Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

THYROID STIMULATING HORMONE

Facility

$1,507.69

Service Code	HCPCS 84443
Hospital Charge Code	3002581
Hospital Revenue Code	301
Min. Negotiated Rate	$226.15
Max. Negotiated Rate	$226.15
Rate for Payer: Qualcare PPO/HMO/WC	$226.15

THYROID STIMULATING HORMONE

Facility

$1,507.69

Service Code	HCPCS 84443
Hospital Charge Code	3002581
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$753.85
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	$753.85
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	$452.31
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$226.15
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	$39.95

THYROID STIMULATING HORMONE

Facility

$880.60

Service Code	HCPCS 84443
Hospital Charge Code	38472644
Hospital Revenue Code	301
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$440.30
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	$440.30
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	$264.18
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.09
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	$23.34

THYROID STIMULATING HORMONE

Facility

$880.60

Service Code	HCPCS 84443
Hospital Charge Code	38472644
Hospital Revenue Code	301
Min. Negotiated Rate	$132.09
Max. Negotiated Rate	$132.09
Rate for Payer: Qualcare PPO/HMO/WC	$132.09

THYROID STIMULATING IMMUNOGLOB

Facility

$1,428.00

Service Code	HCPCS 84445
Hospital Charge Code	38473120
Hospital Revenue Code	301
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$214.20
Rate for Payer: Qualcare PPO/HMO/WC	$214.20

THYROID STIMULATING IMMUNOGLOB

Facility

$1,428.00

Service Code	HCPCS 84445
Hospital Charge Code	38473120
Hospital Revenue Code	301
Min. Negotiated Rate	$37.84
Max. Negotiated Rate	$714.00
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	$714.00
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	$428.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.20
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	$37.84

THYROID TAB 60MG

Facility

$3.20

Hospital Charge Code	60628262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$0.48
Rate for Payer: Qualcare PPO/HMO/WC	$0.48

THYROID TAB 60MG

Facility

$3.20

Hospital Charge Code	60628262
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.60
Rate for Payer: Aetna Commercial	$1.22
Rate for Payer: Aetna Medicare Advantage	$0.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.82
Rate for Payer: Cigna Commercial	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.96
Rate for Payer: Oxford Commercial	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.48
Rate for Payer: UnitedHealthcare Commercial	$0.64
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

THYROID UPTAKE MULT DETERMINE

Facility

$475.25

Hospital Charge Code	4500040
Hospital Revenue Code	341
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$180.59
Rate for Payer: Aetna Medicare Advantage	$142.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.19
Rate for Payer: Cigna Commercial	$237.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.57
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.29
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

THYROID UPTAKE MULT DETERMINE

Facility

$475.25

Hospital Charge Code	4500040
Hospital Revenue Code	341
Min. Negotiated Rate	$71.29
Max. Negotiated Rate	$71.29
Rate for Payer: Qualcare PPO/HMO/WC	$71.29

THYROPAR INJ/10IU/VIAL

Facility

$946.00

Hospital Charge Code	60634267
Hospital Revenue Code	636
Min. Negotiated Rate	$141.90
Max. Negotiated Rate	$228.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.93
Rate for Payer: Qualcare PPO/HMO/WC	$141.90

THYROPAR INJ/10IU/VIAL

Facility

$946.00

Hospital Charge Code	60634267
Hospital Revenue Code	636
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$473.00
Rate for Payer: Aetna Commercial	$359.48
Rate for Payer: Aetna Medicare Advantage	$283.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.23
Rate for Payer: Cigna Commercial	$473.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.93
Rate for Payer: Qualcare PPO/HMO/WC	$141.90
Rate for Payer: UnitedHealthcare Community & State	$22.80
Rate for Payer: Wellpoint Medicaid Managed Care	$25.07

THYROXINE BINDING GLOBULIN

Facility

$153.65

Service Code	HCPCS 84442
Hospital Charge Code	3007705
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
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	$76.83
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	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
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	$4.07

THYROXINE BINDING GLOBULIN

Facility

$153.65

Service Code	HCPCS 84442
Hospital Charge Code	3002524B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
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	$76.83
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	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
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	$4.07

THYROXINE BINDING GLOBULIN

Facility

$153.65

Service Code	HCPCS 84442
Hospital Charge Code	3002524B
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

THYROXINE BINDING GLOBULIN

Facility

$153.65

Service Code	HCPCS 84442
Hospital Charge Code	3007705
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

THYROXINE BINDING GLOBULIN (TB

Facility

$214.00

Service Code	HCPCS 84442
Hospital Charge Code	38472647
Hospital Revenue Code	301
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

THYROXINE BINDING GLOBULIN (TB

Facility

$214.00

Service Code	HCPCS 84442
Hospital Charge Code	38472647
Hospital Revenue Code	301
Min. Negotiated Rate	$5.67
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	$107.00
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	$64.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
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	$5.67

TIAGABINE TAB 12MG

Facility

$11.25

Hospital Charge Code	60629021
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

TIAGABINE TAB 12MG

Facility

$11.25

Hospital Charge Code	60629021
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

TIAGABINE TAB 16MG

Facility

$20.85

Hospital Charge Code	60628774
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.25
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$4.17
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

TIAGABINE TAB 16MG

Facility

$20.85

Hospital Charge Code	60628774
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

TI ALIF SA SPACER 10X34X24 15D

Facility

$33,125.00

Hospital Charge Code	270703553
Hospital Revenue Code	278
Min. Negotiated Rate	$798.31
Max. Negotiated Rate	$16,562.50
Rate for Payer: Aetna Commercial	$12,587.50
Rate for Payer: Aetna Medicare Advantage	$9,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,446.88
Rate for Payer: Cigna Commercial	$16,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,287.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75
Rate for Payer: UnitedHealthcare Community & State	$798.31
Rate for Payer: Wellpoint Medicaid Managed Care	$877.81

TI ALIF SA SPACER 10X34X24 15D

Facility

$33,125.00

Hospital Charge Code	270703553
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.75
Max. Negotiated Rate	$8,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,287.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75

TIBAL KNEE BASE FX BEARING SZ

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685508
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

Know your out-of-pocket cost for care.

All Charges