Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THYROGLOBULIN PROFILE I

Facility

$667.59

Service Code	HCPCS 84432
Hospital Charge Code	39990076A
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

THYROGLOBULIN PROFILE II

Facility

$667.59

Service Code	HCPCS 86800
Hospital Charge Code	39990076B
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

THYROGLOBULIN PROFILE II

Facility

$667.59

Service Code	HCPCS 86800
Hospital Charge Code	39990076B
Hospital Revenue Code	302
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$43.28
Rate for Payer: Aetna Medicare Advantage	$51.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.91
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	$57.43
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$15.91
Rate for Payer: Clover Medicare Advantage	$15.11
Rate for Payer: EmblemHealth Commercial	$47.73
Rate for Payer: Humana Medicare Advantage	$16.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.91
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	$12.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.91
Rate for Payer: Wellcare Medicare Advantage	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

THYROGLOBULIN-THYROGLOBULIN AB

Facility

$231.25

Hospital Charge Code	3007894
Hospital Revenue Code	301
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$34.69
Rate for Payer: Qualcare PPO/HMO/WC	$34.69

THYROGLOBULIN-THYROGLOBULIN AB

Facility

$231.25

Hospital Charge Code	3007894
Hospital Revenue Code	301
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$87.88
Rate for Payer: Aetna Medicare Advantage	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.97
Rate for Payer: Cigna Commercial	$115.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.38
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$5.57
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

THYROGLOBULIN W/O TGAB

Facility

$390.00

Service Code	HCPCS 84432
Hospital Charge Code	39900523
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

THYROGLOBULIN W/O TGAB

Facility

$390.00

Service Code	HCPCS 84432
Hospital Charge Code	39900523
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

THYROID

Facility

$6,700.00

Service Code	HCPCS 76536
Hospital Charge Code	94061157
Hospital Revenue Code	402
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,010.00
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$161.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$177.55

THYROID

Facility

$6,700.00

Service Code	HCPCS 76536
Hospital Charge Code	94061157
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

THYROID/60MG/TAB

Facility

$3.00

Hospital Charge Code	60634025
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

THYROID/60MG/TAB

Facility

$3.00

Hospital Charge Code	60634025
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

THYROID AB (ATA,TPO)

Facility

$390.00

Service Code	HCPCS 86376
Hospital Charge Code	39990082A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.58
Rate for Payer: Aetna Medicare Advantage	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.52
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.55
Rate for Payer: Clover Medicare Advantage	$13.82
Rate for Payer: EmblemHealth Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.55
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	$11.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.55
Rate for Payer: Wellcare Medicare Advantage	$14.55
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

THYROID AB (ATA,TPO)

Facility

$390.00

Service Code	HCPCS 86800
Hospital Charge Code	39990082B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

THYROID AB (ATA,TPO)

Facility

$390.00

Service Code	HCPCS 86800
Hospital Charge Code	39990082B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$43.28
Rate for Payer: Aetna Medicare Advantage	$51.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.91
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	$57.43
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.91
Rate for Payer: Clover Medicare Advantage	$15.11
Rate for Payer: EmblemHealth Commercial	$47.73
Rate for Payer: Humana Medicare Advantage	$16.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.91
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	$12.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.91
Rate for Payer: Wellcare Medicare Advantage	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

THYROID AB (ATA,TPO)

Facility

$390.00

Service Code	HCPCS 86376
Hospital Charge Code	39990082A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

THYROID ANITTHYROGLUBULIN ANTI

Facility

$116.85

Service Code	HCPCS 86800
Hospital Charge Code	3038146
Hospital Revenue Code	302
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$43.28
Rate for Payer: Aetna Medicare Advantage	$51.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.91
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	$57.43
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: Cigna Medicare Advantage	$15.91
Rate for Payer: Clover Medicare Advantage	$15.11
Rate for Payer: EmblemHealth Commercial	$47.73
Rate for Payer: Humana Medicare Advantage	$16.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.91
Rate for Payer: Wellcare Medicare Advantage	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

THYROID ANITTHYROGLUBULIN ANTI

Facility

$116.85

Service Code	HCPCS 86800
Hospital Charge Code	3038146
Hospital Revenue Code	302
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

THYROID CASCADE PROFILE

Facility

$244.26

Service Code	HCPCS 84443
Hospital Charge Code	3037015
Hospital Revenue Code	301
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$124.00
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	$122.13
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	$73.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.64
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	$6.47

THYROID CASCADE PROFILE

Facility

$244.26

Service Code	HCPCS 84443
Hospital Charge Code	3037015
Hospital Revenue Code	301
Min. Negotiated Rate	$36.64
Max. Negotiated Rate	$36.64
Rate for Payer: Qualcare PPO/HMO/WC	$36.64

THYROID CASCADING REFLEX(SERUM

Facility

$130.00

Service Code	HCPCS 84443
Hospital Charge Code	401384443
Hospital Revenue Code	301
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

THYROID CASCADING REFLEX(SERUM

Facility

$130.00

Service Code	HCPCS 84443
Hospital Charge Code	401384443
Hospital Revenue Code	301
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$124.00
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	$65.00
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	$39.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
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	$3.44

THYROID DESICCATED 30 MG TAB

Facility

$4.00

Hospital Charge Code	60628261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

THYROID DESICCATED 30 MG TAB

Facility

$4.00

Hospital Charge Code	60628261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

THYROID DISORDERS

Facility

$25,120.51

Service Code	APR-DRG 4274
Min. Negotiated Rate	$24,627.95
Max. Negotiated Rate	$25,120.51
Rate for Payer: UnitedHealthcare Community & State	$24,627.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,120.51
Rate for Payer: Wellpoint Medicaid Managed Care	$24,627.95

THYROID DISORDERS

Facility

$5,650.69

Service Code	APR-DRG 4271
Min. Negotiated Rate	$5,539.89
Max. Negotiated Rate	$5,650.69
Rate for Payer: UnitedHealthcare Community & State	$5,539.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,650.69
Rate for Payer: Wellpoint Medicaid Managed Care	$5,539.89

Know your out-of-pocket cost for care.

All Charges