Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE 22X55 12MM

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695934
Hospital Revenue Code	278
Min. Negotiated Rate	$982.08
Max. Negotiated Rate	$20,375.00
Rate for Payer: Aetna Commercial	$15,485.00
Rate for Payer: Aetna Medicare Advantage	$12,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,391.25
Rate for Payer: Cigna Commercial	$20,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50
Rate for Payer: UnitedHealthcare Community & State	$982.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,079.88

CAGE 22X55 12MM

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695934
Hospital Revenue Code	278
Min. Negotiated Rate	$6,112.50
Max. Negotiated Rate	$9,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50

CAGE 22X55X12MM 12D

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697298
Hospital Revenue Code	278
Min. Negotiated Rate	$6,112.50
Max. Negotiated Rate	$9,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50

CAGE 22X55X12MM 12D

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697298
Hospital Revenue Code	278
Min. Negotiated Rate	$982.08
Max. Negotiated Rate	$20,375.00
Rate for Payer: Aetna Commercial	$15,485.00
Rate for Payer: Aetna Medicare Advantage	$12,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,391.25
Rate for Payer: Cigna Commercial	$20,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50
Rate for Payer: UnitedHealthcare Community & State	$982.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,079.88

CAGE 25MMX10X12MM #11-5350

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704906
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

CAGE 25MMX10X12MM #11-5350

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704906
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 28X10

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705131
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

CAGE 28X10

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705131
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 2C TPLIF PEEK 9X29MM

Facility

$36,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270696505
Hospital Revenue Code	278
Min. Negotiated Rate	$867.60
Max. Negotiated Rate	$18,000.00
Rate for Payer: Aetna Commercial	$13,680.00
Rate for Payer: Aetna Medicare Advantage	$10,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,180.00
Rate for Payer: Cigna Commercial	$18,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,712.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,920.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,400.00
Rate for Payer: UnitedHealthcare Community & State	$867.60
Rate for Payer: Wellpoint Medicaid Managed Care	$954.00

CAGE 2C TPLIF PEEK 9X29MM

Facility

$36,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270696505
Hospital Revenue Code	278
Min. Negotiated Rate	$5,400.00
Max. Negotiated Rate	$8,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,712.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,920.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,400.00

CAGE 3D CERV 14.5X12X10MM 7D

Facility

$34,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270696613
Hospital Revenue Code	278
Min. Negotiated Rate	$825.42
Max. Negotiated Rate	$17,125.00
Rate for Payer: Aetna Commercial	$13,015.00
Rate for Payer: Aetna Medicare Advantage	$10,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,733.75
Rate for Payer: Cigna Commercial	$17,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,288.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,535.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,137.50
Rate for Payer: UnitedHealthcare Community & State	$825.42
Rate for Payer: Wellpoint Medicaid Managed Care	$907.62

CAGE 3D CERV 14.5X12X10MM 7D

Facility

$34,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270696613
Hospital Revenue Code	278
Min. Negotiated Rate	$5,137.50
Max. Negotiated Rate	$8,288.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,288.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,535.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,137.50

CAGE 4MM LARGE

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270681009
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CAGE 4MM LARGE

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270681009
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

CAGE 6MM 6DEG

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705703
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

CAGE 6MM 6DEG

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705703
Hospital Revenue Code	278
Min. Negotiated Rate	$469.95
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$469.95
Rate for Payer: Wellpoint Medicaid Managed Care	$516.75

CAGE 6MM LARGE

Facility

$9,080.00

Service Code	HCPCS C1889
Hospital Charge Code	270705060
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.00
Max. Negotiated Rate	$2,197.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,997.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00

CAGE 6MM LARGE

Facility

$9,080.00

Service Code	HCPCS C1889
Hospital Charge Code	270705060
Hospital Revenue Code	278
Min. Negotiated Rate	$218.83
Max. Negotiated Rate	$4,540.00
Rate for Payer: Aetna Commercial	$3,450.40
Rate for Payer: Aetna Medicare Advantage	$2,724.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,315.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,315.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,315.40
Rate for Payer: Cigna Commercial	$4,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,997.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00
Rate for Payer: UnitedHealthcare Community & State	$218.83
Rate for Payer: Wellpoint Medicaid Managed Care	$240.62

CAGE 7MM. 6DEG

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705704
Hospital Revenue Code	279
Min. Negotiated Rate	$469.95
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,850.00
Rate for Payer: Oxford Commercial	$3,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Commercial	$3,900.00
Rate for Payer: UnitedHealthcare Community & State	$469.95
Rate for Payer: Wellpoint Medicaid Managed Care	$516.75

CAGE 7MM. 6DEG

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705704
Hospital Revenue Code	279
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$2,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

CAGE 7 MM PEEK

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270691453
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

CAGE 7 MM PEEK

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270691453
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

CAGE 7MM PEEL

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270689964
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

CAGE 7MM PEEL

Facility

$0.01

Service Code	HCPCS C1889
Hospital Charge Code	270689964
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

CAGE 7 MM REG

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270693117
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

Know your out-of-pocket cost for care.

All Charges