Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NM THERPY HYPERTHYROID INITIAL

Facility

$1,374.25

Service Code	HCPCS 79105
Hospital Charge Code	4501000
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERPY HYPERTHYROID SUBSQNT

Facility

$1,374.25

Service Code	HCPCS 79105
Hospital Charge Code	4501001
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THERPY HYPERTHYROID SUBSQNT

Facility

$1,374.25

Service Code	HCPCS 79105
Hospital Charge Code	4501001
Hospital Revenue Code	342
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$522.22
Rate for Payer: Aetna Medicare Advantage	$412.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.43
Rate for Payer: Cigna Commercial	$687.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.27
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.12
Rate for Payer: Wellpoint Medicaid Managed Care	$36.42

NM THRPY ABLTON THYRD CARCNOMA

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4500998
Hospital Revenue Code	342
Min. Negotiated Rate	$292.69
Max. Negotiated Rate	$292.69
Rate for Payer: Qualcare PPO/HMO/WC	$292.69

NM THRPY ABLTON THYRD CARCNOMA

Facility

$1,951.25

Service Code	HCPCS 79005
Hospital Charge Code	4500998
Hospital Revenue Code	342
Min. Negotiated Rate	$47.03
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$754.01
Rate for Payer: Aetna Medicare Advantage	$898.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$277.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,000.64
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: Cigna Medicare Advantage	$194.05
Rate for Payer: Clover Medicare Advantage	$263.35
Rate for Payer: EmblemHealth Commercial	$831.63
Rate for Payer: Humana Medicare Advantage	$285.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$277.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.38
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.69
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$47.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$51.71

NM THRPY INTR-ARTICLR RADIOPHM

Facility

$1,374.25

Service Code	HCPCS 79440
Hospital Charge Code	4501003
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THRPY INTR-ARTICLR RADIOPHM

Facility

$1,374.25

Service Code	HCPCS 79440
Hospital Charge Code	4501003
Hospital Revenue Code	342
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$754.01
Rate for Payer: Aetna Medicare Advantage	$898.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$277.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,000.64
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: Cigna Medicare Advantage	$194.05
Rate for Payer: Clover Medicare Advantage	$263.35
Rate for Payer: EmblemHealth Commercial	$831.63
Rate for Payer: Humana Medicare Advantage	$285.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$277.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.27
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$36.42

NM THRPY NONTHYRD/NONHEMALOGIC

Facility

$1,374.25

Service Code	HCPCS 79101
Hospital Charge Code	4501006
Hospital Revenue Code	342
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Qualcare PPO/HMO/WC	$206.14

NM THRPY NONTHYRD/NONHEMALOGIC

Facility

$1,374.25

Service Code	HCPCS 79101
Hospital Charge Code	4501006
Hospital Revenue Code	342
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$754.01
Rate for Payer: Aetna Medicare Advantage	$898.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,000.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$277.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,000.64
Rate for Payer: Cigna Commercial	$555.67
Rate for Payer: Cigna Medicare Advantage	$194.05
Rate for Payer: Clover Medicare Advantage	$263.35
Rate for Payer: EmblemHealth Commercial	$831.63
Rate for Payer: Humana Medicare Advantage	$285.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$277.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.27
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.14
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$33.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$277.21
Rate for Payer: Wellcare Medicare Advantage	$277.21
Rate for Payer: Wellpoint Medicaid Managed Care	$36.42

NM THYRD IMAGING W/VASCLR FLOW

Facility

$985.85

Hospital Charge Code	4501011
Hospital Revenue Code	341
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$374.62
Rate for Payer: Aetna Medicare Advantage	$295.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.39
Rate for Payer: Cigna Commercial	$492.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.75
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.88
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$23.76
Rate for Payer: Wellpoint Medicaid Managed Care	$26.13

NM THYRD IMAGING W/VASCLR FLOW

Facility

$985.85

Hospital Charge Code	4501011
Hospital Revenue Code	341
Min. Negotiated Rate	$147.88
Max. Negotiated Rate	$147.88
Rate for Payer: Qualcare PPO/HMO/WC	$147.88

NM THYRD UPTK STIM/SPPRSS/DSCH

Facility

$1,249.20

Hospital Charge Code	4501012
Hospital Revenue Code	341
Min. Negotiated Rate	$187.38
Max. Negotiated Rate	$187.38
Rate for Payer: Qualcare PPO/HMO/WC	$187.38

