Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERICARDIOCENTESIS I

Facility

$1,613.00

Service Code	HCPCS 33010
Hospital Charge Code	366833010
Hospital Revenue Code	361
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$1,016.00
Rate for Payer: Aetna Commercial	$612.94
Rate for Payer: Aetna Medicare Advantage	$483.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.31
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	$411.31
Rate for Payer: Cigna Commercial	$806.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.90
Rate for Payer: Qualcare PPO/HMO/WC	$241.95
Rate for Payer: UnitedHealthcare Community & State	$38.87
Rate for Payer: Wellpoint Medicaid Managed Care	$42.74

PERICARDIOCENTESIS I

Facility

$1,613.00

Service Code	HCPCS 33010
Hospital Charge Code	7411007
Hospital Revenue Code	361
Min. Negotiated Rate	$241.95
Max. Negotiated Rate	$241.95
Rate for Payer: Qualcare PPO/HMO/WC	$241.95

PERICARDIOCENTESIS I

Facility

$1,613.00

Service Code	HCPCS 33010
Hospital Charge Code	366833010
Hospital Revenue Code	361
Min. Negotiated Rate	$241.95
Max. Negotiated Rate	$241.95
Rate for Payer: Qualcare PPO/HMO/WC	$241.95

PERICARDIOCENTESIS I

Facility

$1,613.00

Service Code	HCPCS 33010
Hospital Charge Code	7411007
Hospital Revenue Code	361
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$1,016.00
Rate for Payer: Aetna Commercial	$612.94
Rate for Payer: Aetna Medicare Advantage	$483.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.31
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	$411.31
Rate for Payer: Cigna Commercial	$806.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$483.90
Rate for Payer: Qualcare PPO/HMO/WC	$241.95
Rate for Payer: UnitedHealthcare Community & State	$38.87
Rate for Payer: Wellpoint Medicaid Managed Care	$42.74

PERICARDIOCENTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	5100225
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

PERICARDIOCENTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	74110025
Hospital Revenue Code	361
Min. Negotiated Rate	$73.19
Max. Negotiated Rate	$1,518.42
Rate for Payer: Aetna Commercial	$1,154.00
Rate for Payer: Aetna Medicare Advantage	$911.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.40
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	$774.40
Rate for Payer: Cigna Commercial	$1,518.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$911.05
Rate for Payer: Qualcare PPO/HMO/WC	$455.53
Rate for Payer: UnitedHealthcare Community & State	$73.19
Rate for Payer: Wellpoint Medicaid Managed Care	$80.48

PERICARDIOCENTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	5100225
Hospital Revenue Code	361
Min. Negotiated Rate	$73.19
Max. Negotiated Rate	$1,518.42
Rate for Payer: Aetna Commercial	$1,154.00
Rate for Payer: Aetna Medicare Advantage	$911.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.40
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	$774.40
Rate for Payer: Cigna Commercial	$1,518.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$911.05
Rate for Payer: Qualcare PPO/HMO/WC	$455.53
Rate for Payer: UnitedHealthcare Community & State	$73.19
Rate for Payer: Wellpoint Medicaid Managed Care	$80.48

PERICARDIOCENTESIS INITIAL

Facility

$3,036.85

Service Code	HCPCS 33010
Hospital Charge Code	74110025
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

PERICARDIOCENTESIS SUBSEQUENT

Facility

$3,036.85

Service Code	HCPCS 33011
Hospital Charge Code	74110026
Hospital Revenue Code	361
Min. Negotiated Rate	$73.19
Max. Negotiated Rate	$1,518.42
Rate for Payer: Aetna Commercial	$1,154.00
Rate for Payer: Aetna Medicare Advantage	$911.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.40
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	$774.40
Rate for Payer: Cigna Commercial	$1,518.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$911.05
Rate for Payer: Qualcare PPO/HMO/WC	$455.53
Rate for Payer: UnitedHealthcare Community & State	$73.19
Rate for Payer: Wellpoint Medicaid Managed Care	$80.48

