Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRYX ENVELOPE ANTIBACT ABOSRB

Facility

$9,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270690980
Hospital Revenue Code	278
Min. Negotiated Rate	$240.40
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,194.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$240.40
Rate for Payer: Wellpoint Medicaid Managed Care	$264.34

TRYX ENVELOPE ANTIBACT ABOSRB

Facility

$9,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270690980
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,194.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

TSH

Facility

$115.50

Service Code	HCPCS 84443
Hospital Charge Code	39900141
Hospital Revenue Code	301
Min. Negotiated Rate	$3.06
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	$57.75
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	$34.65
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.32
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	$3.06

TSH

Facility

$115.50

Service Code	HCPCS 84443
Hospital Charge Code	39900141
Hospital Revenue Code	301
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$17.32
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

TSH RECEPTOR AB

Facility

$1,204.00

Service Code	HCPCS 84235
Hospital Charge Code	38472036
Hospital Revenue Code	301
Min. Negotiated Rate	$31.91
Max. Negotiated Rate	$602.00
Rate for Payer: Aetna Commercial	$193.75
Rate for Payer: Aetna Medicare Advantage	$230.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$257.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$71.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$257.12
Rate for Payer: Cigna Commercial	$602.00
Rate for Payer: Cigna Medicare Advantage	$71.23
Rate for Payer: Clover Medicare Advantage	$67.67
Rate for Payer: EmblemHealth Commercial	$213.69
Rate for Payer: Humana Medicare Advantage	$73.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$71.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$56.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.23
Rate for Payer: Wellcare Medicare Advantage	$71.23
Rate for Payer: Wellpoint Medicaid Managed Care	$31.91

TSH RECEPTOR AB

Facility

$1,204.00

Service Code	HCPCS 84235
Hospital Charge Code	38472036
Hospital Revenue Code	301
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$180.60
Rate for Payer: Qualcare PPO/HMO/WC	$180.60

TSH RECEPTOR AB (RIA)

Facility

$585.17

Service Code	HCPCS 83520
Hospital Charge Code	3009032
Hospital Revenue Code	301
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$87.78

TSH RECEPTOR AB (RIA)

Facility

$585.17

Service Code	HCPCS 83520
Hospital Charge Code	3009032
Hospital Revenue Code	301
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$292.58
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.34
Rate for Payer: Cigna Commercial	$292.58
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.55
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.78
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$15.51

TSH WITH FREE T4 REFLEX

Facility

$244.26

Service Code	HCPCS 84443
Hospital Charge Code	3000706
Hospital Revenue Code	301
Min. Negotiated Rate	$36.64
Max. Negotiated Rate	$36.64
Rate for Payer: Qualcare PPO/HMO/WC	$36.64

TSH WITH FREE T4 REFLEX

Facility

$244.26

Service Code	HCPCS 84443
Hospital Charge Code	3000706
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

TSI

Facility

$390.00

Service Code	HCPCS 84445
Hospital Charge Code	39900142
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

TSI

Facility

$390.00

Service Code	HCPCS 84445
Hospital Charge Code	39900142
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TSI-THYROID STIMUL IMMUNOGLBN

Facility

$438.00

Hospital Charge Code	3010527
Hospital Revenue Code	301
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$219.00
Rate for Payer: Aetna Commercial	$166.44
Rate for Payer: Aetna Medicare Advantage	$131.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.69
Rate for Payer: Cigna Commercial	$219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.56
Rate for Payer: Wellpoint Medicaid Managed Care	$11.61

TSI-THYROID STIMUL IMMUNOGLBN

Facility

$438.00

Hospital Charge Code	3010527
Hospital Revenue Code	301
Min. Negotiated Rate	$65.70
Max. Negotiated Rate	$65.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.70

T-SLING 45X1.1cm W/SLV CALTS10

Facility

$3,825.00

Hospital Charge Code	270632449
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$841.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

T-SLING 45X1.1cm W/SLV CALTS10

Facility

$3,825.00

Hospital Charge Code	270632449
Hospital Revenue Code	278
Min. Negotiated Rate	$92.18
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,453.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$841.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Community & State	$92.18
Rate for Payer: Wellpoint Medicaid Managed Care	$101.36

