Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLENOSPHERE 39

Facility

$10,500.00

Hospital Charge Code	270672426
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

GLENOSPHERE 39 +2.5

Facility

$10,500.00

Hospital Charge Code	270672427
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

GLENOSPHERE 39 +2.5

Facility

$10,500.00

Hospital Charge Code	270672427
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

GLENOSPHERE 39 +4

Facility

$10,500.00

Hospital Charge Code	270672428
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

GLENOSPHERE 39 +4

Facility

$10,500.00

Hospital Charge Code	270672428
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

GLENOSPHERE 42

Facility

$10,500.00

Hospital Charge Code	270672429
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

GLENOSPHERE 42

Facility

$10,500.00

Hospital Charge Code	270672429
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

GLENOSPHERE 42 +2.5

Facility

$10,500.00

Hospital Charge Code	270672430
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

GLENOSPHERE 42 +2.5

Facility

$10,500.00

Hospital Charge Code	270672430
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

GLENOSPHERE 42 +4

Facility

$10,500.00

Hospital Charge Code	270672431
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

GLENOSPHERE 42 +4

Facility

$10,500.00

Hospital Charge Code	270672431
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

GLENOSPHERE 42MM REVERSE

Facility

$6,470.00

Service Code	HCPCS C1776
Hospital Charge Code	270679734
Hospital Revenue Code	278
Min. Negotiated Rate	$970.50
Max. Negotiated Rate	$1,565.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,294.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,565.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,423.40
Rate for Payer: Qualcare PPO/HMO/WC	$970.50

GLENOSPHERE 42MM REVERSE

Facility

$6,470.00

Service Code	HCPCS C1776
Hospital Charge Code	270679734
Hospital Revenue Code	278
Min. Negotiated Rate	$155.93
Max. Negotiated Rate	$3,235.00
Rate for Payer: Aetna Commercial	$2,458.60
Rate for Payer: Aetna Medicare Advantage	$1,941.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,649.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,649.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,649.85
Rate for Payer: Cigna Commercial	$3,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,565.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,423.40
Rate for Payer: Qualcare PPO/HMO/WC	$970.50
Rate for Payer: UnitedHealthcare Community & State	$155.93
Rate for Payer: Wellpoint Medicaid Managed Care	$171.46

GLENOSPHERE 5MM CON

Facility

$10,116.70

Service Code	HCPCS C1776
Hospital Charge Code	270689494
Hospital Revenue Code	278
Min. Negotiated Rate	$1,517.51
Max. Negotiated Rate	$2,448.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,023.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,448.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,225.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,517.51

GLENOSPHERE 5MM CON

Facility

$10,116.70

Service Code	HCPCS C1776
Hospital Charge Code	270689494
Hospital Revenue Code	278
Min. Negotiated Rate	$243.81
Max. Negotiated Rate	$5,058.35
Rate for Payer: Aetna Commercial	$3,844.35
Rate for Payer: Aetna Medicare Advantage	$3,035.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,579.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,579.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,023.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,579.76
Rate for Payer: Cigna Commercial	$5,058.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,448.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,225.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,517.51
Rate for Payer: UnitedHealthcare Community & State	$243.81
Rate for Payer: Wellpoint Medicaid Managed Care	$268.09

GLENOSPHERE ECCENTRIC 5 MM

Facility

$10,236.70

Service Code	HCPCS C1776
Hospital Charge Code	270689492
Hospital Revenue Code	278
Min. Negotiated Rate	$246.70
Max. Negotiated Rate	$5,118.35
Rate for Payer: Aetna Commercial	$3,889.95
Rate for Payer: Aetna Medicare Advantage	$3,071.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,610.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,610.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,047.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,610.36
Rate for Payer: Cigna Commercial	$5,118.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,477.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,252.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,535.51
Rate for Payer: UnitedHealthcare Community & State	$246.70
Rate for Payer: Wellpoint Medicaid Managed Care	$271.27

GLENOSPHERE ECCENTRIC 5 MM

Facility

$10,236.70

Service Code	HCPCS C1776
Hospital Charge Code	270689492
Hospital Revenue Code	278
Min. Negotiated Rate	$1,535.51
Max. Negotiated Rate	$2,477.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,047.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,477.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,252.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,535.51

GLENOSPHERE ECCENTRICAL 36MM

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270674583
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

GLENOSPHERE ECCENTRICAL 36MM

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270674583
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

GLENOSPHERE REVRS LAT 3X42MM

Facility

$34,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270700525
Hospital Revenue Code	278
Min. Negotiated Rate	$5,110.50
Max. Negotiated Rate	$8,244.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,814.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,244.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,495.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,110.50

GLENOSPHERE REVRS LAT 3X42MM

Facility

$34,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270700525
Hospital Revenue Code	278
Min. Negotiated Rate	$821.09
Max. Negotiated Rate	$17,035.00
Rate for Payer: Aetna Commercial	$12,946.60
Rate for Payer: Aetna Medicare Advantage	$10,221.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,687.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,687.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,814.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,687.85
Rate for Payer: Cigna Commercial	$17,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,244.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,495.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,110.50
Rate for Payer: UnitedHealthcare Community & State	$821.09
Rate for Payer: Wellpoint Medicaid Managed Care	$902.86

GLENOSPHERE RVS 32X22

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270696736
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,905.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

GLENOSPHERE RVS 32X22

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270696736
Hospital Revenue Code	278
Min. Negotiated Rate	$427.77
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,905.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$427.77
Rate for Payer: Wellpoint Medicaid Managed Care	$470.38

GLENOSPHERE SMR SHOULDER 36MM

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270688708
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

GLENOSPHERE SMR SHOULDER 36MM

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270688708
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

Know your out-of-pocket cost for care.

All Charges