NM THYRD UPTK STIM/SPPRSS/DSCH

Facility

$1,249.20

Hospital Charge Code	4501012
Hospital Revenue Code	341
Min. Negotiated Rate	$30.11
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$474.70
Rate for Payer: Aetna Medicare Advantage	$374.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.55
Rate for Payer: Cigna Commercial	$624.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$374.76
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.38
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$30.11
Rate for Payer: Wellpoint Medicaid Managed Care	$33.10

NM THYROID IMAGE W UPTAKE MULT

Facility

$1,248.00

Hospital Charge Code	4500899
Hospital Revenue Code	341
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$187.20
Rate for Payer: Qualcare PPO/HMO/WC	$187.20

NM THYROID IMAGE W UPTAKE MULT

Facility

$1,248.00

Hospital Charge Code	4500899
Hospital Revenue Code	341
Min. Negotiated Rate	$30.08
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$474.24
Rate for Payer: Aetna Medicare Advantage	$374.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.24
Rate for Payer: Cigna Commercial	$624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$374.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$30.08
Rate for Payer: Wellpoint Medicaid Managed Care	$33.07

NM THYROID IMAGE W UPTAKE SIN

Facility

$1,148.00

Hospital Charge Code	4500897
Hospital Revenue Code	341
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$172.20
Rate for Payer: Qualcare PPO/HMO/WC	$172.20

NM THYROID IMAGE W UPTAKE SIN

Facility

$1,148.00

Hospital Charge Code	4500897
Hospital Revenue Code	341
Min. Negotiated Rate	$27.67
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$436.24
Rate for Payer: Aetna Medicare Advantage	$344.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$292.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$292.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$292.74
Rate for Payer: Cigna Commercial	$574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$27.67
Rate for Payer: Wellpoint Medicaid Managed Care	$30.42

NM THYROID IMAGING ONLY

Facility

$788.52

Service Code	HCPCS 78010
Hospital Charge Code	4507005
Hospital Revenue Code	341
Min. Negotiated Rate	$118.28
Max. Negotiated Rate	$118.28
Rate for Payer: Qualcare PPO/HMO/WC	$118.28

NM THYROID IMAGING ONLY

Facility

$788.52

Service Code	HCPCS 78010
Hospital Charge Code	4507005
Hospital Revenue Code	341
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$299.64
Rate for Payer: Aetna Medicare Advantage	$236.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.07
Rate for Payer: Cigna Commercial	$394.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.56
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.28
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$19.00
Rate for Payer: Wellpoint Medicaid Managed Care	$20.90

NM-THYROID IMAGING W/UPTAKE S

Facility

$2,043.00

Service Code	HCPCS 78014
Hospital Charge Code	4507010
Hospital Revenue Code	341
Min. Negotiated Rate	$49.24
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.90
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.45
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$49.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$54.14

NM-THYROID IMAGING W/UPTAKE S

Facility

$2,043.00

Service Code	HCPCS 78014
Hospital Charge Code	4507010
Hospital Revenue Code	341
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

NM THYROID METS IMAG W ADD ST

Facility

$1,685.65

Service Code	HCPCS 78016
Hospital Charge Code	4500934
Hospital Revenue Code	341
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$505.69
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$252.85
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$40.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$44.67

NM THYROID METS IMAG W ADD ST

Facility

$1,685.65

Service Code	HCPCS 78016
Hospital Charge Code	4500934
Hospital Revenue Code	341
Min. Negotiated Rate	$252.85
Max. Negotiated Rate	$252.85
Rate for Payer: Qualcare PPO/HMO/WC	$252.85

NM THYROID METS IMA LIMIT AREA

Facility

$1,248.00

Service Code	HCPCS 78015
Hospital Charge Code	4500900
Hospital Revenue Code	341
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$187.20
Rate for Payer: Qualcare PPO/HMO/WC	$187.20

NM THYROID METS IMA LIMIT AREA

Facility

$1,248.00

Service Code	HCPCS 78015
Hospital Charge Code	4500900
Hospital Revenue Code	341
Min. Negotiated Rate	$30.08
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,714.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,714.39
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$374.40
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.20
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$30.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$33.07

Know your out-of-pocket cost for care.

All Charges