Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPACER PLIF ZFUZE 12X22MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695411
Hospital Revenue Code	278
Min. Negotiated Rate	$3,075.00
Max. Negotiated Rate	$4,961.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,961.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,510.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,075.00

SPACER POLY TIBIAL 20MM

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270682844
Hospital Revenue Code	278
Min. Negotiated Rate	$206.42
Max. Negotiated Rate	$4,282.50
Rate for Payer: Aetna Commercial	$3,254.70
Rate for Payer: Aetna Medicare Advantage	$2,569.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,184.07
Rate for Payer: Cigna Commercial	$4,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,884.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75
Rate for Payer: UnitedHealthcare Community & State	$206.42
Rate for Payer: Wellpoint Medicaid Managed Care	$226.97

SPACER POLY TIBIAL 20MM

Facility

$8,565.00

Service Code	HCPCS C1776
Hospital Charge Code	270682844
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$2,072.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,884.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

SPACER SABLE 10X22X6MM 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693833
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

SPACER SABLE 10X22X6MM 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693833
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

SPACER SABLE 10X26 7-14MM 15D

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693237
Hospital Revenue Code	278
Min. Negotiated Rate	$8,625.00
Max. Negotiated Rate	$13,915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00

SPACER SABLE 10X26 7-14MM 15D

Facility

$57,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693237
Hospital Revenue Code	278
Min. Negotiated Rate	$1,385.75
Max. Negotiated Rate	$28,750.00
Rate for Payer: Aetna Commercial	$21,850.00
Rate for Payer: Aetna Medicare Advantage	$17,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,662.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,662.50
Rate for Payer: Cigna Commercial	$28,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,915.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,625.00
Rate for Payer: UnitedHealthcare Community & State	$1,385.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1,523.75

SPACER SABLE 10X26 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693489
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

SPACER SABLE 10X26 8D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693489
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

SPACER SDK DYNLOK 4.0 843.165

Facility

$368.85

Hospital Charge Code	270616296
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$184.43
Rate for Payer: Aetna Commercial	$140.16
Rate for Payer: Aetna Medicare Advantage	$110.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.06
Rate for Payer: Cigna Commercial	$184.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.66
Rate for Payer: Oxford Commercial	$73.77
Rate for Payer: Qualcare PPO/HMO/WC	$55.33
Rate for Payer: UnitedHealthcare Commercial	$73.77
Rate for Payer: UnitedHealthcare Community & State	$8.89
Rate for Payer: Wellpoint Medicaid Managed Care	$9.77

SPACER SDK DYNLOK 4.0 843.165

Facility

$368.85

Hospital Charge Code	270616296
Hospital Revenue Code	272
Min. Negotiated Rate	$55.33
Max. Negotiated Rate	$55.33
Rate for Payer: Qualcare PPO/HMO/WC	$55.33

SPACERS (FOR RADIUM SEED)

Facility

$126.00

Hospital Charge Code	270335234
Hospital Revenue Code	278
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$47.88
Rate for Payer: Aetna Medicare Advantage	$37.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27.72
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.34

SPACERS (FOR RADIUM SEED)

Facility

$126.00

Hospital Charge Code	270335234
Hospital Revenue Code	278
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$30.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27.72
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

SPACER SIDE RAIL

Facility

$77.00

Hospital Charge Code	270679661
Hospital Revenue Code	272
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$11.55

SPACER SIDE RAIL

Facility

$77.00

Hospital Charge Code	270679661
Hospital Revenue Code	272
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$38.50
Rate for Payer: Aetna Commercial	$29.26
Rate for Payer: Aetna Medicare Advantage	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.64
Rate for Payer: Cigna Commercial	$38.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.10
Rate for Payer: Oxford Commercial	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$11.55
Rate for Payer: UnitedHealthcare Commercial	$15.40
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

SPACER SPINE PK CAPST 26X11MM

Facility

$35,190.00

Service Code	HCPCS C1889
Hospital Charge Code	270696283
Hospital Revenue Code	278
Min. Negotiated Rate	$848.08
Max. Negotiated Rate	$17,595.00
Rate for Payer: Aetna Commercial	$13,372.20
Rate for Payer: Aetna Medicare Advantage	$10,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,973.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,973.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,038.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,973.45
Rate for Payer: Cigna Commercial	$17,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,515.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,741.80
Rate for Payer: Qualcare PPO/HMO/WC	$5,278.50
Rate for Payer: UnitedHealthcare Community & State	$848.08
Rate for Payer: Wellpoint Medicaid Managed Care	$932.53

SPACER SPINE PK CAPST 26X11MM

Facility

$35,190.00

Service Code	HCPCS C1889
Hospital Charge Code	270696283
Hospital Revenue Code	278
Min. Negotiated Rate	$5,278.50
Max. Negotiated Rate	$8,515.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,038.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,515.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,741.80
Rate for Payer: Qualcare PPO/HMO/WC	$5,278.50

SPACER STEALTH PEEK 12X14X7 0D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695241
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

SPACER STEALTH PEEK 12X14X7 0D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695241
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

SPACER SUPERION IDS 10MM

Facility

$56,500.00

Service Code	HCPCS C1821
Hospital Charge Code	270698041
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.65
Max. Negotiated Rate	$28,250.00
Rate for Payer: Aetna Commercial	$21,470.00
Rate for Payer: Aetna Medicare Advantage	$16,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,407.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,407.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,407.50
Rate for Payer: Cigna Commercial	$28,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,673.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,475.00
Rate for Payer: UnitedHealthcare Community & State	$1,361.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1,497.25

SPACER SUPERION IDS 10MM

Facility

$56,500.00

Service Code	HCPCS C1821
Hospital Charge Code	270698041
Hospital Revenue Code	278
Min. Negotiated Rate	$8,475.00
Max. Negotiated Rate	$13,673.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,673.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,475.00

SPACER,TI PC 7X10X25MM

Facility

$23,250.00

Hospital Charge Code	270703574
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.50
Max. Negotiated Rate	$5,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,115.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50

SPACER,TI PC 7X10X25MM

Facility

$23,250.00

Hospital Charge Code	27070321
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.50
Max. Negotiated Rate	$5,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,115.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50

SPACER,TI PC 7X10X25MM

Facility

$23,250.00

Hospital Charge Code	270703574
Hospital Revenue Code	278
Min. Negotiated Rate	$560.33
Max. Negotiated Rate	$11,625.00
Rate for Payer: Aetna Commercial	$8,835.00
Rate for Payer: Aetna Medicare Advantage	$6,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,928.75
Rate for Payer: Cigna Commercial	$11,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,115.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50
Rate for Payer: UnitedHealthcare Community & State	$560.33
Rate for Payer: Wellpoint Medicaid Managed Care	$616.12

SPACER,TI PC 7X10X25MM

Facility

$23,250.00

Hospital Charge Code	27070321
Hospital Revenue Code	278
Min. Negotiated Rate	$560.33
Max. Negotiated Rate	$11,625.00
Rate for Payer: Aetna Commercial	$8,835.00
Rate for Payer: Aetna Medicare Advantage	$6,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,928.75
Rate for Payer: Cigna Commercial	$11,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,115.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50
Rate for Payer: UnitedHealthcare Community & State	$560.33
Rate for Payer: Wellpoint Medicaid Managed Care	$616.12

Know your out-of-pocket cost for care.

All Charges