Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PACEMAKER LEADS DUAL INSERT

Facility

$27,008.30

Service Code	HCPCS 33217
Hospital Charge Code	74110033
Hospital Revenue Code	361
Min. Negotiated Rate	$4,051.24
Max. Negotiated Rate	$4,051.24
Rate for Payer: Qualcare PPO/HMO/WC	$4,051.24

PACEMAKER LEADS DUAL INSERT

Facility

$27,008.30

Service Code	HCPCS 33217
Hospital Charge Code	5100296
Hospital Revenue Code	361
Min. Negotiated Rate	$4,051.24
Max. Negotiated Rate	$4,051.24
Rate for Payer: Qualcare PPO/HMO/WC	$4,051.24

PACEMAKER LEAD SETROX 45

Facility

$2,365.00

Service Code	HCPCS C1898
Hospital Charge Code	270675163
Hospital Revenue Code	275
Min. Negotiated Rate	$354.75
Max. Negotiated Rate	$572.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$473.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$520.30
Rate for Payer: Qualcare PPO/HMO/WC	$354.75

PACEMAKER LEAD SETROX 45

Facility

$2,365.00

Service Code	HCPCS C1898
Hospital Charge Code	270675163
Hospital Revenue Code	275
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$1,182.50
Rate for Payer: Aetna Commercial	$898.70
Rate for Payer: Aetna Medicare Advantage	$709.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$603.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$603.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$473.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$603.08
Rate for Payer: Cigna Commercial	$1,182.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$572.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$520.30
Rate for Payer: Qualcare PPO/HMO/WC	$354.75
Rate for Payer: UnitedHealthcare Community & State	$57.00
Rate for Payer: Wellpoint Medicaid Managed Care	$62.67

PACEMAKER LEAD TENDRIL DC

Facility

$24,500.00

Hospital Charge Code	270CH0120
Hospital Revenue Code	275
Min. Negotiated Rate	$3,675.00
Max. Negotiated Rate	$5,929.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,929.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,675.00

PACEMAKER LEAD TENDRIL DC

Facility

$24,500.00

Hospital Charge Code	270CH0120
Hospital Revenue Code	275
Min. Negotiated Rate	$590.45
Max. Negotiated Rate	$12,250.00
Rate for Payer: Aetna Commercial	$9,310.00
Rate for Payer: Aetna Medicare Advantage	$7,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,247.50
Rate for Payer: Cigna Commercial	$12,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,929.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,675.00
Rate for Payer: UnitedHealthcare Community & State	$590.45
Rate for Payer: Wellpoint Medicaid Managed Care	$649.25

PACEMAKER MEDT*******

Facility

$10,000.00

Hospital Charge Code	270601715
Hospital Revenue Code	275
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PACEMAKER MEDT*******

Facility

$10,000.00

Hospital Charge Code	270601715
Hospital Revenue Code	275
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

PACEMAKER MEDT 2029M/S

Facility

$20,946.45

Hospital Charge Code	270608808
Hospital Revenue Code	275
Min. Negotiated Rate	$504.81
Max. Negotiated Rate	$10,473.23
Rate for Payer: Aetna Commercial	$7,959.65
Rate for Payer: Aetna Medicare Advantage	$6,283.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,341.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,341.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,189.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,341.34
Rate for Payer: Cigna Commercial	$10,473.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,069.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,608.22
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.97
Rate for Payer: UnitedHealthcare Community & State	$504.81
Rate for Payer: Wellpoint Medicaid Managed Care	$555.08

PACEMAKER MEDT 2029M/S

Facility

$20,946.45

Hospital Charge Code	270608808
Hospital Revenue Code	275
Min. Negotiated Rate	$3,141.97
Max. Negotiated Rate	$5,069.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,189.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,069.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,608.22
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.97

PACEMAKER MEDT 2029M/S

Facility

$15,083.25

Hospital Charge Code	270608906
Hospital Revenue Code	275
Min. Negotiated Rate	$363.51
Max. Negotiated Rate	$7,541.62
Rate for Payer: Aetna Commercial	$5,731.64
Rate for Payer: Aetna Medicare Advantage	$4,524.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,846.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,846.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,016.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,846.23
Rate for Payer: Cigna Commercial	$7,541.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,650.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,318.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,262.49
Rate for Payer: UnitedHealthcare Community & State	$363.51
Rate for Payer: Wellpoint Medicaid Managed Care	$399.71

PACEMAKER MEDT 2029M/S

Facility

$15,083.25

Hospital Charge Code	270608906
Hospital Revenue Code	275
Min. Negotiated Rate	$2,262.49
Max. Negotiated Rate	$3,650.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,016.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,650.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,318.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,262.49

