Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERI AMNIOINFUSION

Facility

$3,138.00

Service Code	HCPCS 59070
Hospital Charge Code	74308015
Hospital Revenue Code	361
Min. Negotiated Rate	$75.63
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.82
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$941.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$470.70
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$75.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$83.16

PERI AMNIOINFUSION

Facility

$3,138.00

Service Code	HCPCS 59070
Hospital Charge Code	74308015
Hospital Revenue Code	361
Min. Negotiated Rate	$470.70
Max. Negotiated Rate	$470.70
Rate for Payer: Qualcare PPO/HMO/WC	$470.70

PERI AMNIOTIC FLUID REDUCT

Facility

$1,706.00

Service Code	HCPCS 59001
Hospital Charge Code	74308035
Hospital Revenue Code	514
Min. Negotiated Rate	$255.90
Max. Negotiated Rate	$255.90
Rate for Payer: Qualcare PPO/HMO/WC	$255.90

PERI AMNIOTIC FLUID REDUCT

Facility

$1,706.00

Service Code	HCPCS 59001
Hospital Charge Code	74308035
Hospital Revenue Code	514
Min. Negotiated Rate	$41.11
Max. Negotiated Rate	$1,306.82
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.82
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.80
Rate for Payer: Qualcare PPO/HMO/WC	$255.90
Rate for Payer: UnitedHealthcare Community & State	$41.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$45.21

PERI BALLN ANG AORTIC ADD

Facility

$12,748.00

Service Code	HCPCS 35472
Hospital Charge Code	7411051
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG AORTIC ADD

Facility

$12,748.00

Service Code	HCPCS 35472
Hospital Charge Code	7411051
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG AORTIC INI

Facility

$12,748.00

Service Code	HCPCS 35472
Hospital Charge Code	7411053
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG AORTIC INI

Facility

$12,748.00

Service Code	HCPCS 35472
Hospital Charge Code	7411053
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG BRA ADD-BI

Facility

$12,748.00

Service Code	HCPCS 3547550
Hospital Charge Code	7411055
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG BRA ADD-BI

Facility

$12,748.00

Service Code	HCPCS 3547550
Hospital Charge Code	7411055
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG BRA ADD-LT

Facility

$12,748.00

Service Code	HCPCS 35475LT
Hospital Charge Code	7411057
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG BRA ADD-LT

Facility

$12,748.00

Service Code	HCPCS 35475LT
Hospital Charge Code	7411057
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG BRA ADD-RT

Facility

$12,748.00

Service Code	HCPCS 35475RT
Hospital Charge Code	7411059
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG BRA ADD-RT

Facility

$12,748.00

Service Code	HCPCS 35475RT
Hospital Charge Code	7411059
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG BRA INI-BI

Facility

$12,748.00

Service Code	HCPCS 3547550
Hospital Charge Code	7411061
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG BRA INI-BI

Facility

$12,748.00

Service Code	HCPCS 3547550
Hospital Charge Code	7411061
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG BRA INI-LT

Facility

$12,748.00

Service Code	HCPCS 35475LT
Hospital Charge Code	7411063
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG BRA INI-LT

Facility

$12,748.00

Service Code	HCPCS 35475LT
Hospital Charge Code	7411063
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG BRA INI-RT

Facility

$12,748.00

Service Code	HCPCS 35475RT
Hospital Charge Code	7411065
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG BRA INI-RT

Facility

$12,748.00

Service Code	HCPCS 35475RT
Hospital Charge Code	7411065
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG R/V ADD-BI

Facility

$12,748.00

Service Code	HCPCS 3547150
Hospital Charge Code	7411039
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG R/V ADD-BI

Facility

$12,748.00

Service Code	HCPCS 3547150
Hospital Charge Code	7411039
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG R/V ADD-LT

Facility

$12,748.00

Service Code	HCPCS 35471LT
Hospital Charge Code	7411041
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

PERI BALLN ANG R/V ADD-LT

Facility

$12,748.00

Service Code	HCPCS 35471LT
Hospital Charge Code	7411041
Hospital Revenue Code	361
Min. Negotiated Rate	$307.23
Max. Negotiated Rate	$6,374.00
Rate for Payer: Aetna Commercial	$4,844.24
Rate for Payer: Aetna Medicare Advantage	$3,824.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,250.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,250.74
Rate for Payer: Cigna Commercial	$6,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20
Rate for Payer: UnitedHealthcare Community & State	$307.23
Rate for Payer: Wellpoint Medicaid Managed Care	$337.82

PERI BALLN ANG R/V ADD-RT

Facility

$12,748.00

Service Code	HCPCS 35471RT
Hospital Charge Code	7411043
Hospital Revenue Code	361
Min. Negotiated Rate	$1,912.20
Max. Negotiated Rate	$1,912.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.20

Know your out-of-pocket cost for care.

All Charges