Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 INI-BI

Facility

$12,748.00

Service Code	HCPCS 3547150
Hospital Charge Code	7411045
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 INI-BI

Facility

$12,748.00

Service Code	HCPCS 3547150
Hospital Charge Code	7411045
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 INI-LT

Facility

$12,748.00

Service Code	HCPCS 35471LT
Hospital Charge Code	7411047
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 INI-LT

Facility

$12,748.00

Service Code	HCPCS 35471LT
Hospital Charge Code	7411047
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 INI-RT

Facility

$12,748.00

Service Code	HCPCS 35471RT
Hospital Charge Code	7411049
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 INI-RT

Facility

$12,748.00

Service Code	HCPCS 35471RT
Hospital Charge Code	7411049
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

PERICARDIAL DRAINAGE, > 6Y0

Facility

$6,404.20

Service Code	HCPCS 33017
Hospital Charge Code	404633017
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

PERICARDIAL DRAINAGE, > 6Y0

Facility

$6,404.20

Service Code	HCPCS 33017
Hospital Charge Code	404133017
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

PERICARDIAL DRAINAGE, > 6Y0

Facility

$6,404.20

Service Code	HCPCS 33017
Hospital Charge Code	411033017
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

PERICARDIAL DRAINAGE, > 6Y0

Facility

$6,404.20

Service Code	HCPCS 33017
Hospital Charge Code	321033017
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

PERICARDIAL DRAINAGE, > 6Y0

Facility

$6,404.20

Service Code	HCPCS 33017
Hospital Charge Code	321033017
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

PERICARDIAL DRAINAGE, > 6Y0

Facility

$6,404.20

Service Code	HCPCS 33017
Hospital Charge Code	411033017
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

PERICARDIAL DRAINAGE, > 6Y0

Facility

$6,404.20

Service Code	HCPCS 33017
Hospital Charge Code	404133017
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

PERICARDIAL DRAINAGE, > 6Y0

Facility

$6,404.20

Service Code	HCPCS 33017
Hospital Charge Code	404633017
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

PERICARDIAL DRAINAGE W CT

Facility

$6,404.20

Service Code	HCPCS 33019
Hospital Charge Code	321033019
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

PERICARDIAL DRAINAGE W CT

Facility

$6,404.20

Service Code	HCPCS 33019
Hospital Charge Code	411033019
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

PERICARDIAL DRAINAGE W CT

Facility

$6,404.20

Service Code	HCPCS 33019
Hospital Charge Code	404633019
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

PERICARDIAL DRAINAGE W CT

Facility

$6,404.20

Service Code	HCPCS 33019
Hospital Charge Code	404633019
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

PERICARDIAL DRAINAGE W CT

Facility

$6,404.20

Service Code	HCPCS 33019
Hospital Charge Code	404133019
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

PERICARDIAL DRAINAGE W CT

Facility

$6,404.20

Service Code	HCPCS 33019
Hospital Charge Code	411033019
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

PERICARDIAL DRAINAGE W CT

Facility

$6,404.20

Service Code	HCPCS 33019
Hospital Charge Code	404133019
Hospital Revenue Code	361
Min. Negotiated Rate	$154.34
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$2,433.60
Rate for Payer: Aetna Medicare Advantage	$1,921.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.07
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	$1,633.07
Rate for Payer: Cigna Commercial	$3,202.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,921.26
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$154.34
Rate for Payer: Wellpoint Medicaid Managed Care	$169.71

PERICARDIAL DRAINAGE W CT

Facility

$6,404.20

Service Code	HCPCS 33019
Hospital Charge Code	321033019
Hospital Revenue Code	361
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

PERICARDIOCENTESIS

Facility

$984.00

Service Code	HCPCS 33010
Hospital Charge Code	7411005
Hospital Revenue Code	361
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$147.60
Rate for Payer: Qualcare PPO/HMO/WC	$147.60

PERICARDIOCENTESIS

Facility

$984.00

Service Code	HCPCS 33010
Hospital Charge Code	7411005
Hospital Revenue Code	361
Min. Negotiated Rate	$23.71
Max. Negotiated Rate	$1,016.00
Rate for Payer: Aetna Commercial	$373.92
Rate for Payer: Aetna Medicare Advantage	$295.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.92
Rate for Payer: Cigna Commercial	$492.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.20
Rate for Payer: Qualcare PPO/HMO/WC	$147.60
Rate for Payer: UnitedHealthcare Community & State	$23.71
Rate for Payer: Wellpoint Medicaid Managed Care	$26.08

Know your out-of-pocket cost for care.

All Charges