Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PACEMAKER ADAPTA SR ADSR01

Facility

$16,795.00

Service Code	HCPCS C1786
Hospital Charge Code	270638414C
Hospital Revenue Code	275
Min. Negotiated Rate	$2,519.25
Max. Negotiated Rate	$4,064.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,064.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,694.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,519.25

PACEMAKER ADAPTA SR ADSR01

Facility

$16,795.00

Service Code	HCPCS C1786
Hospital Charge Code	270638414C
Hospital Revenue Code	275
Min. Negotiated Rate	$404.76
Max. Negotiated Rate	$8,397.50
Rate for Payer: Aetna Commercial	$6,382.10
Rate for Payer: Aetna Medicare Advantage	$5,038.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,282.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,282.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,282.73
Rate for Payer: Cigna Commercial	$8,397.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,064.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,694.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,519.25
Rate for Payer: UnitedHealthcare Community & State	$404.76
Rate for Payer: Wellpoint Medicaid Managed Care	$445.07

PACEMAKER ADAPTA SR ADSR01

Facility

$25,945.00

Service Code	HCPCS C1786
Hospital Charge Code	270638414N
Hospital Revenue Code	275
Min. Negotiated Rate	$625.27
Max. Negotiated Rate	$12,972.50
Rate for Payer: Aetna Commercial	$9,859.10
Rate for Payer: Aetna Medicare Advantage	$7,783.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,615.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,615.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,615.98
Rate for Payer: Cigna Commercial	$12,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,278.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,707.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,891.75
Rate for Payer: UnitedHealthcare Community & State	$625.27
Rate for Payer: Wellpoint Medicaid Managed Care	$687.54

PACEMAKER ADAPTA SR ADSR01

Facility

$25,945.00

Service Code	HCPCS C1786
Hospital Charge Code	270638414N
Hospital Revenue Code	275
Min. Negotiated Rate	$3,891.75
Max. Negotiated Rate	$6,278.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,278.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,707.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,891.75

PACEMAKER ADAPTER SR ADSR06

Facility

$25,945.00

Hospital Charge Code	270638428C
Hospital Revenue Code	275
Min. Negotiated Rate	$3,891.75
Max. Negotiated Rate	$6,278.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,278.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,707.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,891.75

PACEMAKER ADAPTER SR ADSR06

Facility

$25,945.00

Hospital Charge Code	270638428C
Hospital Revenue Code	275
Min. Negotiated Rate	$625.27
Max. Negotiated Rate	$12,972.50
Rate for Payer: Aetna Commercial	$9,859.10
Rate for Payer: Aetna Medicare Advantage	$7,783.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,615.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,615.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,615.98
Rate for Payer: Cigna Commercial	$12,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,278.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,707.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,891.75
Rate for Payer: UnitedHealthcare Community & State	$625.27
Rate for Payer: Wellpoint Medicaid Managed Care	$687.54

PACEMAKER ADPATA

Facility

$32,585.00

Hospital Charge Code	270638389
Hospital Revenue Code	275
Min. Negotiated Rate	$4,887.75
Max. Negotiated Rate	$7,885.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,517.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,885.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,168.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,887.75

PACEMAKER ADPATA

Facility

$32,585.00

Hospital Charge Code	270638389
Hospital Revenue Code	275
Min. Negotiated Rate	$785.30
Max. Negotiated Rate	$16,292.50
Rate for Payer: Aetna Commercial	$12,382.30
Rate for Payer: Aetna Medicare Advantage	$9,775.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,309.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,309.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,517.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,309.17
Rate for Payer: Cigna Commercial	$16,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,885.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,168.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,887.75
Rate for Payer: UnitedHealthcare Community & State	$785.30
Rate for Payer: Wellpoint Medicaid Managed Care	$863.50

PACEMAKER ADVISA DR MRI

Facility

$26,425.00

Service Code	HCPCS C1785
Hospital Charge Code	270663723
Hospital Revenue Code	275
Min. Negotiated Rate	$3,963.75
Max. Negotiated Rate	$6,394.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,394.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,813.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,963.75

PACEMAKER ADVISA DR MRI

Facility

$26,425.00

Service Code	HCPCS C1785
Hospital Charge Code	270663723
Hospital Revenue Code	275
Min. Negotiated Rate	$636.84
Max. Negotiated Rate	$13,212.50
Rate for Payer: Aetna Commercial	$10,041.50
Rate for Payer: Aetna Medicare Advantage	$7,927.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,738.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,738.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,738.38
Rate for Payer: Cigna Commercial	$13,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,394.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,813.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,963.75
Rate for Payer: UnitedHealthcare Community & State	$636.84
Rate for Payer: Wellpoint Medicaid Managed Care	$700.26

PACEMAKER ADVISA SR

Facility

$20,975.00

Service Code	HCPCS C1786
Hospital Charge Code	270676130
Hospital Revenue Code	275
Min. Negotiated Rate	$3,146.25
Max. Negotiated Rate	$5,075.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,075.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,614.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,146.25

