Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTEGRAL PRIMARY/REV 13X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270688618
Hospital Revenue Code	278
Min. Negotiated Rate	$7,558.20
Max. Negotiated Rate	$12,193.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,193.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,085.36
Rate for Payer: Qualcare PPO/HMO/WC	$7,558.20

INTEGRAL PRMRY 14x180MM 166014

Facility

$15,802.45

Hospital Charge Code	270608169
Hospital Revenue Code	278
Min. Negotiated Rate	$2,370.37
Max. Negotiated Rate	$3,824.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,160.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,476.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,370.37

INTEGRAL PRMRY 14x180MM 166014

Facility

$15,802.45

Hospital Charge Code	270608169
Hospital Revenue Code	278
Min. Negotiated Rate	$380.84
Max. Negotiated Rate	$7,901.23
Rate for Payer: Aetna Commercial	$6,004.93
Rate for Payer: Aetna Medicare Advantage	$4,740.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,029.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,029.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,160.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,029.62
Rate for Payer: Cigna Commercial	$7,901.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,824.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,476.54
Rate for Payer: Qualcare PPO/HMO/WC	$2,370.37
Rate for Payer: UnitedHealthcare Community & State	$380.84
Rate for Payer: Wellpoint Medicaid Managed Care	$418.76

INTEGRA POR STAND SZ8 120MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694498
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

INTEGRA POR STAND SZ8 120MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694498
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

INTEGRA SINGLE LAYER 2X2IN

Facility

$9,890.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657179
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.50
Max. Negotiated Rate	$2,393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,978.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,393.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,175.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,483.50

INTEGRA SINGLE LAYER 2X2IN

Facility

$9,890.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657179
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,393.38
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,978.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,393.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,175.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,483.50
Rate for Payer: UnitedHealthcare Community & State	$238.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$262.08

INTEGRA SINGLE LAYER 4X5IN

Facility

$17,475.00

Hospital Charge Code	270657181
Hospital Revenue Code	636
Min. Negotiated Rate	$421.15
Max. Negotiated Rate	$8,737.50
Rate for Payer: Aetna Commercial	$6,640.50
Rate for Payer: Aetna Medicare Advantage	$5,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,456.12
Rate for Payer: Cigna Commercial	$8,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25
Rate for Payer: UnitedHealthcare Community & State	$421.15
Rate for Payer: Wellpoint Medicaid Managed Care	$463.09

INTEGRA SINGLE LAYER 4X5IN

Facility

$17,475.00

Hospital Charge Code	270657181
Hospital Revenue Code	636
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

INTEGRATE-C FUSION DEVICE. 17X

Facility

$8,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270706189
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

INTEGRATE-C FUSION DEVICE. 17X

Facility

$8,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270706189
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INTEGRATED PLATE 24MM 1 HOLE

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695935
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

INTEGRATED PLATE 24MM 1 HOLE

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695935
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

INTEGRATOR STRIPS CLASS 5

Facility

$0.64

Hospital Charge Code	270645806
Hospital Revenue Code	278
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.10

INTEGRATOR STRIPS CLASS 5

Facility

$0.64

Hospital Charge Code	270645806
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna Commercial	$0.24
Rate for Payer: Aetna Medicare Advantage	$0.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.16
Rate for Payer: Cigna Commercial	$0.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.10
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

INTEGRA WND DRSG 2X2CM

Facility

$2,273.00

Hospital Charge Code	270332613
Hospital Revenue Code	636
Min. Negotiated Rate	$54.78
Max. Negotiated Rate	$1,136.50
Rate for Payer: Aetna Commercial	$863.74
Rate for Payer: Aetna Medicare Advantage	$681.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$579.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$579.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$579.62
Rate for Payer: Cigna Commercial	$1,136.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.07
Rate for Payer: Qualcare PPO/HMO/WC	$340.95
Rate for Payer: UnitedHealthcare Community & State	$54.78
Rate for Payer: Wellpoint Medicaid Managed Care	$60.23

INTEGRA WND DRSG 2X2CM

Facility

$2,273.00

Hospital Charge Code	270332613
Hospital Revenue Code	636
Min. Negotiated Rate	$340.95
Max. Negotiated Rate	$550.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.07
Rate for Payer: Qualcare PPO/HMO/WC	$340.95

INTEGRA WND DRSG 2X2/SQ CMJW

Facility

$568.25

Hospital Charge Code	270332613W
Hospital Revenue Code	636
Min. Negotiated Rate	$85.24
Max. Negotiated Rate	$137.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.52
Rate for Payer: Qualcare PPO/HMO/WC	$85.24

INTEGRA WND DRSG 2X2/SQ CMJW

Facility

$568.25

Hospital Charge Code	270332613W
Hospital Revenue Code	636
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$284.12
Rate for Payer: Aetna Commercial	$215.94
Rate for Payer: Aetna Medicare Advantage	$170.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.90
Rate for Payer: Cigna Commercial	$284.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.52
Rate for Payer: Qualcare PPO/HMO/WC	$85.24
Rate for Payer: UnitedHealthcare Community & State	$13.69
Rate for Payer: Wellpoint Medicaid Managed Care	$15.06

INTEGRA WND DRSG 4X10CM/SQCMJW

Facility

$66.28

Hospital Charge Code	270332610W
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.14
Rate for Payer: Aetna Commercial	$25.19
Rate for Payer: Aetna Medicare Advantage	$19.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.90
Rate for Payer: Cigna Commercial	$33.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.94
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

INTEGRA WND DRSG 4X10CM/SQCMJW

Facility

$66.28

Hospital Charge Code	270332610W
Hospital Revenue Code	636
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$16.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.94

INTEGRA WND DRSG 8X10CM

Facility

$3,743.00

Hospital Charge Code	270332612
Hospital Revenue Code	636
Min. Negotiated Rate	$90.21
Max. Negotiated Rate	$1,871.50
Rate for Payer: Aetna Commercial	$1,422.34
Rate for Payer: Aetna Medicare Advantage	$1,122.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$954.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$954.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$954.47
Rate for Payer: Cigna Commercial	$1,871.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.81
Rate for Payer: Qualcare PPO/HMO/WC	$561.45
Rate for Payer: UnitedHealthcare Community & State	$90.21
Rate for Payer: Wellpoint Medicaid Managed Care	$99.19

INTEGRA WND DRSG 8X10CM

Facility

$3,743.00

Hospital Charge Code	270332612
Hospital Revenue Code	636
Min. Negotiated Rate	$561.45
Max. Negotiated Rate	$905.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.81
Rate for Payer: Qualcare PPO/HMO/WC	$561.45

INTEGRA WND DRSG 8X10/SQCMJW

Facility

$46.79

Hospital Charge Code	270332612W
Hospital Revenue Code	636
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$11.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

INTEGRA WND DRSG 8X10/SQCMJW

Facility

$46.79

Hospital Charge Code	270332612W
Hospital Revenue Code	636
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.39
Rate for Payer: Aetna Commercial	$17.78
Rate for Payer: Aetna Medicare Advantage	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.93
Rate for Payer: Cigna Commercial	$23.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.02
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

Know your out-of-pocket cost for care.

All Charges