

$8,167.40

Hospital Charge Code	270702829
Hospital Revenue Code	278
Min. Negotiated Rate	$196.83
Max. Negotiated Rate	$4,083.70
Rate for Payer: Aetna Commercial	$3,103.61
Rate for Payer: Aetna Medicare Advantage	$2,450.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,082.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,082.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,633.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,082.69
Rate for Payer: Cigna Commercial	$4,083.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,976.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,796.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,225.11
Rate for Payer: UnitedHealthcare Community & State	$196.83
Rate for Payer: Wellpoint Medicaid Managed Care	$216.44

LRG ROCKER SHOE - LNG

Facility

$8,167.40

Hospital Charge Code	270702829
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.11
Max. Negotiated Rate	$1,976.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,633.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,976.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,796.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,225.11

LR IRRIGANT 3000CC 2B7487

Facility

$29.78

Hospital Charge Code	270645428
Hospital Revenue Code	272
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Qualcare PPO/HMO/WC	$4.47

LR IRRIGANT 3000CC 2B7487

Facility

$29.78

Hospital Charge Code	270645428
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.89
Rate for Payer: Aetna Commercial	$11.32
Rate for Payer: Aetna Medicare Advantage	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.59
Rate for Payer: Cigna Commercial	$14.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.93
Rate for Payer: Oxford Commercial	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$4.47
Rate for Payer: UnitedHealthcare Commercial	$5.96
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

LSFMC DI RY 2ND & 3RD TMT PT

Facility

$8,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270701595
Hospital Revenue Code	278
Min. Negotiated Rate	$201.48
Max. Negotiated Rate	$4,180.00
Rate for Payer: Aetna Commercial	$3,176.80
Rate for Payer: Aetna Medicare Advantage	$2,508.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,131.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,131.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,131.80
Rate for Payer: Cigna Commercial	$4,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,023.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,839.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,254.00
Rate for Payer: UnitedHealthcare Community & State	$201.48
Rate for Payer: Wellpoint Medicaid Managed Care	$221.54

LSFMC DI RY 2ND & 3RD TMT PT

Facility

$8,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270701595
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.00
Max. Negotiated Rate	$2,023.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,023.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,839.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,254.00

L/S RATIO***

Facility

$67.00

Hospital Charge Code	3010261
Hospital Revenue Code	301
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

L/S RATIO***

Facility

$67.00

Hospital Charge Code	3010261
Hospital Revenue Code	301
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

L/S RATIO, AMNIOTIC FLUID

Facility

$437.00

Service Code	HCPCS 83661
Hospital Charge Code	38473110
Hospital Revenue Code	301
Min. Negotiated Rate	$65.55
Max. Negotiated Rate	$65.55
Rate for Payer: Qualcare PPO/HMO/WC	$65.55

L/S RATIO, AMNIOTIC FLUID

Facility

$437.00

Service Code	HCPCS 83661
Hospital Charge Code	38473110
Hospital Revenue Code	301
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$218.50
Rate for Payer: Aetna Commercial	$59.81
Rate for Payer: Aetna Medicare Advantage	$71.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.38
Rate for Payer: Cigna Commercial	$218.50
Rate for Payer: Cigna Medicare Advantage	$21.99
Rate for Payer: Clover Medicare Advantage	$20.89
Rate for Payer: EmblemHealth Commercial	$65.97
Rate for Payer: Humana Medicare Advantage	$22.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.99
Rate for Payer: Wellcare Medicare Advantage	$21.99
Rate for Payer: Wellpoint Medicaid Managed Care	$11.58

LS TIBIAL BEARING 22MM

Facility

$5,625.00

Hospital Charge Code	270678333
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

LS TIBIAL BEARING 22MM

Facility

$5,625.00

Hospital Charge Code	270678333
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

LT PIPE STORZ FITTING THREADED

Facility

$2,920.05

Service Code	HCPCS C1713
Hospital Charge Code	270704143
Hospital Revenue Code	278
Min. Negotiated Rate	$438.01
Max. Negotiated Rate	$706.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$584.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$642.41
Rate for Payer: Qualcare PPO/HMO/WC	$438.01

LT PIPE STORZ FITTING THREADED

Facility

$2,920.05

Service Code	HCPCS C1713
Hospital Charge Code	270704143
Hospital Revenue Code	278
Min. Negotiated Rate	$70.37
Max. Negotiated Rate	$1,460.03
Rate for Payer: Aetna Commercial	$1,109.62
Rate for Payer: Aetna Medicare Advantage	$876.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$584.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$744.61
Rate for Payer: Cigna Commercial	$1,460.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$642.41
Rate for Payer: Qualcare PPO/HMO/WC	$438.01
Rate for Payer: UnitedHealthcare Community & State	$70.37
Rate for Payer: Wellpoint Medicaid Managed Care	$77.38

LTX NANOTEC SPACER 6X22X55MM 1

Facility

$50,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270706118
Hospital Revenue Code	278
Min. Negotiated Rate	$7,631.25
Max. Negotiated Rate	$12,311.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,311.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,192.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,631.25

LTX NANOTEC SPACER 6X22X55MM 1

Facility

$50,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270706118
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.09
Max. Negotiated Rate	$25,437.50
Rate for Payer: Aetna Commercial	$19,332.50
Rate for Payer: Aetna Medicare Advantage	$15,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,973.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,973.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,973.12
Rate for Payer: Cigna Commercial	$25,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,311.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,192.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,631.25
Rate for Payer: UnitedHealthcare Community & State	$1,226.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1,348.19

LUBRICANT EYE DROPS UD

Facility

$4.00

Service Code	NDC 23050601
Hospital Charge Code	60628083
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LUBRICANT EYE DROPS UD

Facility

$4.00

Service Code	NDC 23050601
Hospital Charge Code	60628083
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

LUBRICANT MIDAS REX

Facility

$31.00

Hospital Charge Code	270335561
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

LUBRICANT MIDAS REX

Facility

$31.00

Hospital Charge Code	270335561
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.30
Rate for Payer: Oxford Commercial	$6.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$6.20
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

LUBRICANT VIPERSLIDE 20ml

Facility

$400.00

Hospital Charge Code	270642016C
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

LUBRICANT VIPERSLIDE 20ml

Facility

$400.00

Hospital Charge Code	270642016C
Hospital Revenue Code	272
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

LUBRICATI EYE DRPS 15ML

Facility

$73.00

Hospital Charge Code	6003370
Hospital Revenue Code	251
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

LUBRICATI EYE DRPS 15ML

Facility

$73.00

Hospital Charge Code	6003370
Hospital Revenue Code	251
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.90
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

Know your out-of-pocket cost for care.

All Charges