Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE LUCENT BULLET 12X27X10 5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270696325
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.00
Max. Negotiated Rate	$3,097.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,097.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,816.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,920.00

CAGE LUCENT BULLET 12X27X10 5D

Facility

$12,800.00

Service Code	HCPCS C1889
Hospital Charge Code	270696325
Hospital Revenue Code	278
Min. Negotiated Rate	$308.48
Max. Negotiated Rate	$6,400.00
Rate for Payer: Aetna Commercial	$4,864.00
Rate for Payer: Aetna Medicare Advantage	$3,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,264.00
Rate for Payer: Cigna Commercial	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,097.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,816.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,920.00
Rate for Payer: UnitedHealthcare Community & State	$308.48
Rate for Payer: Wellpoint Medicaid Managed Care	$339.20

CAGE LUCENT L 18X55X10MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270694703
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT L 18X55X10MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270694703
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT L 18X55X10MM 6D

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270697482
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT L 18X55X10MM 6D

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270697482
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENTL 18X60X10MM 12D PC

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696811
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENTL 18X60X10MM 12D PC

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696811
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENTL 22X55X10MM 12D PC

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696812
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENTL 22X55X10MM 12D PC

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696812
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT L 22X55X8MM 6D PC

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696391
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT L 22X55X8MM 6D PC

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696391
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT LAT 12D 22X55X12MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696636
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT LAT 12D 22X55X12MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696636
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT LAT 18D 22X55X10MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696638
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT LAT 18D 22X55X10MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696638
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT LAT 18D 22X55X8MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696637
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT LAT 18D 22X55X8MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696637
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT L PC 12D22X55X12MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696634
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT L PC 12D22X55X12MM

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270696634
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT L PC 22X60X8MM 12D

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270698044
Hospital Revenue Code	278
Min. Negotiated Rate	$510.92
Max. Negotiated Rate	$10,600.00
Rate for Payer: Aetna Commercial	$8,056.00
Rate for Payer: Aetna Medicare Advantage	$6,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,406.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,406.00
Rate for Payer: Cigna Commercial	$10,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00
Rate for Payer: UnitedHealthcare Community & State	$510.92
Rate for Payer: Wellpoint Medicaid Managed Care	$561.80

CAGE LUCENT L PC 22X60X8MM 12D

Facility

$21,200.00

Service Code	HCPCS C1889
Hospital Charge Code	270698044
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$5,130.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,130.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,664.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,180.00

CAGE LUCENT PC 10X22X13MM 5D

Facility

$6,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270694706
Hospital Revenue Code	278
Min. Negotiated Rate	$154.24
Max. Negotiated Rate	$3,200.00
Rate for Payer: Aetna Commercial	$2,432.00
Rate for Payer: Aetna Medicare Advantage	$1,920.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,632.00
Rate for Payer: Cigna Commercial	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,408.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.00
Rate for Payer: UnitedHealthcare Community & State	$154.24
Rate for Payer: Wellpoint Medicaid Managed Care	$169.60

CAGE LUCENT PC 10X22X13MM 5D

Facility

$6,400.00

Service Code	HCPCS C1889
Hospital Charge Code	270694706
Hospital Revenue Code	278
Min. Negotiated Rate	$960.00
Max. Negotiated Rate	$1,548.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,408.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.00

CAGE LUCENT PC 12X17X11MM 5D

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693128
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

Know your out-of-pocket cost for care.

All Charges