Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PEEK INTERBODY 12MMX12MMX7M

Facility

$13,500.00

Hospital Charge Code	270661262
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

PEEK LORDOTIC 12x12x7MM

Facility

$11,140.00

Hospital Charge Code	270659694
Hospital Revenue Code	278
Min. Negotiated Rate	$268.47
Max. Negotiated Rate	$5,570.00
Rate for Payer: Aetna Commercial	$4,233.20
Rate for Payer: Aetna Medicare Advantage	$3,342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,840.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,840.70
Rate for Payer: Cigna Commercial	$5,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,450.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00
Rate for Payer: UnitedHealthcare Community & State	$268.47
Rate for Payer: Wellpoint Medicaid Managed Care	$295.21

PEEK LORDOTIC 12x12x7MM

Facility

$11,140.00

Hospital Charge Code	270659694
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$2,695.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,450.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.00

PEEK LORDOTIC 12 X 12 X 8

Facility

$13,500.00

Hospital Charge Code	270659693
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

PEEK LORDOTIC 12 X 12 X 8

Facility

$13,500.00

Hospital Charge Code	270659693
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

PEEK OPTIMA LT+1 TANTALUM

Facility

$28,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686591
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$6,776.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,160.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

PEEK OPTIMA LT+1 TANTALUM

Facility

$28,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686591
Hospital Revenue Code	278
Min. Negotiated Rate	$674.80
Max. Negotiated Rate	$14,000.00
Rate for Payer: Aetna Commercial	$10,640.00
Rate for Payer: Aetna Medicare Advantage	$8,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,140.00
Rate for Payer: Cigna Commercial	$14,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,160.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00
Rate for Payer: UnitedHealthcare Community & State	$674.80
Rate for Payer: Wellpoint Medicaid Managed Care	$742.00

PEEK OPTIMA LT1 TANTALUM

Facility

$11,665.00

Service Code	HCPCS C1713
Hospital Charge Code	270688032
Hospital Revenue Code	278
Min. Negotiated Rate	$281.13
Max. Negotiated Rate	$5,832.50
Rate for Payer: Aetna Commercial	$4,432.70
Rate for Payer: Aetna Medicare Advantage	$3,499.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,974.57
Rate for Payer: Cigna Commercial	$5,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75
Rate for Payer: UnitedHealthcare Community & State	$281.13
Rate for Payer: Wellpoint Medicaid Managed Care	$309.12

PEEK OPTIMA LT1 TANTALUM

Facility

$11,665.00

Service Code	HCPCS C1713
Hospital Charge Code	270688032
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.75
Max. Negotiated Rate	$2,822.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75

PEEK PSACKER 11 X 11 X 9

Facility

$10,675.00

Hospital Charge Code	270657421
Hospital Revenue Code	278
Min. Negotiated Rate	$257.27
Max. Negotiated Rate	$5,337.50
Rate for Payer: Aetna Commercial	$4,056.50
Rate for Payer: Aetna Medicare Advantage	$3,202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,722.12
Rate for Payer: Cigna Commercial	$5,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25
Rate for Payer: UnitedHealthcare Community & State	$257.27
Rate for Payer: Wellpoint Medicaid Managed Care	$282.89

PEEK PSACKER 11 X 11 X 9

Facility

$10,675.00

Hospital Charge Code	270657421
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$2,583.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

PEEK PUSHLOCK 2.9x12.5MM

Facility

$1,800.00

Hospital Charge Code	270675325
Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

PEEK PUSHLOCK 2.9x12.5MM

Facility

$1,800.00

Hospital Charge Code	270675325
Hospital Revenue Code	272
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.00
Rate for Payer: Oxford Commercial	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$360.00
Rate for Payer: UnitedHealthcare Community & State	$43.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.70

peek spacer 11 x 11 x 8

Facility

$10,675.00

Hospital Charge Code	270657501
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.25
Max. Negotiated Rate	$2,583.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25

peek spacer 11 x 11 x 8

Facility

$10,675.00

Hospital Charge Code	270657501
Hospital Revenue Code	278
Min. Negotiated Rate	$257.27
Max. Negotiated Rate	$5,337.50
Rate for Payer: Aetna Commercial	$4,056.50
Rate for Payer: Aetna Medicare Advantage	$3,202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,722.12
Rate for Payer: Cigna Commercial	$5,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25
Rate for Payer: UnitedHealthcare Community & State	$257.27
Rate for Payer: Wellpoint Medicaid Managed Care	$282.89

PEEK SUTURE TAK 3 MM X 14.5

Facility

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270693093
Hospital Revenue Code	278
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$350.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$319.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

PEEK SUTURE TAK 3 MM X 14.5

Facility

$1,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270693093
Hospital Revenue Code	278
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$319.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

PEEK SUTURTAK 3x12.2MM

Facility

$1,275.00

Hospital Charge Code	270675326
Hospital Revenue Code	272
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.50
Rate for Payer: Oxford Commercial	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Commercial	$255.00
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

PEEK SUTURTAK 3x12.2MM

Facility

$1,275.00

Hospital Charge Code	270675326
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$191.25
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

PEEK SWIVELOCK 3.9 X 17.9 MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270687857
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

PEEK SWIVELOCK 3.9 X 17.9 MM

Facility

$1,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270687857
Hospital Revenue Code	278
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

PEEK SWIVELOCK 4.75 X 191

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270690218
Hospital Revenue Code	278
Min. Negotiated Rate	$51.21
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$51.21
Rate for Payer: Wellpoint Medicaid Managed Care	$56.31

PEEK SWIVELOCK 4.75 X 191

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270690218
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

PEEL-AWAY INTRODUCER 10FR 30c

Facility

$495.00

Hospital Charge Code	270CH0107
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

PEEL-AWAY INTRODUCER 10FR 30c

Facility

$495.00

Hospital Charge Code	270CH0107
Hospital Revenue Code	272
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.50
Rate for Payer: Oxford Commercial	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$99.00
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

Know your out-of-pocket cost for care.

All Charges