Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIR-PERC TRANSHEP CHOLANG

Facility

$3,012.00

Hospital Charge Code	2007035
Hospital Revenue Code	320
Min. Negotiated Rate	$72.59
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,144.56
Rate for Payer: Aetna Medicare Advantage	$903.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.06
Rate for Payer: Cigna Commercial	$1,506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$903.60
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$451.80
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$72.59
Rate for Payer: Wellpoint Medicaid Managed Care	$79.82

DISALCID/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DISALCID/500MG/TAB

Facility

$3.00

Hospital Charge Code	60632870
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

DISALCID/750MG/TAB

Facility

$3.00

Hospital Charge Code	60632871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

DISALCID/750MG/TAB

Facility

$3.00

Hospital Charge Code	60632871
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DISC 10X22X11MM 5DEG CAGE PC

Facility

$8,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692593
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

DISC 10X22X11MM 5DEG CAGE PC

Facility

$8,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692593
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

DISC 10 X 22 X 12 5 DEG

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692722
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

DISC 10 X 22 X 12 5 DEG

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692722
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

DISC 12X27X13MM 5 DEG CAGE PC

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692588
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

DISC 12X27X13MM 5 DEG CAGE PC

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692588
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

DISC CERVICAL 15X15 H5

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692518
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

DISC CERVICAL 15X15 H5

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692518
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

DISC CERVICAL 17 X17 H7 MOBI-C

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692561
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

DISC CERVICAL 17 X17 H7 MOBI-C

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692561
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

DISC CERVICAL M6-C 6LL 17X16MM

Facility

$31,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270696757
Hospital Revenue Code	278
Min. Negotiated Rate	$747.10
Max. Negotiated Rate	$15,500.00
Rate for Payer: Aetna Commercial	$11,780.00
Rate for Payer: Aetna Medicare Advantage	$9,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,905.00
Rate for Payer: Cigna Commercial	$15,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,502.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,650.00
Rate for Payer: UnitedHealthcare Community & State	$747.10
Rate for Payer: Wellpoint Medicaid Managed Care	$821.50

DISC CERVICAL M6-C 6LL 17X16MM

Facility

$31,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270696757
Hospital Revenue Code	278
Min. Negotiated Rate	$4,650.00
Max. Negotiated Rate	$7,502.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,502.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,650.00

DISC CERVICAL M6-C LF6X17X14MM

Facility

$31,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270696758
Hospital Revenue Code	278
Min. Negotiated Rate	$4,650.00
Max. Negotiated Rate	$7,502.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,502.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,650.00

DISC CERVICAL M6-C LF6X17X14MM

Facility

$31,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270696758
Hospital Revenue Code	278
Min. Negotiated Rate	$747.10
Max. Negotiated Rate	$15,500.00
Rate for Payer: Aetna Commercial	$11,780.00
Rate for Payer: Aetna Medicare Advantage	$9,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,905.00
Rate for Payer: Cigna Commercial	$15,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,502.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,650.00
Rate for Payer: UnitedHealthcare Community & State	$747.10
Rate for Payer: Wellpoint Medicaid Managed Care	$821.50

DISC CERVICAL MOBI C 15 X 7

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692002
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

DISC CERVICAL MOBI C 15 X 7

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692002
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

DISC CERVICAL MOBI-C 17X17 H5

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692491
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

DISC CERVICAL MOBI-C 17X17 H5

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692491
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

DISC CERV INTERV 7MMX16MM TI

Facility

$44,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693269
Hospital Revenue Code	278
Min. Negotiated Rate	$1,072.45
Max. Negotiated Rate	$22,250.00
Rate for Payer: Aetna Commercial	$16,910.00
Rate for Payer: Aetna Medicare Advantage	$13,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,347.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,347.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,347.50
Rate for Payer: Cigna Commercial	$22,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,769.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,790.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,675.00
Rate for Payer: UnitedHealthcare Community & State	$1,072.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1,179.25

DISC CERV INTERV 7MMX16MM TI

Facility

$44,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693269
Hospital Revenue Code	278
Min. Negotiated Rate	$6,675.00
Max. Negotiated Rate	$10,769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,769.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,790.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,675.00

Know your out-of-pocket cost for care.

All Charges