Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PERISCREW 3.5MMX10MM W/2.7MM H

Facility

$176.95

Hospital Charge Code	270663180
Hospital Revenue Code	278
Min. Negotiated Rate	$26.54
Max. Negotiated Rate	$42.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.93
Rate for Payer: Qualcare PPO/HMO/WC	$26.54

PERISCREW 3.5MMX10MM W/2.7MM H

Facility

$176.95

Hospital Charge Code	270663180
Hospital Revenue Code	278
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$88.47
Rate for Payer: Aetna Commercial	$67.24
Rate for Payer: Aetna Medicare Advantage	$53.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.12
Rate for Payer: Cigna Commercial	$88.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.93
Rate for Payer: Qualcare PPO/HMO/WC	$26.54
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

PERISCREW 3.5MMX12MM W/2.7MM H

Facility

$176.95

Hospital Charge Code	270663181
Hospital Revenue Code	278
Min. Negotiated Rate	$26.54
Max. Negotiated Rate	$42.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.93
Rate for Payer: Qualcare PPO/HMO/WC	$26.54

PERISCREW 3.5MMX12MM W/2.7MM H

Facility

$176.95

Hospital Charge Code	270663181
Hospital Revenue Code	278
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$88.47
Rate for Payer: Aetna Commercial	$67.24
Rate for Payer: Aetna Medicare Advantage	$53.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.12
Rate for Payer: Cigna Commercial	$88.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.93
Rate for Payer: Qualcare PPO/HMO/WC	$26.54
Rate for Payer: UnitedHealthcare Community & State	$4.26
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

PERI SONOGRAM ABDOMINAL

Facility

$2,499.00

Service Code	HCPCS 76700
Hospital Charge Code	74308090
Hospital Revenue Code	402
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$374.85
Rate for Payer: Qualcare PPO/HMO/WC	$374.85

PERI SONOGRAM ABDOMINAL

Facility

$2,499.00

Service Code	HCPCS 76700
Hospital Charge Code	74308090
Hospital Revenue Code	402
Min. Negotiated Rate	$60.23
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$749.70
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$374.85
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$60.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$66.22

PERIST DRY STAP LINE PSD6006UV

Facility

$4,455.00

Hospital Charge Code	270638672
Hospital Revenue Code	272
Min. Negotiated Rate	$107.37
Max. Negotiated Rate	$2,227.50
Rate for Payer: Aetna Commercial	$1,692.90
Rate for Payer: Aetna Medicare Advantage	$1,336.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,136.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,136.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,136.03
Rate for Payer: Cigna Commercial	$2,227.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,336.50
Rate for Payer: Oxford Commercial	$891.00
Rate for Payer: Qualcare PPO/HMO/WC	$668.25
Rate for Payer: UnitedHealthcare Commercial	$891.00
Rate for Payer: UnitedHealthcare Community & State	$107.37
Rate for Payer: Wellpoint Medicaid Managed Care	$118.06

PERIST DRY STAP LINE PSD6006UV

Facility

$4,455.00

Hospital Charge Code	270638672
Hospital Revenue Code	272
Min. Negotiated Rate	$668.25
Max. Negotiated Rate	$668.25
Rate for Payer: Qualcare PPO/HMO/WC	$668.25

PERI STENT PLACE-ADD

Facility

$24,869.00

Hospital Charge Code	7411135
Hospital Revenue Code	361
Min. Negotiated Rate	$3,730.35
Max. Negotiated Rate	$3,730.35
Rate for Payer: Qualcare PPO/HMO/WC	$3,730.35

PERI STENT PLACE-ADD

Facility

$24,869.00

Hospital Charge Code	7411135
Hospital Revenue Code	361
Min. Negotiated Rate	$599.34
Max. Negotiated Rate	$12,434.50
Rate for Payer: Aetna Commercial	$9,450.22
Rate for Payer: Aetna Medicare Advantage	$7,460.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,341.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,341.60
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	$6,341.60
Rate for Payer: Cigna Commercial	$12,434.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,460.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,730.35
Rate for Payer: UnitedHealthcare Community & State	$599.34
Rate for Payer: Wellpoint Medicaid Managed Care	$659.03

PERI STENT PLACE-INITIAL

Facility

$53,150.12

Hospital Charge Code	7411133
Hospital Revenue Code	361
Min. Negotiated Rate	$1,280.92
Max. Negotiated Rate	$26,575.06
Rate for Payer: Aetna Commercial	$20,197.05
Rate for Payer: Aetna Medicare Advantage	$15,945.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,553.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,553.28
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	$13,553.28
Rate for Payer: Cigna Commercial	$26,575.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,945.04
Rate for Payer: Qualcare PPO/HMO/WC	$7,972.52
Rate for Payer: UnitedHealthcare Community & State	$1,280.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1,408.48

