Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LUPUS PROFILE II

Facility

$667.59

Service Code	HCPCS 85730
Hospital Charge Code	39990077B
Hospital Revenue Code	305
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$16.35
Rate for Payer: Aetna Medicare Advantage	$19.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.69
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.01
Rate for Payer: Clover Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$6.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.01
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	$4.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.01
Rate for Payer: Wellcare Medicare Advantage	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

LUPUS PROFILE II

Facility

$667.59

Service Code	HCPCS 85730
Hospital Charge Code	39990077B
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LURIDE/1MG/TAB

Facility

$3.00

Hospital Charge Code	60633338
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

LURIDE/1MG/TAB

Facility

$3.00

Hospital Charge Code	60633338
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LURIDE-SF/1MG/TAB

Facility

$3.00

Hospital Charge Code	60633340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

LURIDE-SF/1MG/TAB

Facility

$3.00

Hospital Charge Code	60633340
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

LURIDE SUGAR FREE/0.125MG

Facility

$49.00

Hospital Charge Code	60633339
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

LURIDE SUGAR FREE/0.125MG

Facility

$49.00

Hospital Charge Code	60633339
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

LUTEINIZING HORMONE (LH)

Facility

$633.00

Service Code	HCPCS 83002
Hospital Charge Code	38472467
Hospital Revenue Code	301
Min. Negotiated Rate	$94.95
Max. Negotiated Rate	$94.95
Rate for Payer: Qualcare PPO/HMO/WC	$94.95

LUTEINIZING HORMONE (LH)

Facility

$633.00

Service Code	HCPCS 83002
Hospital Charge Code	38472467
Hospital Revenue Code	301
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$316.50
Rate for Payer: Aetna Commercial	$50.37
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.85
Rate for Payer: Cigna Commercial	$316.50
Rate for Payer: Cigna Medicare Advantage	$18.52
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.90
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.95
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Medicare Advantage	$18.52
Rate for Payer: Wellpoint Medicaid Managed Care	$16.77

LUTEINIZING HORMONE, LH

Facility

$192.85

Service Code	HCPCS 83002
Hospital Charge Code	3006319
Hospital Revenue Code	301
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.37
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.85
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: Cigna Medicare Advantage	$18.52
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.85
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Medicare Advantage	$18.52
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

LUTEINIZING HORMONE, LH

Facility

$192.85

Service Code	HCPCS 83002
Hospital Charge Code	3006319
Hospital Revenue Code	301
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

LUVOX 100MG UD

Facility

$7.00

Hospital Charge Code	60635095
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

LUVOX 100MG UD

Facility

$7.00

Hospital Charge Code	60635095
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LUVOX 50MG UD

Facility

$7.00

Hospital Charge Code	60635094
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LUVOX 50MG UD

Facility

$7.00

Hospital Charge Code	60635094
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

L VENTRIC PACING LEAD ADD ON

Facility

$27,941.00

Service Code	HCPCS 33225
Hospital Charge Code	411033225
Hospital Revenue Code	481
Min. Negotiated Rate	$673.38
Max. Negotiated Rate	$17,313.00
Rate for Payer: Aetna Commercial	$10,617.58
Rate for Payer: Aetna Medicare Advantage	$8,382.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,124.95
Rate for Payer: Cigna Commercial	$13,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,382.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$10,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,191.15
Rate for Payer: UnitedHealthcare Commercial	$17,313.00
Rate for Payer: UnitedHealthcare Community & State	$673.38
Rate for Payer: Wellpoint Medicaid Managed Care	$740.44

L VENTRIC PACING LEAD ADD ON

Facility

$27,941.00

Service Code	HCPCS 33225
Hospital Charge Code	411033225
Hospital Revenue Code	481
Min. Negotiated Rate	$4,191.15
Max. Negotiated Rate	$4,191.15
Rate for Payer: Qualcare PPO/HMO/WC	$4,191.15

LV GRAM INJ

Facility

$1,061.55

Service Code	HCPCS 93565
Hospital Charge Code	5100185
Hospital Revenue Code	481
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$403.39
Rate for Payer: Aetna Medicare Advantage	$318.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.70
Rate for Payer: Cigna Commercial	$530.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.23
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$25.58
Rate for Payer: Wellpoint Medicaid Managed Care	$28.13

LV GRAM INJ

Facility

$1,061.55

Service Code	HCPCS 93565
Hospital Charge Code	5100185
Hospital Revenue Code	481
Min. Negotiated Rate	$159.23
Max. Negotiated Rate	$159.23
Rate for Payer: Qualcare PPO/HMO/WC	$159.23

LV GRAM INJ

Facility

$1,061.55

Service Code	HCPCS 93565
Hospital Charge Code	74110020
Hospital Revenue Code	481
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$403.39
Rate for Payer: Aetna Medicare Advantage	$318.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$270.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$270.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$270.70
Rate for Payer: Cigna Commercial	$530.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.23
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$25.58
Rate for Payer: Wellpoint Medicaid Managed Care	$28.13

LV GRAM INJ

Facility

$1,061.55

Service Code	HCPCS 93565
Hospital Charge Code	74110020
Hospital Revenue Code	481
Min. Negotiated Rate	$159.23
Max. Negotiated Rate	$159.23
Rate for Payer: Qualcare PPO/HMO/WC	$159.23

LYME AB IGG, IGM IFA CSF I

Facility

$390.00

Service Code	HCPCS 8661891
Hospital Charge Code	39990086A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LYME AB IGG, IGM IFA CSF I

Facility

$390.00

Service Code	HCPCS 8661891
Hospital Charge Code	39990086A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

LYME AB IGG, IGM IFA CSF II

Facility

$390.00

Service Code	HCPCS 8661891
Hospital Charge Code	39990086B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges