Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38472626
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$146.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$7.74

T3 UPTAKE (THBR)

Facility

$667.59

Service Code	HCPCS 84479
Hospital Charge Code	3002516
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

T3 UPTAKE (THBR)

Facility

$667.59

Service Code	HCPCS 84479
Hospital Charge Code	3002516
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
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	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

T4 FREE

Facility

$634.20

Service Code	HCPCS 84439
Hospital Charge Code	38472632
Hospital Revenue Code	301
Min. Negotiated Rate	$95.13
Max. Negotiated Rate	$95.13
Rate for Payer: Qualcare PPO/HMO/WC	$95.13

T4 FREE

Facility

$634.20

Service Code	HCPCS 84439
Hospital Charge Code	38472632
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$317.10
Rate for Payer: Aetna Commercial	$24.53
Rate for Payer: Aetna Medicare Advantage	$29.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.56
Rate for Payer: Cigna Commercial	$317.10
Rate for Payer: Cigna Medicare Advantage	$9.02
Rate for Payer: Clover Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$27.06
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.26
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.13
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.02
Rate for Payer: Wellcare Medicare Advantage	$9.02
Rate for Payer: Wellpoint Medicaid Managed Care	$16.81

T4 FREE (THYROXINE)

Facility

$775.43

Service Code	HCPCS 84439
Hospital Charge Code	3001328
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$387.71
Rate for Payer: Aetna Commercial	$24.53
Rate for Payer: Aetna Medicare Advantage	$29.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.56
Rate for Payer: Cigna Commercial	$387.71
Rate for Payer: Cigna Medicare Advantage	$9.02
Rate for Payer: Clover Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$27.06
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.63
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.31
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.02
Rate for Payer: Wellcare Medicare Advantage	$9.02
Rate for Payer: Wellpoint Medicaid Managed Care	$20.55

T4 FREE (THYROXINE)

Facility

$775.43

Service Code	HCPCS 84439
Hospital Charge Code	3001328
Hospital Revenue Code	301
Min. Negotiated Rate	$116.31
Max. Negotiated Rate	$116.31
Rate for Payer: Qualcare PPO/HMO/WC	$116.31

T4 HOODS

Facility

$98.03

Hospital Charge Code	270654872
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

T4 HOODS

Facility

$98.03

Hospital Charge Code	270654872
Hospital Revenue Code	270
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.02
Rate for Payer: Aetna Commercial	$37.25
Rate for Payer: Aetna Medicare Advantage	$29.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.00
Rate for Payer: Cigna Commercial	$49.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.41
Rate for Payer: Oxford Commercial	$19.61
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$19.61
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

T4 PERSONAL PROTECTIVE SEPTEM

Facility

$5,314.05

Hospital Charge Code	270656389
Hospital Revenue Code	272
Min. Negotiated Rate	$797.11
Max. Negotiated Rate	$797.11
Rate for Payer: Qualcare PPO/HMO/WC	$797.11

T4 PERSONAL PROTECTIVE SEPTEM

Facility

$5,314.05

Hospital Charge Code	270656389
Hospital Revenue Code	272
Min. Negotiated Rate	$128.07
Max. Negotiated Rate	$2,657.03
Rate for Payer: Aetna Commercial	$2,019.34
Rate for Payer: Aetna Medicare Advantage	$1,594.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,355.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,355.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,355.08
Rate for Payer: Cigna Commercial	$2,657.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,594.21
Rate for Payer: Oxford Commercial	$1,062.81
Rate for Payer: Qualcare PPO/HMO/WC	$797.11
Rate for Payer: UnitedHealthcare Commercial	$1,062.81
Rate for Payer: UnitedHealthcare Community & State	$128.07
Rate for Payer: Wellpoint Medicaid Managed Care	$140.82

T4 (THYROXINE)

Facility

$394.80

Service Code	HCPCS 84436
Hospital Charge Code	38472629
Hospital Revenue Code	301
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$59.22
Rate for Payer: Qualcare PPO/HMO/WC	$59.22

T4 (THYROXINE)

