Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GO
Hospital Charge Code	420397129
Hospital Revenue Code	430
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$46.63
Rate for Payer: Aetna Medicare Advantage	$36.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.29
Rate for Payer: Cigna Commercial	$61.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.81
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.25

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GN
Hospital Charge Code	420497129
Hospital Revenue Code	440
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GP
Hospital Charge Code	40919712P
Hospital Revenue Code	420
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GO
Hospital Charge Code	409197129
Hospital Revenue Code	430
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$46.63
Rate for Payer: Aetna Medicare Advantage	$36.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.29
Rate for Payer: Cigna Commercial	$61.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.81
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.25

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GO
Hospital Charge Code	420397129
Hospital Revenue Code	430
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GN
Hospital Charge Code	420497129
Hospital Revenue Code	440
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$46.63
Rate for Payer: Aetna Medicare Advantage	$36.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.29
Rate for Payer: Cigna Commercial	$61.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.81
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.25

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GO
Hospital Charge Code	409197129
Hospital Revenue Code	430
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GP
Hospital Charge Code	40919713P
Hospital Revenue Code	420
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$17.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.59

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GN
Hospital Charge Code	420497130
Hospital Revenue Code	440
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$17.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.59

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GN
Hospital Charge Code	420497130
Hospital Revenue Code	440
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna Medicare Advantage	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.91
Rate for Payer: Cigna Commercial	$58.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.19
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.83
Rate for Payer: Wellpoint Medicaid Managed Care	$3.11

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GO
Hospital Charge Code	420397130
Hospital Revenue Code	430
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna Medicare Advantage	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.91
Rate for Payer: Cigna Commercial	$58.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.19
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.83
Rate for Payer: Wellpoint Medicaid Managed Care	$3.11

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GO
Hospital Charge Code	420397130
Hospital Revenue Code	430
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$17.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.59

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GP
Hospital Charge Code	40919713P
Hospital Revenue Code	420
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna Medicare Advantage	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.91
Rate for Payer: Cigna Commercial	$58.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.19
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.83
Rate for Payer: Wellpoint Medicaid Managed Care	$3.11

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GO
Hospital Charge Code	409197130
Hospital Revenue Code	430
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$17.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.59

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GO
Hospital Charge Code	409197130
Hospital Revenue Code	430
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna Medicare Advantage	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.91
Rate for Payer: Cigna Commercial	$58.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.19
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.83
Rate for Payer: Wellpoint Medicaid Managed Care	$3.11

THERMACHOICE III UTERINE TC003

Facility

$6,795.93

Hospital Charge Code	270636329
Hospital Revenue Code	272
Min. Negotiated Rate	$1,019.39
Max. Negotiated Rate	$1,019.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.39

THERMACHOICE III UTERINE TC003

Facility

$6,795.93

Hospital Charge Code	270636329
Hospital Revenue Code	272
Min. Negotiated Rate	$163.78
Max. Negotiated Rate	$3,397.97
Rate for Payer: Aetna Commercial	$2,582.45
Rate for Payer: Aetna Medicare Advantage	$2,038.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,732.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,732.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,732.96
Rate for Payer: Cigna Commercial	$3,397.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,038.78
Rate for Payer: Oxford Commercial	$1,359.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,019.39
Rate for Payer: UnitedHealthcare Commercial	$1,359.19
Rate for Payer: UnitedHealthcare Community & State	$163.78
Rate for Payer: Wellpoint Medicaid Managed Care	$180.09

THERMAL ENDOMETER TUMOR ABL LT

Facility

$32,257.60

Service Code	HCPCS 58353
Hospital Charge Code	1600000785
Hospital Revenue Code	360
Min. Negotiated Rate	$4,838.64
Max. Negotiated Rate	$4,838.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,838.64

THERMAL ENDOMETER TUMOR ABL LT

Facility

$32,257.60

Service Code	HCPCS 58353
Hospital Charge Code	1600000785
Hospital Revenue Code	360
Min. Negotiated Rate	$777.41
Max. Negotiated Rate	$21,452.59
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,452.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,452.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,452.59
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,677.28
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,838.64
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$777.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$854.83

THERMASPLINT SGL MED 15-29010

Facility

$77.65

Hospital Charge Code	270613913
Hospital Revenue Code	272
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$38.83
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$15.53
Rate for Payer: UnitedHealthcare Community & State	$1.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

THERMASPLINT SGL MED 15-29010

Facility

$77.65

Hospital Charge Code	270613913
Hospital Revenue Code	272
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

THERMAZENE CRM 1% 400GM

Facility

$181.15

Hospital Charge Code	6007249
Hospital Revenue Code	251
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$90.58
Rate for Payer: Aetna Commercial	$68.84
Rate for Payer: Aetna Medicare Advantage	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.19
Rate for Payer: Cigna Commercial	$90.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.34
Rate for Payer: Oxford Commercial	$36.23
Rate for Payer: Qualcare PPO/HMO/WC	$27.17
Rate for Payer: UnitedHealthcare Commercial	$36.23
Rate for Payer: UnitedHealthcare Community & State	$4.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

THERMAZENE CRM 1% 400GM

Facility

$181.15

Hospital Charge Code	6007249
Hospital Revenue Code	251
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$27.17
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

THERMAZENE CRM 1% 50GM

Facility

$48.00

Hospital Charge Code	6007215
Hospital Revenue Code	251
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

THERMAZENE CRM 1% 50GM

Facility

$48.00

Hospital Charge Code	6007215
Hospital Revenue Code	251
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

Know your out-of-pocket cost for care.

All Charges