PACEMAKER MEDT 5033

Facility

$3,158.45

Hospital Charge Code	270602740
Hospital Revenue Code	275
Min. Negotiated Rate	$76.12
Max. Negotiated Rate	$1,579.22
Rate for Payer: Aetna Commercial	$1,200.21
Rate for Payer: Aetna Medicare Advantage	$947.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$805.40
Rate for Payer: Cigna Commercial	$1,579.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$694.86
Rate for Payer: Qualcare PPO/HMO/WC	$473.77
Rate for Payer: UnitedHealthcare Community & State	$76.12
Rate for Payer: Wellpoint Medicaid Managed Care	$83.70

PACEMAKER MEDT 5033

Facility

$3,158.45

Hospital Charge Code	270602740
Hospital Revenue Code	275
Min. Negotiated Rate	$473.77
Max. Negotiated Rate	$764.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$694.86
Rate for Payer: Qualcare PPO/HMO/WC	$473.77

PACEMAKER MEDT 5033

Facility

$3,625.00

Hospital Charge Code	270602740C
Hospital Revenue Code	275
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,377.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75
Rate for Payer: UnitedHealthcare Community & State	$87.36
Rate for Payer: Wellpoint Medicaid Managed Care	$96.06

PACEMAKER MEDT 5033

Facility

$3,625.00

Hospital Charge Code	270602740C
Hospital Revenue Code	275
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$877.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

PACEMAKER MEDT 7084***

Facility

$16,200.00

Hospital Charge Code	270602701
Hospital Revenue Code	275
Min. Negotiated Rate	$390.42
Max. Negotiated Rate	$8,100.00
Rate for Payer: Aetna Commercial	$6,156.00
Rate for Payer: Aetna Medicare Advantage	$4,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,131.00
Rate for Payer: Cigna Commercial	$8,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,920.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,564.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,430.00
Rate for Payer: UnitedHealthcare Community & State	$390.42
Rate for Payer: Wellpoint Medicaid Managed Care	$429.30

PACEMAKER MEDT 7084***

Facility

$16,200.00

Hospital Charge Code	270602701
Hospital Revenue Code	275
Min. Negotiated Rate	$2,430.00
Max. Negotiated Rate	$3,920.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,920.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,564.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,430.00

PACEMAKER MEDT 7085***

Facility

$16,200.00

Hospital Charge Code	270602702
Hospital Revenue Code	275
Min. Negotiated Rate	$2,430.00
Max. Negotiated Rate	$3,920.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,920.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,564.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,430.00

PACEMAKER MEDT 7085***

Facility

$16,200.00

Hospital Charge Code	270602702
Hospital Revenue Code	275
Min. Negotiated Rate	$390.42
Max. Negotiated Rate	$8,100.00
Rate for Payer: Aetna Commercial	$6,156.00
Rate for Payer: Aetna Medicare Advantage	$4,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,131.00
Rate for Payer: Cigna Commercial	$8,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,920.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,564.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,430.00
Rate for Payer: UnitedHealthcare Community & State	$390.42
Rate for Payer: Wellpoint Medicaid Managed Care	$429.30

PACEMAKER MEDT 7086***

Facility

$16,200.00

Hospital Charge Code	270602703
Hospital Revenue Code	275
Min. Negotiated Rate	$2,430.00
Max. Negotiated Rate	$3,920.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,920.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,564.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,430.00

PACEMAKER MEDT 7086***

Facility

$16,200.00

Hospital Charge Code	270602703
Hospital Revenue Code	275
Min. Negotiated Rate	$390.42
Max. Negotiated Rate	$8,100.00
Rate for Payer: Aetna Commercial	$6,156.00
Rate for Payer: Aetna Medicare Advantage	$4,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,131.00
Rate for Payer: Cigna Commercial	$8,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,920.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,564.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,430.00
Rate for Payer: UnitedHealthcare Community & State	$390.42
Rate for Payer: Wellpoint Medicaid Managed Care	$429.30

PACEMAKER MEDT 7107***

Facility

$12,960.00

Hospital Charge Code	270602710
Hospital Revenue Code	275
Min. Negotiated Rate	$312.34
Max. Negotiated Rate	$6,480.00
Rate for Payer: Aetna Commercial	$4,924.80
Rate for Payer: Aetna Medicare Advantage	$3,888.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,304.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,304.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,592.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,304.80
Rate for Payer: Cigna Commercial	$6,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,136.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,851.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.00
Rate for Payer: UnitedHealthcare Community & State	$312.34
Rate for Payer: Wellpoint Medicaid Managed Care	$343.44

PACEMAKER MEDT 7107***

Facility

$12,960.00

Hospital Charge Code	270602710
Hospital Revenue Code	275
Min. Negotiated Rate	$1,944.00
Max. Negotiated Rate	$3,136.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,592.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,136.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,851.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.00

PACEMAKER MEDT 7108***

Facility

$12,960.00

Hospital Charge Code	270602711
Hospital Revenue Code	275
Min. Negotiated Rate	$1,944.00
Max. Negotiated Rate	$3,136.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,592.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,136.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,851.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.00

Know your out-of-pocket cost for care.

All Charges