Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DEVICE SPIDER FX 5 0X320X190

Facility

$1,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270657526N
Hospital Revenue Code	278
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

DEVICE SPIDER FX 6 0X320x190

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,534.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

DEVICE SPIDER FX 6 0X320x190

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527
Hospital Revenue Code	278
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,534.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$168.10
Rate for Payer: Wellpoint Medicaid Managed Care	$184.84

DEVICE SPIDER FX 6 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527N
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 6 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527S
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

DEVICE SPIDER FX 6 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527S
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 6 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527N
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

DEVICE SPIDER FX 7.0XSVG-320-1

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657528
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

DEVICE SPIDER FX 7.0XSVG-320-1

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657528N
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

DEVICE SPIDER FX 7.0XSVG-320-1

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657528
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 7.0XSVG-320-1

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657528N
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICESPIDERFX7.0XSVG-320 190/

Facility

$6,500.00

Hospital Charge Code	2709004038
Hospital Revenue Code	272
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$975.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICESPIDERFX7.0XSVG-320 190/

Facility

$6,500.00

Hospital Charge Code	2709004038
Hospital Revenue Code	272
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,950.00
Rate for Payer: Oxford Commercial	$1,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Commercial	$1,300.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

DEVICE SPRING GRIP 5-10 174110

Facility

$60.85

Hospital Charge Code	270627957
Hospital Revenue Code	272
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$9.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.13

DEVICE SPRING GRIP 5-10 174110

Facility

$60.85

Hospital Charge Code	270627957
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.43
Rate for Payer: Aetna Commercial	$23.12
Rate for Payer: Aetna Medicare Advantage	$18.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.52
Rate for Payer: Cigna Commercial	$30.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.25
Rate for Payer: Oxford Commercial	$12.17
Rate for Payer: Qualcare PPO/HMO/WC	$9.13
Rate for Payer: UnitedHealthcare Commercial	$12.17
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

DEVICE SPRING GRIP 5MM 174104

Facility

$60.85

Hospital Charge Code	270627956
Hospital Revenue Code	272
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$9.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.13

DEVICE SPRING GRIP 5MM 174104

Facility

$60.85

Hospital Charge Code	270627956
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.43
Rate for Payer: Aetna Commercial	$23.12
Rate for Payer: Aetna Medicare Advantage	$18.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.52
Rate for Payer: Cigna Commercial	$30.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.25
Rate for Payer: Oxford Commercial	$12.17
Rate for Payer: Qualcare PPO/HMO/WC	$9.13
Rate for Payer: UnitedHealthcare Commercial	$12.17
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

DEVICE STATLK WCLMP 0684000472

Facility

$91.25

Hospital Charge Code	270634501
Hospital Revenue Code	272
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

DEVICE STATLK WCLMP 0684000472

Facility

$91.25

Hospital Charge Code	270634501
Hospital Revenue Code	272
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$45.62
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$18.25
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$18.25
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

DEVICE STONE NTRAP 3FR

Facility

$1,127.65

Hospital Charge Code	270658409
Hospital Revenue Code	270
Min. Negotiated Rate	$169.15
Max. Negotiated Rate	$169.15
Rate for Payer: Qualcare PPO/HMO/WC	$169.15

DEVICE STONE NTRAP 3FR

Facility

$1,127.65

Hospital Charge Code	270658409
Hospital Revenue Code	270
Min. Negotiated Rate	$27.18
Max. Negotiated Rate	$563.83
Rate for Payer: Aetna Commercial	$428.51
Rate for Payer: Aetna Medicare Advantage	$338.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.55
Rate for Payer: Cigna Commercial	$563.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.30
Rate for Payer: Oxford Commercial	$225.53
Rate for Payer: Qualcare PPO/HMO/WC	$169.15
Rate for Payer: UnitedHealthcare Commercial	$225.53
Rate for Payer: UnitedHealthcare Community & State	$27.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.88

DEVICE TIBIA; FIXATION 9MM

Facility

$3,055.00

Hospital Charge Code	270656651
Hospital Revenue Code	278
Min. Negotiated Rate	$458.25
Max. Negotiated Rate	$739.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$611.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$739.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$672.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.25

DEVICE TIBIA; FIXATION 9MM

Facility

$3,055.00

Hospital Charge Code	270656651
Hospital Revenue Code	278
Min. Negotiated Rate	$73.63
Max. Negotiated Rate	$1,527.50
Rate for Payer: Aetna Commercial	$1,160.90
Rate for Payer: Aetna Medicare Advantage	$916.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$779.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$779.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$611.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$779.02
Rate for Payer: Cigna Commercial	$1,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$739.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$672.10
Rate for Payer: Qualcare PPO/HMO/WC	$458.25
Rate for Payer: UnitedHealthcare Community & State	$73.63
Rate for Payer: Wellpoint Medicaid Managed Care	$80.96

DEVICE TOGGLE LOC FIXATION

Facility

$4,180.00

Hospital Charge Code	270665366
Hospital Revenue Code	278
Min. Negotiated Rate	$100.74
Max. Negotiated Rate	$2,090.00
Rate for Payer: Aetna Commercial	$1,588.40
Rate for Payer: Aetna Medicare Advantage	$1,254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,065.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,065.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,065.90
Rate for Payer: Cigna Commercial	$2,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,011.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$919.60
Rate for Payer: Qualcare PPO/HMO/WC	$627.00
Rate for Payer: UnitedHealthcare Community & State	$100.74
Rate for Payer: Wellpoint Medicaid Managed Care	$110.77

DEVICE TOGGLE LOC FIXATION

Facility

$4,180.00

Hospital Charge Code	270665366
Hospital Revenue Code	278
Min. Negotiated Rate	$627.00
Max. Negotiated Rate	$1,011.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$836.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,011.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$919.60
Rate for Payer: Qualcare PPO/HMO/WC	$627.00

Know your out-of-pocket cost for care.

All Charges