Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PACER TEMP INSERTION

Facility

$13,567.40

Service Code	HCPCS 33210
Hospital Charge Code	74110014
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.11
Max. Negotiated Rate	$2,035.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.11

PACER TEMP INSERTION

Facility

$13,567.40

Service Code	HCPCS 33210
Hospital Charge Code	5100102
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.11
Max. Negotiated Rate	$2,035.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.11

PACER TEMP INSERTION

Facility

$13,567.40

Service Code	HCPCS 33210
Hospital Charge Code	5100102
Hospital Revenue Code	361
Min. Negotiated Rate	$326.97
Max. Negotiated Rate	$35,488.33
Rate for Payer: Aetna Commercial	$26,741.35
Rate for Payer: Aetna Medicare Advantage	$31,853.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,488.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,488.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,831.38
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	$35,488.33
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: Cigna Medicare Advantage	$9,831.38
Rate for Payer: Clover Medicare Advantage	$9,339.81
Rate for Payer: EmblemHealth Commercial	$29,494.14
Rate for Payer: Humana Medicare Advantage	$10,126.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,831.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,070.22
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.11
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$326.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,831.38
Rate for Payer: Wellcare Medicare Advantage	$9,831.38
Rate for Payer: Wellpoint Medicaid Managed Care	$359.54

PACER TEMP INSERTION

Facility

$13,567.40

Service Code	HCPCS 33210
Hospital Charge Code	74110014
Hospital Revenue Code	361
Min. Negotiated Rate	$326.97
Max. Negotiated Rate	$35,488.33
Rate for Payer: Aetna Commercial	$26,741.35
Rate for Payer: Aetna Medicare Advantage	$31,853.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,488.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,488.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,831.38
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	$35,488.33
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: Cigna Medicare Advantage	$9,831.38
Rate for Payer: Clover Medicare Advantage	$9,339.81
Rate for Payer: EmblemHealth Commercial	$29,494.14
Rate for Payer: Humana Medicare Advantage	$10,126.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,831.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,070.22
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.11
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$326.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,831.38
Rate for Payer: Wellcare Medicare Advantage	$9,831.38
Rate for Payer: Wellpoint Medicaid Managed Care	$359.54

Pacific Plus 2.5x120x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683470
Hospital Revenue Code	278
Min. Negotiated Rate	$25.24
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$25.24
Rate for Payer: Wellpoint Medicaid Managed Care	$27.76

Pacific Plus 2.5x120x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683470
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Pacific Plus 2.5x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683470N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 2.5x120x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683470S
Hospital Revenue Code	278
Min. Negotiated Rate	$25.24
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$25.24
Rate for Payer: Wellpoint Medicaid Managed Care	$27.76

Pacific Plus 2.5x120x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683470S
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Pacific Plus 2.5x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683470N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 2.5x40x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683468
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 2.5x40x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683468N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 2.5x40x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683468N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 2.5x40x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683468
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 2.5x80x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683469
Hospital Revenue Code	278
Min. Negotiated Rate	$25.24
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$25.24
Rate for Payer: Wellpoint Medicaid Managed Care	$27.76

Pacific Plus 2.5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683469N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 2.5x80x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683469
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Pacific Plus 2.5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683469N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 2x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683466
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 2x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683466
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 2x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683466N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 2x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683466N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 2x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683466S
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 2x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683466S
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$250.80
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$27.47
Rate for Payer: Wellpoint Medicaid Managed Care	$30.21

Pacific Plus 2x150x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683467S
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$230.43
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Know your out-of-pocket cost for care.

All Charges