Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CH THC DAU

Facility

$44.00

Service Code	HCPCS 80300
Hospital Charge Code	397071293
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

CH THC, URINE (RANDOM)

Facility

$37.00

Service Code	HCPCS 80300
Hospital Charge Code	397071367
Hospital Revenue Code	301
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

CH THC, URINE (RANDOM)

Facility

$37.00

Service Code	HCPCS 80300
Hospital Charge Code	397071367
Hospital Revenue Code	301
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.06
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

CH THEOPHYLLINE

Facility

$128.00

Service Code	HCPCS 80198
Hospital Charge Code	397071103
Hospital Revenue Code	301
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$38.46
Rate for Payer: Aetna Medicare Advantage	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.04
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: Cigna Medicare Advantage	$14.14
Rate for Payer: Clover Medicare Advantage	$13.43
Rate for Payer: EmblemHealth Commercial	$42.42
Rate for Payer: Humana Medicare Advantage	$14.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.14
Rate for Payer: Wellcare Medicare Advantage	$14.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

CH THEOPHYLLINE

Facility

$128.00

Service Code	HCPCS 80198
Hospital Charge Code	397071103
Hospital Revenue Code	301
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

CH THER PLASMA APHERESIS

Facility

$12,480.00

Service Code	HCPCS 36514
Hospital Charge Code	397031175
Hospital Revenue Code	361
Min. Negotiated Rate	$1,872.00
Max. Negotiated Rate	$1,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00

CH THER PLASMA APHERESIS

Facility

$12,480.00

Service Code	HCPCS 36514
Hospital Charge Code	397031175
Hospital Revenue Code	361
Min. Negotiated Rate	$300.77
Max. Negotiated Rate	$6,678.88
Rate for Payer: Aetna Commercial	$5,032.71
Rate for Payer: Aetna Medicare Advantage	$5,994.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,678.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,678.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,850.26
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	$6,678.88
Rate for Payer: Cigna Commercial	$3,708.85
Rate for Payer: Cigna Medicare Advantage	$1,850.26
Rate for Payer: Clover Medicare Advantage	$1,757.75
Rate for Payer: EmblemHealth Commercial	$5,550.78
Rate for Payer: Humana Medicare Advantage	$1,905.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,850.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.00
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$300.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,850.26
Rate for Payer: Wellcare Medicare Advantage	$1,850.26
Rate for Payer: Wellpoint Medicaid Managed Care	$330.72

CH THIOCYANATE SERUM

Facility

$226.00

Service Code	HCPCS 84430
Hospital Charge Code	397073093
Hospital Revenue Code	301
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.63
Rate for Payer: Aetna Medicare Advantage	$37.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.98
Rate for Payer: Cigna Commercial	$113.00
Rate for Payer: Cigna Medicare Advantage	$11.63
Rate for Payer: Clover Medicare Advantage	$11.05
Rate for Payer: EmblemHealth Commercial	$34.89
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.90
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.63
Rate for Payer: Wellcare Medicare Advantage	$11.63
Rate for Payer: Wellpoint Medicaid Managed Care	$5.99

CH THIOCYANATE SERUM

Facility

$226.00

Service Code	HCPCS 84430
Hospital Charge Code	397073093
Hospital Revenue Code	301
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$33.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.90

CH THIOCYANATE URINE

Facility

$139.00

Service Code	HCPCS 84430
Hospital Charge Code	397073092
Hospital Revenue Code	301
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

CH THIOCYANATE URINE

Facility

$139.00

Service Code	HCPCS 84430
Hospital Charge Code	397073092
Hospital Revenue Code	301
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.63
Rate for Payer: Aetna Medicare Advantage	$37.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.98
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: Cigna Medicare Advantage	$11.63
Rate for Payer: Clover Medicare Advantage	$11.05
Rate for Payer: EmblemHealth Commercial	$34.89
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.63
Rate for Payer: Wellcare Medicare Advantage	$11.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.68

CH THIORIDAZINE

Facility

$144.00

Service Code	HCPCS 80342
Hospital Charge Code	397072128
Hospital Revenue Code	301
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

CH THIORIDAZINE

Facility

$144.00

Service Code	HCPCS 80342
Hospital Charge Code	397072128
Hospital Revenue Code	301
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

CH THROMBIN TIME

Facility

$78.00

Service Code	HCPCS 85670
Hospital Charge Code	397021032
Hospital Revenue Code	305
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.83
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

CH THROMBIN TIME

Facility

$78.00

Service Code	HCPCS 85670
Hospital Charge Code	397021032
Hospital Revenue Code	305
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

