Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPACER HUMERAL 42MM +6

Facility

$2,450.00

Hospital Charge Code	270672440
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 +9

Facility

$2,450.00

Hospital Charge Code	270672441
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 +9

Facility

$2,450.00

Hospital Charge Code	270672441
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 DELTA XTEND 9MM

Facility

$8,560.00

Service Code	HCPCS C1776
Hospital Charge Code	270686438
Hospital Revenue Code	278
Min. Negotiated Rate	$206.30
Max. Negotiated Rate	$4,280.00
Rate for Payer: Aetna Commercial	$3,252.80
Rate for Payer: Aetna Medicare Advantage	$2,568.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,182.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,182.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,182.80
Rate for Payer: Cigna Commercial	$4,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,071.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,883.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.00
Rate for Payer: UnitedHealthcare Community & State	$206.30
Rate for Payer: Wellpoint Medicaid Managed Care	$226.84

SPACER HUMERAL DELTA XTEND 9MM

Facility

$8,560.00

Service Code	HCPCS C1776
Hospital Charge Code	270686438
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.00
Max. Negotiated Rate	$2,071.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,712.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,071.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,883.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.00

SPACER,IDENT ALIFSA 9X38X28,15

Facility

$33,165.00

Hospital Charge Code	270703006
Hospital Revenue Code	278
Min. Negotiated Rate	$799.28
Max. Negotiated Rate	$16,582.50
Rate for Payer: Aetna Commercial	$12,602.70
Rate for Payer: Aetna Medicare Advantage	$9,949.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,457.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,457.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,633.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,457.08
Rate for Payer: Cigna Commercial	$16,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,025.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,296.30
Rate for Payer: Qualcare PPO/HMO/WC	$4,974.75
Rate for Payer: UnitedHealthcare Community & State	$799.28
Rate for Payer: Wellpoint Medicaid Managed Care	$878.87

SPACER,IDENT ALIFSA 9X38X28,15

Facility

$33,165.00

Hospital Charge Code	270703006
Hospital Revenue Code	278
Min. Negotiated Rate	$4,974.75
Max. Negotiated Rate	$8,025.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,633.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,025.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,296.30
Rate for Payer: Qualcare PPO/HMO/WC	$4,974.75

SPACER IDENTITI 6X14X12MM 7D

Facility

$17,190.00

Service Code	HCPCS C1889
Hospital Charge Code	270697765
Hospital Revenue Code	278
Min. Negotiated Rate	$2,578.50
Max. Negotiated Rate	$4,159.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,438.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,159.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,781.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,578.50

SPACER IDENTITI 6X14X12MM 7D

Facility

$17,190.00

Service Code	HCPCS C1889
Hospital Charge Code	270697765
Hospital Revenue Code	278
Min. Negotiated Rate	$414.28
Max. Negotiated Rate	$8,595.00
Rate for Payer: Aetna Commercial	$6,532.20
Rate for Payer: Aetna Medicare Advantage	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,383.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,383.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,383.45
Rate for Payer: Cigna Commercial	$8,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,159.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,781.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,578.50
Rate for Payer: UnitedHealthcare Community & State	$414.28
Rate for Payer: Wellpoint Medicaid Managed Care	$455.54

SPACER IDENTITI ALIF 7X38X28

Facility

$33,165.00

Hospital Charge Code	270703008
Hospital Revenue Code	278
Min. Negotiated Rate	$799.28
Max. Negotiated Rate	$16,582.50
Rate for Payer: Aetna Commercial	$12,602.70
Rate for Payer: Aetna Medicare Advantage	$9,949.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,457.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,457.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,633.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,457.08
Rate for Payer: Cigna Commercial	$16,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,025.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,296.30
Rate for Payer: Qualcare PPO/HMO/WC	$4,974.75
Rate for Payer: UnitedHealthcare Community & State	$799.28
Rate for Payer: Wellpoint Medicaid Managed Care	$878.87

SPACER IDENTITI ALIF 7X38X28

Facility

$33,165.00

Hospital Charge Code	270703008
Hospital Revenue Code	278
Min. Negotiated Rate	$4,974.75
Max. Negotiated Rate	$8,025.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,633.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,025.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,296.30
Rate for Payer: Qualcare PPO/HMO/WC	$4,974.75

SPACER IDENTITI SA 7X14X12MM7D

Facility

$17,190.00

Service Code	HCPCS C1889
Hospital Charge Code	270698831
Hospital Revenue Code	278
Min. Negotiated Rate	$414.28
Max. Negotiated Rate	$8,595.00
Rate for Payer: Aetna Commercial	$6,532.20
Rate for Payer: Aetna Medicare Advantage	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,383.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,383.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,383.45
Rate for Payer: Cigna Commercial	$8,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,159.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,781.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,578.50
Rate for Payer: UnitedHealthcare Community & State	$414.28
Rate for Payer: Wellpoint Medicaid Managed Care	$455.54

