Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PACEMAKER SENSIA SR

Facility

$15,680.00

Service Code	HCPCS C1786
Hospital Charge Code	270638082
Hospital Revenue Code	275
Min. Negotiated Rate	$2,352.00
Max. Negotiated Rate	$3,794.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,794.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,449.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,352.00

PACEMAKER SENSIA SR

Facility

$15,680.00

Service Code	HCPCS C1786
Hospital Charge Code	270638082
Hospital Revenue Code	275
Min. Negotiated Rate	$377.89
Max. Negotiated Rate	$7,840.00
Rate for Payer: Aetna Commercial	$5,958.40
Rate for Payer: Aetna Medicare Advantage	$4,704.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,998.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,998.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,998.40
Rate for Payer: Cigna Commercial	$7,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,794.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,449.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,352.00
Rate for Payer: UnitedHealthcare Community & State	$377.89
Rate for Payer: Wellpoint Medicaid Managed Care	$415.52

PACEMAKER SINGL CHAMBER KSR903

Facility

$25,742.45

Hospital Charge Code	270625758
Hospital Revenue Code	275
Min. Negotiated Rate	$3,861.37
Max. Negotiated Rate	$6,229.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,148.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,229.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,861.37

PACEMAKER SINGL CHAMBER KSR903

Facility

$25,742.45

Hospital Charge Code	270625758C
Hospital Revenue Code	275
Min. Negotiated Rate	$620.39
Max. Negotiated Rate	$12,871.23
Rate for Payer: Aetna Commercial	$9,782.13
Rate for Payer: Aetna Medicare Advantage	$7,722.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,564.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,564.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,148.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,564.32
Rate for Payer: Cigna Commercial	$12,871.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,229.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,861.37
Rate for Payer: UnitedHealthcare Community & State	$620.39
Rate for Payer: Wellpoint Medicaid Managed Care	$682.17

PACEMAKER SINGL CHAMBER KSR903

Facility

$25,742.45

Hospital Charge Code	270625758C
Hospital Revenue Code	275
Min. Negotiated Rate	$3,861.37
Max. Negotiated Rate	$6,229.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,148.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,229.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,861.37

PACEMAKER SINGL CHAMBER KSR903

Facility

$25,742.45

Hospital Charge Code	270625758
Hospital Revenue Code	275
Min. Negotiated Rate	$620.39
Max. Negotiated Rate	$12,871.23
Rate for Payer: Aetna Commercial	$9,782.13
Rate for Payer: Aetna Medicare Advantage	$7,722.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,564.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,564.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,148.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,564.32
Rate for Payer: Cigna Commercial	$12,871.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,229.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,861.37
Rate for Payer: UnitedHealthcare Community & State	$620.39
Rate for Payer: Wellpoint Medicaid Managed Care	$682.17

PACEMAKER SJM INTEG AFXDR 5342

Facility

$24,172.00

Hospital Charge Code	270622691
Hospital Revenue Code	275
Min. Negotiated Rate	$582.55
Max. Negotiated Rate	$12,086.00
Rate for Payer: Aetna Commercial	$9,185.36
Rate for Payer: Aetna Medicare Advantage	$7,251.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,163.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,163.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,834.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,163.86
Rate for Payer: Cigna Commercial	$12,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,849.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,317.84
Rate for Payer: Qualcare PPO/HMO/WC	$3,625.80
Rate for Payer: UnitedHealthcare Community & State	$582.55
Rate for Payer: Wellpoint Medicaid Managed Care	$640.56

PACEMAKER SJM INTEG AFXDR 5342

Facility

$24,172.00

Hospital Charge Code	270622691
Hospital Revenue Code	275
Min. Negotiated Rate	$3,625.80
Max. Negotiated Rate	$5,849.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,834.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,849.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,317.84
Rate for Payer: Qualcare PPO/HMO/WC	$3,625.80

PACEMAKER SJM INTEG AFXDR 5342

Facility

$24,172.00

Hospital Charge Code	270622691C
Hospital Revenue Code	275
Min. Negotiated Rate	$582.55
Max. Negotiated Rate	$12,086.00
Rate for Payer: Aetna Commercial	$9,185.36
Rate for Payer: Aetna Medicare Advantage	$7,251.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,163.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,163.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,834.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,163.86
Rate for Payer: Cigna Commercial	$12,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,849.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,317.84
Rate for Payer: Qualcare PPO/HMO/WC	$3,625.80
Rate for Payer: UnitedHealthcare Community & State	$582.55
Rate for Payer: Wellpoint Medicaid Managed Care	$640.56

PACEMAKER SJM INTEG AFXDR 5342

Facility

$24,172.00

Hospital Charge Code	270622691C
Hospital Revenue Code	275
Min. Negotiated Rate	$3,625.80
Max. Negotiated Rate	$5,849.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,834.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,849.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,317.84
Rate for Payer: Qualcare PPO/HMO/WC	$3,625.80

PACEMAKER SLZR 294-23***

Facility

$27,720.00

Hospital Charge Code	270605850
Hospital Revenue Code	275
Min. Negotiated Rate	$4,158.00
Max. Negotiated Rate	$6,708.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,544.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,708.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,098.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,158.00