T-SLING W/ CENSORB 1.1x45 TS05

Facility

$17,236.00

Hospital Charge Code	270632403
Hospital Revenue Code	278
Min. Negotiated Rate	$2,585.40
Max. Negotiated Rate	$4,171.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,447.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,171.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,791.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,585.40

T-SLING W/ CENSORB 1.1x45 TS05

Facility

$17,236.00

Hospital Charge Code	270632403
Hospital Revenue Code	278
Min. Negotiated Rate	$415.39
Max. Negotiated Rate	$8,618.00
Rate for Payer: Aetna Commercial	$6,549.68
Rate for Payer: Aetna Medicare Advantage	$5,170.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,395.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,395.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,447.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,395.18
Rate for Payer: Cigna Commercial	$8,618.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,171.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,791.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,585.40
Rate for Payer: UnitedHealthcare Community & State	$415.39
Rate for Payer: Wellpoint Medicaid Managed Care	$456.75

T-SLING W/CENSORB 21X2 CALTS02

Facility

$3,447.25

Hospital Charge Code	270632448
Hospital Revenue Code	278
Min. Negotiated Rate	$517.09
Max. Negotiated Rate	$834.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$689.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$758.39
Rate for Payer: Qualcare PPO/HMO/WC	$517.09

T-SLING W/CENSORB 21X2 CALTS02

Facility

$3,447.25

Hospital Charge Code	270632448
Hospital Revenue Code	278
Min. Negotiated Rate	$83.08
Max. Negotiated Rate	$1,723.62
Rate for Payer: Aetna Commercial	$1,309.95
Rate for Payer: Aetna Medicare Advantage	$1,034.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$689.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.05
Rate for Payer: Cigna Commercial	$1,723.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$758.39
Rate for Payer: Qualcare PPO/HMO/WC	$517.09
Rate for Payer: UnitedHealthcare Community & State	$83.08
Rate for Payer: Wellpoint Medicaid Managed Care	$91.35

T-SPOT TB TEST

Facility

$855.89

Service Code	HCPCS 86481
Hospital Charge Code	401186481
Hospital Revenue Code	302
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$427.94
Rate for Payer: Aetna Commercial	$272.00
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.97
Rate for Payer: Cigna Commercial	$427.94
Rate for Payer: Cigna Medicare Advantage	$100.00
Rate for Payer: Clover Medicare Advantage	$95.00
Rate for Payer: EmblemHealth Commercial	$300.00
Rate for Payer: Humana Medicare Advantage	$103.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.38
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$80.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$100.00
Rate for Payer: Wellcare Medicare Advantage	$100.00
Rate for Payer: Wellpoint Medicaid Managed Care	$22.68

T-SPOT TB TEST

Facility

$855.89

Service Code	HCPCS 86481
Hospital Charge Code	401186481
Hospital Revenue Code	302
Min. Negotiated Rate	$128.38
Max. Negotiated Rate	$128.38
Rate for Payer: Qualcare PPO/HMO/WC	$128.38

TSSE HUMAN MICRNZD INJCTBL 2CC

Facility

$1,910.00

Hospital Charge Code	270645717
Hospital Revenue Code	636
Min. Negotiated Rate	$286.50
Max. Negotiated Rate	$462.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$462.22
Rate for Payer: Qualcare PPO/HMO/WC	$286.50

TSSE HUMAN MICRNZD INJCTBL 2CC

Facility

$1,910.00

Hospital Charge Code	270645717
Hospital Revenue Code	636
Min. Negotiated Rate	$46.03
Max. Negotiated Rate	$955.00
Rate for Payer: Aetna Commercial	$725.80
Rate for Payer: Aetna Medicare Advantage	$573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$487.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$487.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$487.05
Rate for Payer: Cigna Commercial	$955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$462.22
Rate for Payer: Qualcare PPO/HMO/WC	$286.50
Rate for Payer: UnitedHealthcare Community & State	$46.03
Rate for Payer: Wellpoint Medicaid Managed Care	$50.62

TSS PRESS FIT STEM SZ 13

Facility

$7,914.75

Service Code	HCPCS C1776
Hospital Charge Code	270690411
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.21
Max. Negotiated Rate	$1,915.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,741.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.21

Know your out-of-pocket cost for care.

All Charges