Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAGE PEEK PTC 14X11X7MM

Facility

$11,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270695965
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

CAGE PEEK PTC 6X14X11MM

Facility

$11,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270695966
Hospital Revenue Code	278
Min. Negotiated Rate	$286.31
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$286.31
Rate for Payer: Wellpoint Medicaid Managed Care	$314.82

CAGE PEEK PTC 6X14X11MM

Facility

$11,880.00

Service Code	HCPCS C1889
Hospital Charge Code	270695966
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

CAGE PIVOX 20X12X60 12DEG

Facility

$36,145.00

Service Code	HCPCS C1889
Hospital Charge Code	270692665
Hospital Revenue Code	278
Min. Negotiated Rate	$5,421.75
Max. Negotiated Rate	$8,747.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,747.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,951.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,421.75

CAGE PIVOX 20X12X60 12DEG

Facility

$36,145.00

Service Code	HCPCS C1889
Hospital Charge Code	270692665
Hospital Revenue Code	278
Min. Negotiated Rate	$871.09
Max. Negotiated Rate	$18,072.50
Rate for Payer: Aetna Commercial	$13,735.10
Rate for Payer: Aetna Medicare Advantage	$10,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,216.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,216.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,216.98
Rate for Payer: Cigna Commercial	$18,072.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,747.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,951.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,421.75
Rate for Payer: UnitedHealthcare Community & State	$871.09
Rate for Payer: Wellpoint Medicaid Managed Care	$957.84

CAGE PIVOX 20X12X60 6 DEG

Facility

$36,145.00

Service Code	HCPCS C1889
Hospital Charge Code	270692664
Hospital Revenue Code	278
Min. Negotiated Rate	$871.09
Max. Negotiated Rate	$18,072.50
Rate for Payer: Aetna Commercial	$13,735.10
Rate for Payer: Aetna Medicare Advantage	$10,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,216.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,216.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,216.98
Rate for Payer: Cigna Commercial	$18,072.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,747.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,951.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,421.75
Rate for Payer: UnitedHealthcare Community & State	$871.09
Rate for Payer: Wellpoint Medicaid Managed Care	$957.84

CAGE PIVOX 20X12X60 6 DEG

Facility

$36,145.00

Service Code	HCPCS C1889
Hospital Charge Code	270692664
Hospital Revenue Code	278
Min. Negotiated Rate	$5,421.75
Max. Negotiated Rate	$8,747.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,747.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,951.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,421.75

CAGE PK WIDE ACI TI HA 10D8MM

Facility

$9,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693659
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

CAGE PK WIDE ACI TI HA 10D8MM

Facility

$9,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693659
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

CAGE PLATEAU-C TI 7MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270699024
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 PLATEAU-C TI 7MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270699024
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 PLATEAU-C TI 8MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270699025
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 PLATEAU-C TI 8MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270699025
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 PLATEAU-C TI 9MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270699029
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 PLATEAU-C TI 9MM

Facility

$5,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270699029
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 PLATE DAKOTA 14X12X6MM 7D

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270696090
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 PLATE DAKOTA 14X12X6MM 7D

Facility

$31,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270696090
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 PLIF 22X9X8MM 7D T3

Facility

$30,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693707
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

CAGE PLIF 22X9X8MM 7D T3

Facility

$30,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693707
Hospital Revenue Code	278
Min. Negotiated Rate	$723.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$723.00
Rate for Payer: Wellpoint Medicaid Managed Care	$795.00

CAGE PLIF 30X10MM

Facility

$31,320.00

Service Code	HCPCS C1889
Hospital Charge Code	270699242
Hospital Revenue Code	278
Min. Negotiated Rate	$4,698.00
Max. Negotiated Rate	$7,579.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,264.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,579.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,890.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,698.00

CAGE PLIF 30X10MM

Facility

$31,320.00

Service Code	HCPCS C1889
Hospital Charge Code	270699242
Hospital Revenue Code	278
Min. Negotiated Rate	$754.81
Max. Negotiated Rate	$15,660.00
Rate for Payer: Aetna Commercial	$11,901.60
Rate for Payer: Aetna Medicare Advantage	$9,396.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,986.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,986.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,986.60
Rate for Payer: Cigna Commercial	$15,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,579.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,890.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,698.00
Rate for Payer: UnitedHealthcare Community & State	$754.81
Rate for Payer: Wellpoint Medicaid Managed Care	$829.98

CAGE PLIF PEEK 8X25X9MM

Facility

$14,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

CAGE PLIF PEEK 8X25X9MM

Facility

$14,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697635
Hospital Revenue Code	278
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

CAGE POSTERIOR 16X14X6MM 7D

Facility

$15,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270695546
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

CAGE POSTERIOR 16X14X6MM 7D

Facility

$15,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270695546
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

Know your out-of-pocket cost for care.

All Charges