PACEMAKER SLZR 294-23***

Facility

$27,720.00

Hospital Charge Code	270605850
Hospital Revenue Code	275
Min. Negotiated Rate	$668.05
Max. Negotiated Rate	$13,860.00
Rate for Payer: Aetna Commercial	$10,533.60
Rate for Payer: Aetna Medicare Advantage	$8,316.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,068.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,068.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,544.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,068.60
Rate for Payer: Cigna Commercial	$13,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,708.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,098.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,158.00
Rate for Payer: UnitedHealthcare Community & State	$668.05
Rate for Payer: Wellpoint Medicaid Managed Care	$734.58

PACEMAKER SLZR NOVA III 282-07

Facility

$19,112.00

Hospital Charge Code	270615112
Hospital Revenue Code	275
Min. Negotiated Rate	$460.60
Max. Negotiated Rate	$9,556.00
Rate for Payer: Aetna Commercial	$7,262.56
Rate for Payer: Aetna Medicare Advantage	$5,733.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,873.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,873.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,822.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,873.56
Rate for Payer: Cigna Commercial	$9,556.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,625.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,204.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,866.80
Rate for Payer: UnitedHealthcare Community & State	$460.60
Rate for Payer: Wellpoint Medicaid Managed Care	$506.47

PACEMAKER SLZR NOVA III 282-07

Facility

$19,112.00

Hospital Charge Code	270615112
Hospital Revenue Code	275
Min. Negotiated Rate	$2,866.80
Max. Negotiated Rate	$4,625.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,822.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,625.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,204.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,866.80

PACEMAKER SORIN SR ICV1102

Facility

$24,500.00

Service Code	HCPCS C1786
Hospital Charge Code	270660758N
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 SORIN SR ICV1102

Facility

$13,737.00

Service Code	HCPCS C1786
Hospital Charge Code	270660758
Hospital Revenue Code	275
Min. Negotiated Rate	$331.06
Max. Negotiated Rate	$6,868.50
Rate for Payer: Aetna Commercial	$5,220.06
Rate for Payer: Aetna Medicare Advantage	$4,121.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,502.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,502.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,747.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,502.93
Rate for Payer: Cigna Commercial	$6,868.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,324.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,022.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,060.55
Rate for Payer: UnitedHealthcare Community & State	$331.06
Rate for Payer: Wellpoint Medicaid Managed Care	$364.03

PACEMAKER SORIN SR ICV1102

Facility

$24,500.00

Service Code	HCPCS C1786
Hospital Charge Code	270660758N
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 SORIN SR ICV1102

Facility

$13,737.00

Service Code	HCPCS C1786
Hospital Charge Code	270660758
Hospital Revenue Code	275
Min. Negotiated Rate	$2,060.55
Max. Negotiated Rate	$3,324.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,747.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,324.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,022.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,060.55

PACEMAKER VERITY ADX 5156

Facility

$22,975.00

Hospital Charge Code	270638746
Hospital Revenue Code	275
Min. Negotiated Rate	$3,446.25
Max. Negotiated Rate	$5,559.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,559.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,054.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,446.25

PACEMAKER VERITY ADX 5156

Facility

$22,975.00

Hospital Charge Code	270638746
Hospital Revenue Code	275
Min. Negotiated Rate	$553.70
Max. Negotiated Rate	$11,487.50
Rate for Payer: Aetna Commercial	$8,730.50
Rate for Payer: Aetna Medicare Advantage	$6,892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,858.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,858.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,858.62
Rate for Payer: Cigna Commercial	$11,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,559.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,054.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,446.25
Rate for Payer: UnitedHealthcare Community & State	$553.70
Rate for Payer: Wellpoint Medicaid Managed Care	$608.84

PACEMAKER WEARABLE INSERTABLE

Facility

$300.65

Service Code	HCPCS 93284
Hospital Charge Code	5100276
Hospital Revenue Code	480
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.05
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.19
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.10
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$7.97

PACEMAKER WEARABLE INSERTABLE

Facility

$300.65

Service Code	HCPCS 93284
Hospital Charge Code	5100276
Hospital Revenue Code	480
Min. Negotiated Rate	$45.10
Max. Negotiated Rate	$45.10
Rate for Payer: Qualcare PPO/HMO/WC	$45.10

PACEMAKER XTDR AZURE SURESCAN

Facility

$27,175.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677N
Hospital Revenue Code	275
Min. Negotiated Rate	$4,076.25
Max. Negotiated Rate	$6,576.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,576.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,978.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,076.25

PACEMAKER XTDR AZURE SURESCAN

Facility

$27,175.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677N
Hospital Revenue Code	275
Min. Negotiated Rate	$654.92
Max. Negotiated Rate	$13,587.50
Rate for Payer: Aetna Commercial	$10,326.50
Rate for Payer: Aetna Medicare Advantage	$8,152.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,929.62
Rate for Payer: Cigna Commercial	$13,587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,576.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,978.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,076.25
Rate for Payer: UnitedHealthcare Community & State	$654.92
Rate for Payer: Wellpoint Medicaid Managed Care	$720.14

PACEMAKER XTDR AZURE SURESCAN

Facility

$27,175.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677S
Hospital Revenue Code	275
Min. Negotiated Rate	$4,076.25
Max. Negotiated Rate	$6,576.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,576.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,978.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,076.25

Know your out-of-pocket cost for care.

All Charges