PERICARDIOCENTESIS SUBSEQUENT

Facility

$3,036.85

Service Code	HCPCS 33011
Hospital Charge Code	74110026
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

PERICARDIOCENTESIS SUBSEQUENT

Facility

$3,036.85

Service Code	HCPCS 33011
Hospital Charge Code	5100226
Hospital Revenue Code	361
Min. Negotiated Rate	$73.19
Max. Negotiated Rate	$1,518.42
Rate for Payer: Aetna Commercial	$1,154.00
Rate for Payer: Aetna Medicare Advantage	$911.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.40
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	$774.40
Rate for Payer: Cigna Commercial	$1,518.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$911.05
Rate for Payer: Qualcare PPO/HMO/WC	$455.53
Rate for Payer: UnitedHealthcare Community & State	$73.19
Rate for Payer: Wellpoint Medicaid Managed Care	$80.48

PERICARDIOCENTESIS SUBSEQUENT

Facility

$3,036.85

Service Code	HCPCS 33011
Hospital Charge Code	5100226
Hospital Revenue Code	361
Min. Negotiated Rate	$455.53
Max. Negotiated Rate	$455.53
Rate for Payer: Qualcare PPO/HMO/WC	$455.53

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	321033016
Hospital Revenue Code	361
Min. Negotiated Rate	$1,432.60
Max. Negotiated Rate	$1,432.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	321033016
Hospital Revenue Code	361
Min. Negotiated Rate	$230.17
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,865.20
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$230.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$253.09

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	411033016
Hospital Revenue Code	361
Min. Negotiated Rate	$230.17
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,865.20
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$230.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$253.09

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	404633016
Hospital Revenue Code	361
Min. Negotiated Rate	$1,432.60
Max. Negotiated Rate	$1,432.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	404633016
Hospital Revenue Code	361
Min. Negotiated Rate	$230.17
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,865.20
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$230.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$253.09

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	323033016
Hospital Revenue Code	450
Min. Negotiated Rate	$1,432.60
Max. Negotiated Rate	$1,432.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	404133016
Hospital Revenue Code	361
Min. Negotiated Rate	$230.17
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,865.20
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$230.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$253.09

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	323033016
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,865.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$253.09

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	411033016
Hospital Revenue Code	361
Min. Negotiated Rate	$1,432.60
Max. Negotiated Rate	$1,432.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60

PERICARDIOCENTESIS W IMAGING

Facility

$9,550.68

Service Code	HCPCS 33016
Hospital Charge Code	404133016
Hospital Revenue Code	361
Min. Negotiated Rate	$1,432.60
Max. Negotiated Rate	$1,432.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,432.60

PERICARDIOCENT KIT W PIGTAIL

Facility

$836.66

Service Code	HCPCS C1729
Hospital Charge Code	270645514
Hospital Revenue Code	278
Min. Negotiated Rate	$125.50
Max. Negotiated Rate	$202.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.07
Rate for Payer: Qualcare PPO/HMO/WC	$125.50

PERICARDIOCENT KIT W PIGTAIL

Facility

$836.66

Service Code	HCPCS C1729
Hospital Charge Code	270645514
Hospital Revenue Code	278
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$418.33
Rate for Payer: Aetna Commercial	$317.93
Rate for Payer: Aetna Medicare Advantage	$251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.35
Rate for Payer: Cigna Commercial	$418.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.07
Rate for Payer: Qualcare PPO/HMO/WC	$125.50
Rate for Payer: UnitedHealthcare Community & State	$20.16
Rate for Payer: Wellpoint Medicaid Managed Care	$22.17

PERICARDIOTOMY REMOVAL OF CLOT

Facility

$17,367.60

Service Code	HCPCS 33020
Hospital Charge Code	1600000783
Hospital Revenue Code	360
Min. Negotiated Rate	$2,605.14
Max. Negotiated Rate	$2,605.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,605.14

Know your out-of-pocket cost for care.

All Charges