SPACER IDENTITI SA 7X14X12MM7D

Facility

$17,190.00

Service Code	HCPCS C1889
Hospital Charge Code	270698831
Hospital Revenue Code	278
Min. Negotiated Rate	$2,578.50
Max. Negotiated Rate	$4,159.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,438.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,159.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,781.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,578.50

SPACER KNEE COPAL XCHANGE G LT

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696274
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 KNEE COPAL XCHANGE G LT

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696274
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

SPACER LUMB SUPERION IDS 12MM

Facility

$13,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270699506
Hospital Revenue Code	278
Min. Negotiated Rate	$2,006.25
Max. Negotiated Rate	$3,236.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,236.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,942.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,006.25

SPACER LUMB SUPERION IDS 12MM

Facility

$13,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270699506
Hospital Revenue Code	278
Min. Negotiated Rate	$322.34
Max. Negotiated Rate	$6,687.50
Rate for Payer: Aetna Commercial	$5,082.50
Rate for Payer: Aetna Medicare Advantage	$4,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,410.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,410.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,410.62
Rate for Payer: Cigna Commercial	$6,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,236.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,942.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,006.25
Rate for Payer: UnitedHealthcare Community & State	$322.34
Rate for Payer: Wellpoint Medicaid Managed Care	$354.44

SPACER MIS COALIT 12X14X7D7MM

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270693441
Hospital Revenue Code	278
Min. Negotiated Rate	$4,782.00
Max. Negotiated Rate	$7,714.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,013.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00

SPACER MIS COALIT 12X14X7D7MM

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270693441
Hospital Revenue Code	278
Min. Negotiated Rate	$768.31
Max. Negotiated Rate	$15,940.00
Rate for Payer: Aetna Commercial	$12,114.40
Rate for Payer: Aetna Medicare Advantage	$9,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,129.40
Rate for Payer: Cigna Commercial	$15,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,013.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00
Rate for Payer: UnitedHealthcare Community & State	$768.31
Rate for Payer: Wellpoint Medicaid Managed Care	$844.82

SPACER MIS COALITION 14X16 7D

Facility

$27,720.00

Service Code	HCPCS C1889
Hospital Charge Code	270692223
Hospital Revenue Code	278
Min. Negotiated Rate	$668.05
Max. Negotiated Rate	$13,860.00
Rate for Payer: Aetna Commercial	$10,533.60
Rate for Payer: Aetna Medicare Advantage	$8,316.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,068.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,068.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,544.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,068.60
Rate for Payer: Cigna Commercial	$13,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,708.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,098.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,158.00
Rate for Payer: UnitedHealthcare Community & State	$668.05
Rate for Payer: Wellpoint Medicaid Managed Care	$734.58

SPACER MIS COALITION 14X16 7D

Facility

$27,720.00

Service Code	HCPCS C1889
Hospital Charge Code	270692223
Hospital Revenue Code	278
Min. Negotiated Rate	$4,158.00
Max. Negotiated Rate	$6,708.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,544.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,708.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,098.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,158.00

SPACER MIS COAL TI 12X14X7D6MM

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270693440
Hospital Revenue Code	278
Min. Negotiated Rate	$4,782.00
Max. Negotiated Rate	$7,714.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,013.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00

SPACER MIS COAL TI 12X14X7D6MM

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270693440
Hospital Revenue Code	278
Min. Negotiated Rate	$768.31
Max. Negotiated Rate	$15,940.00
Rate for Payer: Aetna Commercial	$12,114.40
Rate for Payer: Aetna Medicare Advantage	$9,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,129.40
Rate for Payer: Cigna Commercial	$15,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,013.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00
Rate for Payer: UnitedHealthcare Community & State	$768.31
Rate for Payer: Wellpoint Medicaid Managed Care	$844.82

SPACER MIS TI 12X14X9MM 7D

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270697647
Hospital Revenue Code	278
Min. Negotiated Rate	$768.31
Max. Negotiated Rate	$15,940.00
Rate for Payer: Aetna Commercial	$12,114.40
Rate for Payer: Aetna Medicare Advantage	$9,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,129.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,129.40
Rate for Payer: Cigna Commercial	$15,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,013.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00
Rate for Payer: UnitedHealthcare Community & State	$768.31
Rate for Payer: Wellpoint Medicaid Managed Care	$844.82

SPACER MIS TI 12X14X9MM 7D

Facility

$31,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270697647
Hospital Revenue Code	278
Min. Negotiated Rate	$4,782.00
Max. Negotiated Rate	$7,714.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,714.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,013.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,782.00

Know your out-of-pocket cost for care.

All Charges