Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPACERFORTICORECERV8X12X14MM6D

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698377
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

SPACERFORTICORECERV8X12X14MM6D

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698377
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

SPACER HAMMERTOE 2.8MM X 10MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270695045
Hospital Revenue Code	278
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

SPACER HAMMERTOE 2.8MM X 10MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270695045
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

SPACER HUMERAL 36MM +12

Facility

$2,450.00

Hospital Charge Code	270672434
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 36MM +12

Facility

$2,450.00

Hospital Charge Code	270672434
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 36MM +15

Facility

$2,450.00

Hospital Charge Code	270672435
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 36MM +15

Facility

$2,450.00

Hospital Charge Code	270672435
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 36MM +6

Facility

$2,450.00

Hospital Charge Code	270672432
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 36MM +6

Facility

$2,450.00

Hospital Charge Code	270672432
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 36MM +9

Facility

$2,450.00

Hospital Charge Code	270672433
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 36MM +9

Facility

$2,450.00

Hospital Charge Code	270672433
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 39MM +12

Facility

$2,450.00

Hospital Charge Code	270672438
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 39MM +12

Facility

$2,450.00

Hospital Charge Code	270672438
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 39MM +15

Facility

$2,450.00

Hospital Charge Code	270672439
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 39MM +15

Facility

$2,450.00

Hospital Charge Code	270672439
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 39MM +6

Facility

$2,450.00

Hospital Charge Code	270672436
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 39MM +6

Facility

$2,450.00

Hospital Charge Code	270672436
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 39MM +9

Facility

$2,450.00

Hospital Charge Code	270672437
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 39MM +9

Facility

$2,450.00

Hospital Charge Code	270672437
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 42MM +12

Facility

$2,450.00

Hospital Charge Code	270672442
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 42MM +12

Facility

$2,450.00

Hospital Charge Code	270672442
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 42MM +15

Facility

$2,450.00

Hospital Charge Code	270672443
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

SPACER HUMERAL 42MM +15

Facility

$2,450.00

Hospital Charge Code	270672443
Hospital Revenue Code	278
Min. Negotiated Rate	$59.05
Max. Negotiated Rate	$1,225.00
Rate for Payer: Aetna Commercial	$931.00
Rate for Payer: Aetna Medicare Advantage	$735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$624.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$624.75
Rate for Payer: Cigna Commercial	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$59.05
Rate for Payer: Wellpoint Medicaid Managed Care	$64.92

SPACER HUMERAL 42MM +6

Facility

$2,450.00

Hospital Charge Code	270672440
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

Know your out-of-pocket cost for care.

All Charges