CH THROMBOPHILIA W/REF HR2

Facility

$1,939.00

Hospital Charge Code	3970730
Hospital Revenue Code	301
Min. Negotiated Rate	$46.73
Max. Negotiated Rate	$969.50
Rate for Payer: Aetna Commercial	$736.82
Rate for Payer: Aetna Medicare Advantage	$581.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.44
Rate for Payer: Cigna Commercial	$969.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$581.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$290.85
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$46.73
Rate for Payer: Wellpoint Medicaid Managed Care	$51.38

CH THROMBOPHILIA W/REF HR2

Facility

$1,939.00

Hospital Charge Code	3970730
Hospital Revenue Code	301
Min. Negotiated Rate	$290.85
Max. Negotiated Rate	$290.85
Rate for Payer: Qualcare PPO/HMO/WC	$290.85

CH THYOXINE BIND GLOBULN TBG

Facility

$180.00

Service Code	HCPCS 84442
Hospital Charge Code	397072130
Hospital Revenue Code	301
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$40.20
Rate for Payer: Aetna Medicare Advantage	$47.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.35
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: Cigna Medicare Advantage	$14.78
Rate for Payer: Clover Medicare Advantage	$14.04
Rate for Payer: EmblemHealth Commercial	$44.34
Rate for Payer: Humana Medicare Advantage	$15.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$11.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.78
Rate for Payer: Wellcare Medicare Advantage	$14.78
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

CH THYOXINE BIND GLOBULN TBG

Facility

$180.00

Service Code	HCPCS 84442
Hospital Charge Code	397072130
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

CH THYROGLOBULIN

Facility

$382.00

Service Code	HCPCS 84432
Hospital Charge Code	397072129
Hospital Revenue Code	301
Min. Negotiated Rate	$57.30
Max. Negotiated Rate	$57.30
Rate for Payer: Qualcare PPO/HMO/WC	$57.30

CH THYROGLOBULIN

Facility

$382.00

Service Code	HCPCS 84432
Hospital Charge Code	397072129
Hospital Revenue Code	301
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$191.00
Rate for Payer: Aetna Commercial	$43.68
Rate for Payer: Aetna Medicare Advantage	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.97
Rate for Payer: Cigna Commercial	$191.00
Rate for Payer: Cigna Medicare Advantage	$16.06
Rate for Payer: Clover Medicare Advantage	$15.26
Rate for Payer: EmblemHealth Commercial	$48.18
Rate for Payer: Humana Medicare Advantage	$16.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.30
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.06
Rate for Payer: Wellcare Medicare Advantage	$16.06
Rate for Payer: Wellpoint Medicaid Managed Care	$10.12

CH THYROID CASCADING REFLEX

Facility

$629.00

Service Code	HCPCS 84443
Hospital Charge Code	397071392
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$314.50
Rate for Payer: Aetna Commercial	$45.70
Rate for Payer: Aetna Medicare Advantage	$54.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.64
Rate for Payer: Cigna Commercial	$314.50
Rate for Payer: Cigna Medicare Advantage	$16.80
Rate for Payer: Clover Medicare Advantage	$15.96
Rate for Payer: EmblemHealth Commercial	$50.40
Rate for Payer: Humana Medicare Advantage	$17.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$94.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.80
Rate for Payer: Wellcare Medicare Advantage	$16.80
Rate for Payer: Wellpoint Medicaid Managed Care	$16.67

CH THYROID CASCADING REFLEX

Facility

$629.00

Service Code	HCPCS 84443
Hospital Charge Code	397071392
Hospital Revenue Code	301
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$94.35
Rate for Payer: Qualcare PPO/HMO/WC	$94.35

CH THYROID STIM IMMUNOGLOBUL

Facility

$1,041.00

Service Code	HCPCS 84445
Hospital Charge Code	397072019
Hospital Revenue Code	301
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$520.50
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna Medicare Advantage	$164.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$50.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.59
Rate for Payer: Cigna Commercial	$520.50
Rate for Payer: Cigna Medicare Advantage	$50.86
Rate for Payer: Clover Medicare Advantage	$48.32
Rate for Payer: EmblemHealth Commercial	$152.58
Rate for Payer: Humana Medicare Advantage	$52.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$50.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$156.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$40.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.86
Rate for Payer: Wellcare Medicare Advantage	$50.86
Rate for Payer: Wellpoint Medicaid Managed Care	$27.59

CH THYROID STIM IMMUNOGLOBUL

Facility

$1,041.00

Service Code	HCPCS 84445
Hospital Charge Code	397072019
Hospital Revenue Code	301
Min. Negotiated Rate	$156.15
Max. Negotiated Rate	$156.15
Rate for Payer: Qualcare PPO/HMO/WC	$156.15

Know your out-of-pocket cost for care.

All Charges