PACEMAKER ADVISA SR

Facility

$20,975.00

Service Code	HCPCS C1786
Hospital Charge Code	270676130
Hospital Revenue Code	275
Min. Negotiated Rate	$505.50
Max. Negotiated Rate	$10,487.50
Rate for Payer: Aetna Commercial	$7,970.50
Rate for Payer: Aetna Medicare Advantage	$6,292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,348.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,348.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,348.62
Rate for Payer: Cigna Commercial	$10,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,075.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,614.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,146.25
Rate for Payer: UnitedHealthcare Community & State	$505.50
Rate for Payer: Wellpoint Medicaid Managed Care	$555.84

PACEMAKER AFFINITY DR PUL 5330

Facility

$26,759.25

Hospital Charge Code	270630598
Hospital Revenue Code	275
Min. Negotiated Rate	$644.90
Max. Negotiated Rate	$13,379.62
Rate for Payer: Aetna Commercial	$10,168.51
Rate for Payer: Aetna Medicare Advantage	$8,027.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,823.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,823.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,351.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,823.61
Rate for Payer: Cigna Commercial	$13,379.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,475.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,887.03
Rate for Payer: Qualcare PPO/HMO/WC	$4,013.89
Rate for Payer: UnitedHealthcare Community & State	$644.90
Rate for Payer: Wellpoint Medicaid Managed Care	$709.12

PACEMAKER AFFINITY DR PUL 5330

Facility

$26,759.25

Hospital Charge Code	270630598
Hospital Revenue Code	275
Min. Negotiated Rate	$4,013.89
Max. Negotiated Rate	$6,475.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,351.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,475.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,887.03
Rate for Payer: Qualcare PPO/HMO/WC	$4,013.89

PACEMAKER AFFIN SR SSIR 5113MS

Facility

$24,056.00

Hospital Charge Code	270623693
Hospital Revenue Code	275
Min. Negotiated Rate	$579.75
Max. Negotiated Rate	$12,028.00
Rate for Payer: Aetna Commercial	$9,141.28
Rate for Payer: Aetna Medicare Advantage	$7,216.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,134.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,134.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,811.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,134.28
Rate for Payer: Cigna Commercial	$12,028.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,821.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,292.32
Rate for Payer: Qualcare PPO/HMO/WC	$3,608.40
Rate for Payer: UnitedHealthcare Community & State	$579.75
Rate for Payer: Wellpoint Medicaid Managed Care	$637.48

PACEMAKER AFFIN SR SSIR 5113MS

Facility

$24,056.00

Hospital Charge Code	270623693C
Hospital Revenue Code	275
Min. Negotiated Rate	$579.75
Max. Negotiated Rate	$12,028.00
Rate for Payer: Aetna Commercial	$9,141.28
Rate for Payer: Aetna Medicare Advantage	$7,216.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,134.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,134.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,811.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,134.28
Rate for Payer: Cigna Commercial	$12,028.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,821.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,292.32
Rate for Payer: Qualcare PPO/HMO/WC	$3,608.40
Rate for Payer: UnitedHealthcare Community & State	$579.75
Rate for Payer: Wellpoint Medicaid Managed Care	$637.48

PACEMAKER AFFIN SR SSIR 5113MS

Facility

$24,056.00

Hospital Charge Code	270623693C
Hospital Revenue Code	275
Min. Negotiated Rate	$3,608.40
Max. Negotiated Rate	$5,821.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,811.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,821.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,292.32
Rate for Payer: Qualcare PPO/HMO/WC	$3,608.40

PACEMAKER AFFIN SR SSIR 5113MS

Facility

$24,056.00

Hospital Charge Code	270623693
Hospital Revenue Code	275
Min. Negotiated Rate	$3,608.40
Max. Negotiated Rate	$5,821.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,811.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,821.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,292.32
Rate for Payer: Qualcare PPO/HMO/WC	$3,608.40

PACEMAKER ALT60 SSIR IS-1 S601

Facility

$22,500.00

Hospital Charge Code	270644194C
Hospital Revenue Code	275
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$8,550.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Community & State	$542.25
Rate for Payer: Wellpoint Medicaid Managed Care	$596.25

PACEMAKER ALT60 SSIR IS-1 S601

Facility

$22,500.00

Hospital Charge Code	270644194C
Hospital Revenue Code	275
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$5,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

PACEMAKER ALTRUA 60 DUAL

Facility

$25,000.00

Hospital Charge Code	270645424C
Hospital Revenue Code	275
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

PACEMAKER ALTRUA 60 DUAL

Facility

$25,000.00

Hospital Charge Code	270645424C
Hospital Revenue Code	275
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

PACEMAKER ALTRUA 60 S601 SR

Facility

$22,500.00

Hospital Charge Code	270646788
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$8,550.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Community & State	$542.25
Rate for Payer: Wellpoint Medicaid Managed Care	$596.25

PACEMAKER ALTRUA 60 S601 SR

Facility

$22,500.00

Hospital Charge Code	270646788
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$5,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

PACEMAKER ALTURA 60DDDR S603DR

Facility

$32,000.00

Service Code	HCPCS C1785
Hospital Charge Code	270661811
Hospital Revenue Code	275
Min. Negotiated Rate	$4,800.00
Max. Negotiated Rate	$7,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00

Know your out-of-pocket cost for care.

All Charges