Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LUBRIGLIDE COATED GUIDWIRE 3C

Facility

$213.10

Hospital Charge Code	270652682
Hospital Revenue Code	270
Min. Negotiated Rate	$31.96
Max. Negotiated Rate	$31.96
Rate for Payer: Qualcare PPO/HMO/WC	$31.96

LUBRIGLIDE COATED GUIDWIRE 3C

Facility

$213.10

Hospital Charge Code	270652682
Hospital Revenue Code	270
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$106.55
Rate for Payer: Aetna Commercial	$80.98
Rate for Payer: Aetna Medicare Advantage	$63.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.34
Rate for Payer: Cigna Commercial	$106.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.93
Rate for Payer: Oxford Commercial	$42.62
Rate for Payer: Qualcare PPO/HMO/WC	$31.96
Rate for Payer: UnitedHealthcare Commercial	$42.62
Rate for Payer: UnitedHealthcare Community & State	$5.14
Rate for Payer: Wellpoint Medicaid Managed Care	$5.65

LUBRI-GLIDE GUIDEWIRE MOVABLE

Facility

$303.00

Hospital Charge Code	270330754
Hospital Revenue Code	278
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$73.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.66
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

LUBRI-GLIDE GUIDEWIRE MOVABLE

Facility

$303.00

Hospital Charge Code	270330754
Hospital Revenue Code	278
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$115.14
Rate for Payer: Aetna Medicare Advantage	$90.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.27
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.66
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Community & State	$7.30
Rate for Payer: Wellpoint Medicaid Managed Care	$8.03

LUDIMOL/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634386
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

LUDIMOL/25MG/TAB

Facility

$3.00

Hospital Charge Code	60634386
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LUDIMOL/75MG/TAB

Facility

$3.00

Hospital Charge Code	60634385
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

LUDIMOL/75MG/TAB

Facility

$3.00

Hospital Charge Code	60634385
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LUDIOMIL/50MG/TAB

Facility

$6.00

Hospital Charge Code	60633335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

LUDIOMIL/50MG/TAB

Facility

$6.00

Hospital Charge Code	60633335
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

LUGOL'S 8 ML UD SOLUTION

Facility

$73.30

Service Code	NDC 10481011108
Hospital Charge Code	60629842
Hospital Revenue Code	250
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$10.99
Rate for Payer: Qualcare PPO/HMO/WC	$10.99

LUGOL'S 8 ML UD SOLUTION

Facility

$73.30

Service Code	NDC 10481011108
Hospital Charge Code	60629842
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$36.65
Rate for Payer: Aetna Commercial	$27.85
Rate for Payer: Aetna Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.69
Rate for Payer: Cigna Commercial	$36.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.99
Rate for Payer: Oxford Commercial	$14.66
Rate for Payer: Qualcare PPO/HMO/WC	$10.99
Rate for Payer: UnitedHealthcare Commercial	$14.66
Rate for Payer: UnitedHealthcare Community & State	$1.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.94

LUGOL'S SOLUTION

Facility

$9.00

Hospital Charge Code	60634768
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

LUGOL'S SOLUTION

Facility

$9.00

Hospital Charge Code	60634768
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

LUMBAR ANCHORS 25MM

Facility

$3,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705490
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

LUMBAR ANCHORS 25MM

Facility

$3,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705490
Hospital Revenue Code	278
Min. Negotiated Rate	$75.31
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Community & State	$75.31
Rate for Payer: Wellpoint Medicaid Managed Care	$82.81

LUMBAR EPIDURAL INJECTION****

Facility

$330.00

Hospital Charge Code	1001145
Hospital Revenue Code	361
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$49.50

LUMBAR EPIDURAL INJECTION****

Facility

$330.00

Hospital Charge Code	1001145
Hospital Revenue Code	361
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$125.40
Rate for Payer: Aetna Medicare Advantage	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.15
Rate for Payer: Cigna Commercial	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.50
Rate for Payer: UnitedHealthcare Community & State	$7.95
Rate for Payer: Wellpoint Medicaid Managed Care	$8.74

LUMBAR PLEXUS BLOCK BIL

Facility

$5,939.55

Service Code	HCPCS 6452050
Hospital Charge Code	1650121
Hospital Revenue Code	361
Min. Negotiated Rate	$143.14
Max. Negotiated Rate	$2,969.78
Rate for Payer: Aetna Commercial	$2,257.03
Rate for Payer: Aetna Medicare Advantage	$1,781.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,514.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,514.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,514.59
Rate for Payer: Cigna Commercial	$2,969.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,781.87
Rate for Payer: Qualcare PPO/HMO/WC	$890.93
Rate for Payer: UnitedHealthcare Community & State	$143.14
Rate for Payer: Wellpoint Medicaid Managed Care	$157.40

LUMBAR PLEXUS BLOCK BIL

Facility

$5,939.55

Service Code	HCPCS 6452050
Hospital Charge Code	1650121
Hospital Revenue Code	361
Min. Negotiated Rate	$890.93
Max. Negotiated Rate	$890.93
Rate for Payer: Qualcare PPO/HMO/WC	$890.93

LUMBAR PLEXUS BLOCK UNI

Facility

$3,959.70

Service Code	HCPCS 64520
Hospital Charge Code	1650120
Hospital Revenue Code	361
Min. Negotiated Rate	$593.96
Max. Negotiated Rate	$593.96
Rate for Payer: Qualcare PPO/HMO/WC	$593.96

LUMBAR PLEXUS BLOCK UNI

Facility

$3,959.70

Service Code	HCPCS 64520
Hospital Charge Code	1650120
Hospital Revenue Code	361
Min. Negotiated Rate	$95.43
Max. Negotiated Rate	$3,793.00
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,793.00
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,187.91
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$593.96
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$95.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$104.93

LUMBAR PUNCTURE

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	1001135
Hospital Revenue Code	361
Min. Negotiated Rate	$76.78
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
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	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.73
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$477.86
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$76.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$84.42

LUMBAR PUNCTURE

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	93500003
Hospital Revenue Code	761
Min. Negotiated Rate	$76.78
Max. Negotiated Rate	$3,027.13
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,027.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,027.13
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.73
Rate for Payer: Oxford Commercial	$637.15
Rate for Payer: Qualcare PPO/HMO/WC	$477.86
Rate for Payer: UnitedHealthcare Commercial	$637.15
Rate for Payer: UnitedHealthcare Community & State	$76.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$84.42

LUMBAR PUNCTURE

Facility

$3,185.75

Service Code	HCPCS 62270
Hospital Charge Code	93500003
Hospital Revenue Code	761
Min. Negotiated Rate	$477.86
Max. Negotiated Rate	$477.86
Rate for Payer: Qualcare PPO/HMO/WC	$477.86

Know your out-of-pocket cost for care.

All Charges