Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTERBODY FUSION DEVICE

Facility

$20,000.00

Hospital Charge Code	270702963
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

INTERBODY FUSION DEVICE

Facility

$20,000.00

Hospital Charge Code	270702963
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

INTERBODY FUSION DEVICE 15WX12

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704521
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERBODY FUSION DEVICE 15WX12

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704521
Hospital Revenue Code	278
Min. Negotiated Rate	$373.55
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$5,890.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00
Rate for Payer: UnitedHealthcare Community & State	$373.55
Rate for Payer: Wellpoint Medicaid Managed Care	$410.75

INTERBODY FUSION DEVICE 15WX12

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704520
Hospital Revenue Code	278
Min. Negotiated Rate	$373.55
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$5,890.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00
Rate for Payer: UnitedHealthcare Community & State	$373.55
Rate for Payer: Wellpoint Medicaid Managed Care	$410.75

INTERBODY FUSION DEVICE 15WX12

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704520
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERBODY PROSTH 18X15X6MM 7D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694452
Hospital Revenue Code	278
Min. Negotiated Rate	$3,637.50
Max. Negotiated Rate	$5,868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50

INTERBODY PROSTH 18X15X6MM 7D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694452
Hospital Revenue Code	278
Min. Negotiated Rate	$584.42
Max. Negotiated Rate	$12,125.00
Rate for Payer: Aetna Commercial	$9,215.00
Rate for Payer: Aetna Medicare Advantage	$7,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,183.75
Rate for Payer: Cigna Commercial	$12,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,335.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50
Rate for Payer: UnitedHealthcare Community & State	$584.42
Rate for Payer: Wellpoint Medicaid Managed Care	$642.62

INTERBODY STANDALONE 12X17X7MM

Facility

$32,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270669220
Hospital Revenue Code	278
Min. Negotiated Rate	$786.26
Max. Negotiated Rate	$16,312.50
Rate for Payer: Aetna Commercial	$12,397.50
Rate for Payer: Aetna Medicare Advantage	$9,787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,319.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,319.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,319.38
Rate for Payer: Cigna Commercial	$16,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,895.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,177.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,893.75
Rate for Payer: UnitedHealthcare Community & State	$786.26
Rate for Payer: Wellpoint Medicaid Managed Care	$864.56

INTERBODY STANDALONE 12X17X7MM

Facility

$32,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270669220
Hospital Revenue Code	278
Min. Negotiated Rate	$4,893.75
Max. Negotiated Rate	$7,895.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,895.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,177.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,893.75

INTERCED 3X4 ABSORBABLE

Facility

$14,628.00

Hospital Charge Code	270656002
Hospital Revenue Code	278
Min. Negotiated Rate	$2,194.20
Max. Negotiated Rate	$3,539.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,925.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,539.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,218.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,194.20

INTERCED 3X4 ABSORBABLE

Facility

$14,628.00

Hospital Charge Code	270656002
Hospital Revenue Code	278
Min. Negotiated Rate	$352.53
Max. Negotiated Rate	$7,314.00
Rate for Payer: Aetna Commercial	$5,558.64
Rate for Payer: Aetna Medicare Advantage	$4,388.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,730.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,730.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,925.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,730.14
Rate for Payer: Cigna Commercial	$7,314.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,539.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,218.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,194.20
Rate for Payer: UnitedHealthcare Community & State	$352.53
Rate for Payer: Wellpoint Medicaid Managed Care	$387.64

INTERCEED ADHESION BARRIER 3x4

Facility

$1,630.42

Hospital Charge Code	270601039
Hospital Revenue Code	272
Min. Negotiated Rate	$244.56
Max. Negotiated Rate	$244.56
Rate for Payer: Qualcare PPO/HMO/WC	$244.56

INTERCEED ADHESION BARRIER 3x4

Facility

$1,630.42

Hospital Charge Code	270601039
Hospital Revenue Code	272
Min. Negotiated Rate	$39.29
Max. Negotiated Rate	$815.21
Rate for Payer: Aetna Commercial	$619.56
Rate for Payer: Aetna Medicare Advantage	$489.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.76
Rate for Payer: Cigna Commercial	$815.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$489.13
Rate for Payer: Oxford Commercial	$326.08
Rate for Payer: Qualcare PPO/HMO/WC	$244.56
Rate for Payer: UnitedHealthcare Commercial	$326.08
Rate for Payer: UnitedHealthcare Community & State	$39.29
Rate for Payer: Wellpoint Medicaid Managed Care	$43.21

INTERDISCAL PERQ ASPIR DX

Facility

$3,392.55

Service Code	HCPCS 62267
Hospital Charge Code	404362267
Hospital Revenue Code	361
Min. Negotiated Rate	$508.88
Max. Negotiated Rate	$508.88
Rate for Payer: Qualcare PPO/HMO/WC	$508.88

INTERDISCAL PERQ ASPIR DX

Facility

$3,392.55

Service Code	HCPCS 62267
Hospital Charge Code	404362267
Hospital Revenue Code	361
Min. Negotiated Rate	$81.76
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,017.76
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$508.88
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$81.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$89.90

INTERFER ALPHA -1 INJ 15MCG/ML

Facility

$379.55

Hospital Charge Code	60628794
Hospital Revenue Code	636
Min. Negotiated Rate	$56.93
Max. Negotiated Rate	$91.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.93

INTERFER ALPHA -1 INJ 15MCG/ML

Facility

$379.55

Hospital Charge Code	60628794
Hospital Revenue Code	636
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$189.78
Rate for Payer: Aetna Commercial	$144.23
Rate for Payer: Aetna Medicare Advantage	$113.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.79
Rate for Payer: Cigna Commercial	$189.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.93
Rate for Payer: UnitedHealthcare Community & State	$9.15
Rate for Payer: Wellpoint Medicaid Managed Care	$10.06

INTERFERANCE SCREW 10 X 28

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270684924
Hospital Revenue Code	278
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

INTERFERANCE SCREW 10 X 28

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270684924
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

INTERFERANCE SCREW 9 X 28

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270684925
Hospital Revenue Code	278
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

INTERFERANCE SCREW 9 X 28

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270684925
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

INTERFERON 3MU

Facility

$153.00

Hospital Charge Code	6000301
Hospital Revenue Code	636
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$37.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.03
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

INTERFERON 3MU

Facility

$153.00

Hospital Charge Code	6000301
Hospital Revenue Code	636
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$58.14
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.03
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Community & State	$3.69
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

INTERFERON ALPHCN1 15MCG/MLINJ

Facility

$517.60

Hospital Charge Code	60628935
Hospital Revenue Code	636
Min. Negotiated Rate	$77.64
Max. Negotiated Rate	$125.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.26
Rate for Payer: Qualcare PPO/HMO/WC	$77.64

Know your out-of-pocket cost for care.

All Charges