Facility

$394.80

Service Code	HCPCS 84436
Hospital Charge Code	38472629
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$197.40
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.80
Rate for Payer: Cigna Commercial	$197.40
Rate for Payer: Cigna Medicare Advantage	$6.87
Rate for Payer: Clover Medicare Advantage	$6.53
Rate for Payer: EmblemHealth Commercial	$20.61
Rate for Payer: Humana Medicare Advantage	$7.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.44
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.22
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.87
Rate for Payer: Wellcare Medicare Advantage	$6.87
Rate for Payer: Wellpoint Medicaid Managed Care	$10.46

T4 TOTAL

Facility

$675.81

Service Code	HCPCS 84436
Hospital Charge Code	3002524A
Hospital Revenue Code	301
Min. Negotiated Rate	$101.37
Max. Negotiated Rate	$101.37
Rate for Payer: Qualcare PPO/HMO/WC	$101.37

T4 TOTAL

Facility

$675.81

Service Code	HCPCS 84436
Hospital Charge Code	3002524A
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$337.90
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.80
Rate for Payer: Cigna Commercial	$337.90
Rate for Payer: Cigna Medicare Advantage	$6.87
Rate for Payer: Clover Medicare Advantage	$6.53
Rate for Payer: EmblemHealth Commercial	$20.61
Rate for Payer: Humana Medicare Advantage	$7.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.74
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$101.37
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.87
Rate for Payer: Wellcare Medicare Advantage	$6.87
Rate for Payer: Wellpoint Medicaid Managed Care	$17.91

TA 11 30-3.5 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334704
Hospital Revenue Code	272
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

TA 11 30-3.5 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334704
Hospital Revenue Code	272
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$155.42
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.70
Rate for Payer: Oxford Commercial	$81.80
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Commercial	$81.80
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: Wellpoint Medicaid Managed Care	$10.84

TA 11 30-4.8 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334705
Hospital Revenue Code	272
Min. Negotiated Rate	$9.86
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$155.42
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.70
Rate for Payer: Oxford Commercial	$81.80
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Commercial	$81.80
Rate for Payer: UnitedHealthcare Community & State	$9.86
Rate for Payer: Wellpoint Medicaid Managed Care	$10.84

TA 11 30-4.8 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334705
Hospital Revenue Code	272
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

TA 11 55-3.5 LOADING UNIT

Facility

$366.00

Hospital Charge Code	270334710
Hospital Revenue Code	272
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Qualcare PPO/HMO/WC	$54.90

TA 11 55-3.5 LOADING UNIT

Facility

$366.00

Hospital Charge Code	270334710
Hospital Revenue Code	272
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$139.08
Rate for Payer: Aetna Medicare Advantage	$109.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.33
Rate for Payer: Cigna Commercial	$183.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.80
Rate for Payer: Oxford Commercial	$73.20
Rate for Payer: Qualcare PPO/HMO/WC	$54.90
Rate for Payer: UnitedHealthcare Commercial	$73.20
Rate for Payer: UnitedHealthcare Community & State	$8.82
Rate for Payer: Wellpoint Medicaid Managed Care	$9.70

TA 30 3.5/4.8 LOAD UNIT *****

Facility

$131.00

Hospital Charge Code	1601004
Hospital Revenue Code	272
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

TA 30 3.5/4.8 LOAD UNIT *****

Facility

$131.00

Hospital Charge Code	1601004
Hospital Revenue Code	272
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$26.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$26.20
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

TA 30 3.5 MULTIF STAPLE *****

Facility

$491.00

Hospital Charge Code	1600980
Hospital Revenue Code	272
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$245.50
Rate for Payer: Aetna Commercial	$186.58
Rate for Payer: Aetna Medicare Advantage	$147.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.20
Rate for Payer: Cigna Commercial	$245.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.30
Rate for Payer: Oxford Commercial	$98.20
Rate for Payer: Qualcare PPO/HMO/WC	$73.65
Rate for Payer: UnitedHealthcare Commercial	$98.20
Rate for Payer: UnitedHealthcare Community & State	$11.83
Rate for Payer: Wellpoint Medicaid Managed Care	$13.01

TA 30 3.5 MULTIF STAPLE *****

Facility

$491.00

Hospital Charge Code	1600980
Hospital Revenue Code	272
Min. Negotiated Rate	$73.65
Max. Negotiated Rate	$73.65
Rate for Payer: Qualcare PPO/HMO/WC	$73.65

Know your out-of-pocket cost for care.

All Charges