Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE INTERBODY 16X14X6MM 7D RT

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694364
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

CAGE INTERBODY 16X14X8MM 7D RT

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693405
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

CAGE INTERBODY 16X14X8MM 7D RT

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693405
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

CAGE INTERBODY 7D 16X14X6MM

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694352
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

CAGE INTERBODY 7D 16X14X6MM

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694352
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

CAGE INTERBODY 7D 16X14X8MM

Facility

$19,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694353
Hospital Revenue Code	278
Min. Negotiated Rate	$463.93
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$463.93
Rate for Payer: Wellpoint Medicaid Managed Care	$510.12

CAGE INTERBODY 7D 16X14X8MM

Facility

$19,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694353
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

CAGE INTERBODY ALIGN 18X55X10

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696684
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 INTERBODY ALIGN 18X55X10

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696684
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 INTERBODY ALIGN 18X60X10

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696683
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 INTERBODY ALIGN 18X60X10

Facility

$40,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696683
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 IO EXPAND LORDOT 10X19MM

Facility

$18,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270699277
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

CAGE IO EXPAND LORDOT 10X19MM

Facility

$18,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270699277
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

CAGE IRIX-C 13X16X6MM 7D

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693471
Hospital Revenue Code	278
Min. Negotiated Rate	$753.12
Max. Negotiated Rate	$15,625.00
Rate for Payer: Aetna Commercial	$11,875.00
Rate for Payer: Aetna Medicare Advantage	$9,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,968.75
Rate for Payer: Cigna Commercial	$15,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,562.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,687.50
Rate for Payer: UnitedHealthcare Community & State	$753.12
Rate for Payer: Wellpoint Medicaid Managed Care	$828.12

CAGE IRIX-C 13X16X6MM 7D

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693471
Hospital Revenue Code	278
Min. Negotiated Rate	$4,687.50
Max. Negotiated Rate	$7,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,562.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,687.50

CAGE IRIX-C 16X13 X

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693292
Hospital Revenue Code	278
Min. Negotiated Rate	$4,687.50
Max. Negotiated Rate	$7,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,562.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,687.50

CAGE IRIX-C 16X13 X

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693292
Hospital Revenue Code	278
Min. Negotiated Rate	$753.12
Max. Negotiated Rate	$15,625.00
Rate for Payer: Aetna Commercial	$11,875.00
Rate for Payer: Aetna Medicare Advantage	$9,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,968.75
Rate for Payer: Cigna Commercial	$15,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,562.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,687.50
Rate for Payer: UnitedHealthcare Community & State	$753.12
Rate for Payer: Wellpoint Medicaid Managed Care	$828.12

CAGE IRIX-C 18X14X7MM 7D

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270696486
Hospital Revenue Code	278
Min. Negotiated Rate	$4,687.50
Max. Negotiated Rate	$7,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,562.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,687.50

CAGE IRIX-C 18X14X7MM 7D

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270696486
Hospital Revenue Code	278
Min. Negotiated Rate	$753.12
Max. Negotiated Rate	$15,625.00
Rate for Payer: Aetna Commercial	$11,875.00
Rate for Payer: Aetna Medicare Advantage	$9,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,968.75
Rate for Payer: Cigna Commercial	$15,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,562.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,687.50
Rate for Payer: UnitedHealthcare Community & State	$753.12
Rate for Payer: Wellpoint Medicaid Managed Care	$828.12

CAGE IRIX-C CERV 13X16X6MM 7D

Facility

$31,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270695413
Hospital Revenue Code	278
Min. Negotiated Rate	$4,710.00
Max. Negotiated Rate	$7,598.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,598.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,908.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,710.00

CAGE IRIX-C CERV 13X16X6MM 7D

Facility

$31,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270695413
Hospital Revenue Code	278
Min. Negotiated Rate	$756.74
Max. Negotiated Rate	$15,700.00
Rate for Payer: Aetna Commercial	$11,932.00
Rate for Payer: Aetna Medicare Advantage	$9,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,007.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,007.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,007.00
Rate for Payer: Cigna Commercial	$15,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,598.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,908.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,710.00
Rate for Payer: UnitedHealthcare Community & State	$756.74
Rate for Payer: Wellpoint Medicaid Managed Care	$832.10

CAGE JULIET TI PO 24X8X8MM 6D

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270699471
Hospital Revenue Code	278
Min. Negotiated Rate	$753.12
Max. Negotiated Rate	$15,625.00
Rate for Payer: Aetna Commercial	$11,875.00
Rate for Payer: Aetna Medicare Advantage	$9,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,968.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,968.75
Rate for Payer: Cigna Commercial	$15,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,562.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,687.50
Rate for Payer: UnitedHealthcare Community & State	$753.12
Rate for Payer: Wellpoint Medicaid Managed Care	$828.12

CAGE JULIET TI PO 24X8X8MM 6D

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270699471
Hospital Revenue Code	278
Min. Negotiated Rate	$4,687.50
Max. Negotiated Rate	$7,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,562.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,687.50

CAGE LARGE Z CORE

Facility

$7,125.00

Hospital Charge Code	270701787
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

CAGE LARGE Z CORE

Facility

$7,125.00

Hospital Charge Code	270701787
Hospital Revenue Code	278
Min. Negotiated Rate	$171.71
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75
Rate for Payer: UnitedHealthcare Community & State	$171.71
Rate for Payer: Wellpoint Medicaid Managed Care	$188.81

Know your out-of-pocket cost for care.

All Charges