Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLENOID BASEPLATE 22X15

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696734
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GLENOID BASEPLATE 22X15

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696734
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

GLENOID BASEPLATE 27 X 15

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687831
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

GLENOID BASEPLATE 27 X 15

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687831
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GLENOID FOSS LNR TM REV 36MM

Facility

$5,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270696096
Hospital Revenue Code	278
Min. Negotiated Rate	$783.75
Max. Negotiated Rate	$1,264.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$783.75

GLENOID FOSS LNR TM REV 36MM

Facility

$5,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270696096
Hospital Revenue Code	278
Min. Negotiated Rate	$125.92
Max. Negotiated Rate	$2,612.50
Rate for Payer: Aetna Commercial	$1,985.50
Rate for Payer: Aetna Medicare Advantage	$1,567.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,332.38
Rate for Payer: Cigna Commercial	$2,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$783.75
Rate for Payer: UnitedHealthcare Community & State	$125.92
Rate for Payer: Wellpoint Medicaid Managed Care	$138.46

GLENOID FOSS TM RES SPACER 9MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696097
Hospital Revenue Code	278
Min. Negotiated Rate	$74.41
Max. Negotiated Rate	$1,543.75
Rate for Payer: Aetna Commercial	$1,173.25
Rate for Payer: Aetna Medicare Advantage	$926.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$787.31
Rate for Payer: Cigna Commercial	$1,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$679.25
Rate for Payer: Qualcare PPO/HMO/WC	$463.12
Rate for Payer: UnitedHealthcare Community & State	$74.41
Rate for Payer: Wellpoint Medicaid Managed Care	$81.82

GLENOID FOSS TM RES SPACER 9MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696097
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$747.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$679.25
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

GLENOID GUIDE PIN 2.5MM

Facility

$750.00

Hospital Charge Code	270704576
Hospital Revenue Code	279
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GLENOID GUIDE PIN 2.5MM

Facility

$750.00

Hospital Charge Code	270704576
Hospital Revenue Code	279
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

GLENOID, HEAD58-54MM

Facility

$8,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270687340
Hospital Revenue Code	278
Min. Negotiated Rate	$203.89
Max. Negotiated Rate	$4,230.00
Rate for Payer: Aetna Commercial	$3,214.80
Rate for Payer: Aetna Medicare Advantage	$2,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,692.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,157.30
Rate for Payer: Cigna Commercial	$4,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,047.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,861.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00
Rate for Payer: UnitedHealthcare Community & State	$203.89
Rate for Payer: Wellpoint Medicaid Managed Care	$224.19

GLENOID, HEAD58-54MM

Facility

$8,460.00

Service Code	HCPCS C1776
Hospital Charge Code	270687340
Hospital Revenue Code	278
Min. Negotiated Rate	$1,269.00
Max. Negotiated Rate	$2,047.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,692.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,047.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,861.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00

GLENOID METAL BACK LARGE

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270680275
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,324.40
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

GLENOID METAL BACK LARGE

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270680275
Hospital Revenue Code	278
Min. Negotiated Rate	$145.08
Max. Negotiated Rate	$3,010.00
Rate for Payer: Aetna Commercial	$2,287.60
Rate for Payer: Aetna Medicare Advantage	$1,806.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,535.10
Rate for Payer: Cigna Commercial	$3,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,324.40
Rate for Payer: Qualcare PPO/HMO/WC	$903.00
Rate for Payer: UnitedHealthcare Community & State	$145.08
Rate for Payer: Wellpoint Medicaid Managed Care	$159.53

GLENOID METAL BACK SMALL

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672311
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,324.40
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

GLENOID METAL BACK SMALL

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672311
Hospital Revenue Code	278
Min. Negotiated Rate	$145.08
Max. Negotiated Rate	$3,010.00
Rate for Payer: Aetna Commercial	$2,287.60
Rate for Payer: Aetna Medicare Advantage	$1,806.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,535.10
Rate for Payer: Cigna Commercial	$3,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,324.40
Rate for Payer: Qualcare PPO/HMO/WC	$903.00
Rate for Payer: UnitedHealthcare Community & State	$145.08
Rate for Payer: Wellpoint Medicaid Managed Care	$159.53

GLENOID METAL BACK STANDARD

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270675412
Hospital Revenue Code	278
Min. Negotiated Rate	$301.85
Max. Negotiated Rate	$6,262.50
Rate for Payer: Aetna Commercial	$4,759.50
Rate for Payer: Aetna Medicare Advantage	$3,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,193.88
Rate for Payer: Cigna Commercial	$6,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,755.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75
Rate for Payer: UnitedHealthcare Community & State	$301.85
Rate for Payer: Wellpoint Medicaid Managed Care	$331.91

GLENOID METAL BACK STANDARD

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270675412
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$3,031.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,755.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

GLENOID MOD 4 PEG SZ4

Facility

$8,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270699889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,771.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

GLENOID MOD 4 PEG SZ4

Facility

$8,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270699889
Hospital Revenue Code	278
Min. Negotiated Rate	$194.00
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$3,059.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,771.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50
Rate for Payer: UnitedHealthcare Community & State	$194.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.32

GLENOID MOD AUGMNT 4PEG LT SZ3

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270699472
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$695.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$632.50
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

GLENOID MOD AUGMNT 4PEG LT SZ3

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270699472
Hospital Revenue Code	278
Min. Negotiated Rate	$69.29
Max. Negotiated Rate	$1,437.50
Rate for Payer: Aetna Commercial	$1,092.50
Rate for Payer: Aetna Medicare Advantage	$862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$733.12
Rate for Payer: Cigna Commercial	$1,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$632.50
Rate for Payer: Qualcare PPO/HMO/WC	$431.25
Rate for Payer: UnitedHealthcare Community & State	$69.29
Rate for Payer: Wellpoint Medicaid Managed Care	$76.19

GLENOID PEGD MED 4 BIOM 113872

Facility

$4,900.50

Hospital Charge Code	270632548
Hospital Revenue Code	272
Min. Negotiated Rate	$118.10
Max. Negotiated Rate	$2,450.25
Rate for Payer: Aetna Commercial	$1,862.19
Rate for Payer: Aetna Medicare Advantage	$1,470.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.63
Rate for Payer: Cigna Commercial	$2,450.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,470.15
Rate for Payer: Oxford Commercial	$980.10
Rate for Payer: Qualcare PPO/HMO/WC	$735.08
Rate for Payer: UnitedHealthcare Commercial	$980.10
Rate for Payer: UnitedHealthcare Community & State	$118.10
Rate for Payer: Wellpoint Medicaid Managed Care	$129.86

GLENOID PEGD MED 4 BIOM 113872

Facility

$4,900.50

Hospital Charge Code	270632548
Hospital Revenue Code	272
Min. Negotiated Rate	$735.08
Max. Negotiated Rate	$735.08
Rate for Payer: Qualcare PPO/HMO/WC	$735.08

GLENOID PEGGED BF 52MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683030
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

Know your out-of-pocket cost for care.

All Charges