Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPACER TLIF TLX 12X11X26MM20D

Facility

$39,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699355
Hospital Revenue Code	278
Min. Negotiated Rate	$939.90
Max. Negotiated Rate	$19,500.00
Rate for Payer: Aetna Commercial	$14,820.00
Rate for Payer: Aetna Medicare Advantage	$11,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,945.00
Rate for Payer: Cigna Commercial	$19,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,438.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,850.00
Rate for Payer: UnitedHealthcare Community & State	$939.90
Rate for Payer: Wellpoint Medicaid Managed Care	$1,033.50

SPACER TLIF TLX 12X11X26MM20D

Facility

$39,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270699355
Hospital Revenue Code	278
Min. Negotiated Rate	$5,850.00
Max. Negotiated Rate	$9,438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,438.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,850.00

SPACER UNICORT PAR 6

Facility

$3,420.00

Service Code	HCPCS C1713
Hospital Charge Code	270688756
Hospital Revenue Code	278
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$1,710.00
Rate for Payer: Aetna Commercial	$1,299.60
Rate for Payer: Aetna Medicare Advantage	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$872.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$872.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$872.10
Rate for Payer: Cigna Commercial	$1,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$827.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$752.40
Rate for Payer: Qualcare PPO/HMO/WC	$513.00
Rate for Payer: UnitedHealthcare Community & State	$82.42
Rate for Payer: Wellpoint Medicaid Managed Care	$90.63

SPACER UNICORT PAR 6

Facility

$3,420.00

Service Code	HCPCS C1713
Hospital Charge Code	270688756
Hospital Revenue Code	278
Min. Negotiated Rate	$513.00
Max. Negotiated Rate	$827.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$827.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$752.40
Rate for Payer: Qualcare PPO/HMO/WC	$513.00

SPACER VBR 14X14.5X13MM

Facility

$41,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697507
Hospital Revenue Code	278
Min. Negotiated Rate	$988.10
Max. Negotiated Rate	$20,500.00
Rate for Payer: Aetna Commercial	$15,580.00
Rate for Payer: Aetna Medicare Advantage	$12,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,455.00
Rate for Payer: Cigna Commercial	$20,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,922.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,150.00
Rate for Payer: UnitedHealthcare Community & State	$988.10
Rate for Payer: Wellpoint Medicaid Managed Care	$1,086.50

SPACER VBR 14X14.5X13MM

Facility

$41,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697507
Hospital Revenue Code	278
Min. Negotiated Rate	$6,150.00
Max. Negotiated Rate	$9,922.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,922.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,020.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,150.00

SPACER VBR 14X14.5X2MM

Facility

$3,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697506
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

SPACER VBR 14X14.5X2MM

Facility

$3,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697506
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

SPACER W/BN GFT 14X12X6 6D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695237
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 W/BN GFT 14X12X6 6D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695237
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 W/BN GFT 16X14X6 6D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695236
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 W/BN GFT 16X14X6 6D

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695236
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 ZFUSE PLIF 22X9MM

Facility

$20,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270695041
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 ZFUSE PLIF 22X9MM

Facility

$20,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270695041
Hospital Revenue Code	278
Min. Negotiated Rate	$494.05
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$7,790.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
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
Rate for Payer: UnitedHealthcare Community & State	$494.05
Rate for Payer: Wellpoint Medicaid Managed Care	$543.25

SPACER ZFUZE PLIF 22X10MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695435
Hospital Revenue Code	278
Min. Negotiated Rate	$494.05
Max. Negotiated Rate	$10,250.00
Rate for Payer: Aetna Commercial	$7,790.00
Rate for Payer: Aetna Medicare Advantage	$6,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,227.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,227.50
Rate for Payer: Cigna Commercial	$10,250.00
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
Rate for Payer: UnitedHealthcare Community & State	$494.05
Rate for Payer: Wellpoint Medicaid Managed Care	$543.25

SPACER ZFUZE PLIF 22X10MM

Facility

$20,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695435
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

SPACR OSTBR IKA KNEE ARTH 40MM

Facility

$22,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270678247
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.00
Max. Negotiated Rate	$5,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00

SPACR OSTBR IKA KNEE ARTH 40MM

Facility

$22,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270678247
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$11,250.00
Rate for Payer: Aetna Commercial	$8,550.00
Rate for Payer: Aetna Medicare Advantage	$6,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,737.50
Rate for Payer: Cigna Commercial	$11,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,950.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,375.00
Rate for Payer: UnitedHealthcare Community & State	$542.25
Rate for Payer: Wellpoint Medicaid Managed Care	$596.25

SPANAID BODY ALIGNER

Facility

$136.85

Hospital Charge Code	270303019
Hospital Revenue Code	270
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.53

SPANAID BODY ALIGNER

Facility

$136.85

Hospital Charge Code	270303019
Hospital Revenue Code	270
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$68.42
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Medicare Advantage	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.90
Rate for Payer: Cigna Commercial	$68.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.05
Rate for Payer: Oxford Commercial	$27.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.53
Rate for Payer: UnitedHealthcare Commercial	$27.37
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

SPANAID BOOT CRADLE

Facility

$98.58

Hospital Charge Code	270302706
Hospital Revenue Code	270
Min. Negotiated Rate	$14.79
Max. Negotiated Rate	$14.79
Rate for Payer: Qualcare PPO/HMO/WC	$14.79

SPANAID BOOT CRADLE

Facility

$98.58

Hospital Charge Code	270302706
Hospital Revenue Code	270
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$49.29
Rate for Payer: Aetna Commercial	$37.46
Rate for Payer: Aetna Medicare Advantage	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.14
Rate for Payer: Cigna Commercial	$49.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.57
Rate for Payer: Oxford Commercial	$19.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.79
Rate for Payer: UnitedHealthcare Commercial	$19.72
Rate for Payer: UnitedHealthcare Community & State	$2.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2.61

SPANAID FOOT DROP STOP

Facility

$633.39

Hospital Charge Code	270303018
Hospital Revenue Code	270
Min. Negotiated Rate	$95.01
Max. Negotiated Rate	$95.01
Rate for Payer: Qualcare PPO/HMO/WC	$95.01

SPANAID FOOT DROP STOP

Facility

$633.39

Hospital Charge Code	270303018
Hospital Revenue Code	270
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$316.69
Rate for Payer: Aetna Commercial	$240.69
Rate for Payer: Aetna Medicare Advantage	$190.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.51
Rate for Payer: Cigna Commercial	$316.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.02
Rate for Payer: Oxford Commercial	$126.68
Rate for Payer: Qualcare PPO/HMO/WC	$95.01
Rate for Payer: UnitedHealthcare Commercial	$126.68
Rate for Payer: UnitedHealthcare Community & State	$15.26
Rate for Payer: Wellpoint Medicaid Managed Care	$16.78

SPAN AID FT DRIP PR *********

Facility

$102.00

Hospital Charge Code	8001679
Hospital Revenue Code	279
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$38.76
Rate for Payer: Aetna Medicare Advantage	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.01
Rate for Payer: Cigna Commercial	$51.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.60
Rate for Payer: Oxford Commercial	$20.40
Rate for Payer: Qualcare PPO/HMO/WC	$15.30
Rate for Payer: UnitedHealthcare Commercial	$20.40
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

Know your out-of-pocket cost for care.

All Charges