Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE CRYSTAL 7D 16X13X10MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270694726
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,355.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,355.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,232.00
Rate for Payer: Qualcare PPO/HMO/WC	$840.00

CAGE CRYSTAL 7D 16X13X9MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270694725
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,355.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,355.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,232.00
Rate for Payer: Qualcare PPO/HMO/WC	$840.00

CAGE CRYSTAL 7D 16X13X9MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270694725
Hospital Revenue Code	278
Min. Negotiated Rate	$134.96
Max. Negotiated Rate	$2,800.00
Rate for Payer: Aetna Commercial	$2,128.00
Rate for Payer: Aetna Medicare Advantage	$1,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,428.00
Rate for Payer: Cigna Commercial	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,355.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,232.00
Rate for Payer: Qualcare PPO/HMO/WC	$840.00
Rate for Payer: UnitedHealthcare Community & State	$134.96
Rate for Payer: Wellpoint Medicaid Managed Care	$148.40

CAGE DAKOTA 14X12X8MM 7D

Facility

$32,555.00

Service Code	HCPCS C1889
Hospital Charge Code	270698150
Hospital Revenue Code	278
Min. Negotiated Rate	$4,883.25
Max. Negotiated Rate	$7,878.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,511.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,878.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,162.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,883.25

CAGE DAKOTA 14X12X8MM 7D

Facility

$32,555.00

Service Code	HCPCS C1889
Hospital Charge Code	270698150
Hospital Revenue Code	278
Min. Negotiated Rate	$784.58
Max. Negotiated Rate	$16,277.50
Rate for Payer: Aetna Commercial	$12,370.90
Rate for Payer: Aetna Medicare Advantage	$9,766.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,301.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,301.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,511.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,301.52
Rate for Payer: Cigna Commercial	$16,277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,878.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,162.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,883.25
Rate for Payer: UnitedHealthcare Community & State	$784.58
Rate for Payer: Wellpoint Medicaid Managed Care	$862.71

CAGE DISC DEEP MED 14X15X6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693150
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

CAGE DISC DEEP MED 14X15X6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693150
Hospital Revenue Code	278
Min. Negotiated Rate	$716.98
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,545.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$716.98
Rate for Payer: Wellpoint Medicaid Managed Care	$788.38

CAGE ELSA 20X60MM 5-20D

Facility

$53,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,295.38
Max. Negotiated Rate	$26,875.00
Rate for Payer: Aetna Commercial	$20,425.00
Rate for Payer: Aetna Medicare Advantage	$16,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,706.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,706.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,706.25
Rate for Payer: Cigna Commercial	$26,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,007.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,825.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,062.50
Rate for Payer: UnitedHealthcare Community & State	$1,295.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1,424.38

CAGE ELSA 20X60MM 5-20D

Facility

$53,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694590
Hospital Revenue Code	278
Min. Negotiated Rate	$8,062.50
Max. Negotiated Rate	$13,007.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,007.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,825.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,062.50

CAGE EXPAND 11X23X10 MM

Facility

$80,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697758
Hospital Revenue Code	278
Min. Negotiated Rate	$12,000.00
Max. Negotiated Rate	$19,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,360.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,000.00

CAGE EXPAND 11X23X10 MM

Facility

$80,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697758
Hospital Revenue Code	278
Min. Negotiated Rate	$1,928.00
Max. Negotiated Rate	$40,000.00
Rate for Payer: Aetna Commercial	$30,400.00
Rate for Payer: Aetna Medicare Advantage	$24,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,400.00
Rate for Payer: Cigna Commercial	$40,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,360.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,000.00
Rate for Payer: UnitedHealthcare Community & State	$1,928.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2,120.00

CAGEEXPANDLUCE10X27X10MM10-15D

Facility

$17,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270698872
Hospital Revenue Code	278
Min. Negotiated Rate	$2,640.00
Max. Negotiated Rate	$4,259.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,259.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.00

CAGEEXPANDLUCE10X27X10MM10-15D

Facility

$17,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270698872
Hospital Revenue Code	278
Min. Negotiated Rate	$424.16
Max. Negotiated Rate	$8,800.00
Rate for Payer: Aetna Commercial	$6,688.00
Rate for Payer: Aetna Medicare Advantage	$5,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,488.00
Rate for Payer: Cigna Commercial	$8,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,259.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,640.00
Rate for Payer: UnitedHealthcare Community & State	$424.16
Rate for Payer: Wellpoint Medicaid Managed Care	$466.40

CAGE FLREHWK SHELL LORDOT 29MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693872
Hospital Revenue Code	278
Min. Negotiated Rate	$475.98
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$475.98
Rate for Payer: Wellpoint Medicaid Managed Care	$523.38

CAGE FLREHWK SHELL LORDOT 29MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693872
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

CAGE FLREHWK SHIM 14MMX29MM

Facility

$18,925.00

Service Code	HCPCS C1889
Hospital Charge Code	270693873
Hospital Revenue Code	278
Min. Negotiated Rate	$456.09
Max. Negotiated Rate	$9,462.50
Rate for Payer: Aetna Commercial	$7,191.50
Rate for Payer: Aetna Medicare Advantage	$5,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,825.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,825.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,825.88
Rate for Payer: Cigna Commercial	$9,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,579.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,163.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,838.75
Rate for Payer: UnitedHealthcare Community & State	$456.09
Rate for Payer: Wellpoint Medicaid Managed Care	$501.51

CAGE FLREHWK SHIM 14MMX29MM

Facility

$18,925.00

Service Code	HCPCS C1889
Hospital Charge Code	270693873
Hospital Revenue Code	278
Min. Negotiated Rate	$2,838.75
Max. Negotiated Rate	$4,579.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,579.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,163.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,838.75

CAGE FORTILINK 11MMX22MM

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692283
Hospital Revenue Code	278
Min. Negotiated Rate	$518.15
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$518.15
Rate for Payer: Wellpoint Medicaid Managed Care	$569.75

CAGE FORTILINK 11MMX22MM

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692283
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

CAGE FORTILINK 12MM 8MM

Facility

$22,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270690755
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

CAGE FORTILINK 12MM 8MM

Facility

$22,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270690755
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

CAGE FORTILINK 14.5X17X8MM

Facility

$16,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270690022
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

CAGE FORTILINK 14.5X17X8MM

Facility

$16,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270690022
Hospital Revenue Code	278
Min. Negotiated Rate	$397.05
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,624.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$397.05
Rate for Payer: Wellpoint Medicaid Managed Care	$436.59

CAGE FORTILINK 18X13X55MM 6D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697267
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

CAGE FORTILINK 18X13X55MM 6D

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270697267
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

Know your out-of-pocket cost for care.

All Charges