PERI STENT PLACE-INITIAL

Facility

$53,150.12

Hospital Charge Code	7411133
Hospital Revenue Code	361
Min. Negotiated Rate	$7,972.52
Max. Negotiated Rate	$7,972.52
Rate for Payer: Qualcare PPO/HMO/WC	$7,972.52

PERI-STRIP

Facility

$330.00

Hospital Charge Code	270335371
Hospital Revenue Code	278
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$79.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$49.50

PERI-STRIP

Facility

$330.00

Hospital Charge Code	270335371
Hospital Revenue Code	278
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$125.40
Rate for Payer: Aetna Medicare Advantage	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.15
Rate for Payer: Cigna Commercial	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$49.50
Rate for Payer: UnitedHealthcare Community & State	$7.95
Rate for Payer: Wellpoint Medicaid Managed Care	$8.74

PERI-STRIP 45MM

Facility

$1,071.00

Hospital Charge Code	270672596
Hospital Revenue Code	272
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Commercial	$406.98
Rate for Payer: Aetna Medicare Advantage	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.11
Rate for Payer: Cigna Commercial	$535.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.30
Rate for Payer: Oxford Commercial	$214.20
Rate for Payer: Qualcare PPO/HMO/WC	$160.65
Rate for Payer: UnitedHealthcare Commercial	$214.20
Rate for Payer: UnitedHealthcare Community & State	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$28.38

PERI-STRIP 45MM

Facility

$1,071.00

Hospital Charge Code	270672596
Hospital Revenue Code	272
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$160.65
Rate for Payer: Qualcare PPO/HMO/WC	$160.65

PERI-STRIP 60MM

Facility

$1,071.00

Hospital Charge Code	270672597
Hospital Revenue Code	272
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$160.65
Rate for Payer: Qualcare PPO/HMO/WC	$160.65

PERI-STRIP 60MM

Facility

$1,071.00

Hospital Charge Code	270672597
Hospital Revenue Code	272
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Commercial	$406.98
Rate for Payer: Aetna Medicare Advantage	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.11
Rate for Payer: Cigna Commercial	$535.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.30
Rate for Payer: Oxford Commercial	$214.20
Rate for Payer: Qualcare PPO/HMO/WC	$160.65
Rate for Payer: UnitedHealthcare Commercial	$214.20
Rate for Payer: UnitedHealthcare Community & State	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$28.38

PERI-STRP DRY STAP PSD4506-U-V

Facility

$979.13

Service Code	HCPCS C1762
Hospital Charge Code	270660315
Hospital Revenue Code	278
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$489.56
Rate for Payer: Aetna Commercial	$372.07
Rate for Payer: Aetna Medicare Advantage	$293.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.68
Rate for Payer: Cigna Commercial	$489.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.41
Rate for Payer: Qualcare PPO/HMO/WC	$146.87
Rate for Payer: UnitedHealthcare Community & State	$23.60
Rate for Payer: Wellpoint Medicaid Managed Care	$25.95

PERI-STRP DRY STAP PSD4506-U-V

Facility

$979.13

Service Code	HCPCS C1762
Hospital Charge Code	270660315
Hospital Revenue Code	278
Min. Negotiated Rate	$146.87
Max. Negotiated Rate	$236.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.41
Rate for Payer: Qualcare PPO/HMO/WC	$146.87

PERI THREE D ENHANCEMENT

Facility

$276.00

Service Code	HCPCS 76376
Hospital Charge Code	74308085
Hospital Revenue Code	333
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$6,852.00
Rate for Payer: Aetna Commercial	$104.88
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.80
Rate for Payer: Oxford Commercial	$3,906.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$6,852.00
Rate for Payer: UnitedHealthcare Community & State	$6.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.31

PERI THREE D ENHANCEMENT

Facility

$276.00

Service Code	HCPCS 76376
Hospital Charge Code	74308085
Hospital Revenue Code	333
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

PERITONEAL ADHESIOLYSIS

Facility

$27,956.11

Service Code	APR-DRG 2243
Min. Negotiated Rate	$27,407.95
Max. Negotiated Rate	$27,956.11
Rate for Payer: UnitedHealthcare Community & State	$27,407.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27,956.11
Rate for Payer: Wellpoint Medicaid Managed Care	$27,407.95

PERITONEAL ADHESIOLYSIS

Facility

$17,007.06

Service Code	APR-DRG 2241
Min. Negotiated Rate	$16,673.59
Max. Negotiated Rate	$17,007.06
Rate for Payer: UnitedHealthcare Community & State	$16,673.59
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,007.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16,673.59

PERITONEAL ADHESIOLYSIS

Facility

$19,972.83

Service Code	APR-DRG 2242
Min. Negotiated Rate	$19,581.21
Max. Negotiated Rate	$19,972.83
Rate for Payer: UnitedHealthcare Community & State	$19,581.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,972.83
Rate for Payer: Wellpoint Medicaid Managed Care	$19,581.21

Know your out-of-pocket cost for care.

All Charges