Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEAD HEMI METASARSAL CANN 18mm

Facility

$6,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270676438
Hospital Revenue Code	278
Min. Negotiated Rate	$918.75
Max. Negotiated Rate	$1,482.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,347.50
Rate for Payer: Qualcare PPO/HMO/WC	$918.75

HEAD HEMI METASARSAL CANN 20mm

Facility

$12,250.00

Hospital Charge Code	270676439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEAD HEMI METASARSAL CANN 20mm

Facility

$12,250.00

Hospital Charge Code	270676439
Hospital Revenue Code	278
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

HEAD HEMI METASARSAL CANN 22mm

Facility

$12,250.00

Hospital Charge Code	270676440
Hospital Revenue Code	278
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

HEAD HEMI METASARSAL CANN 22mm

Facility

$12,250.00

Hospital Charge Code	270676440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEAD HUM ARTIC BIO-MOD 54X22MM

Facility

$9,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270698840
Hospital Revenue Code	278
Min. Negotiated Rate	$221.72
Max. Negotiated Rate	$4,600.00
Rate for Payer: Aetna Commercial	$3,496.00
Rate for Payer: Aetna Medicare Advantage	$2,760.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,346.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,346.00
Rate for Payer: Cigna Commercial	$4,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,226.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,024.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.00
Rate for Payer: UnitedHealthcare Community & State	$221.72
Rate for Payer: Wellpoint Medicaid Managed Care	$243.80

HEAD HUM ARTIC BIO-MOD 54X22MM

Facility

$9,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270698840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,380.00
Max. Negotiated Rate	$2,226.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,226.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,024.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.00

HEAD HUM ECCENTRIC SZ 52x18mm

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270685584
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,742.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,584.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00

HEAD HUM ECCENTRIC SZ 52x18mm

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270685584
Hospital Revenue Code	278
Min. Negotiated Rate	$173.52
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$2,736.00
Rate for Payer: Aetna Medicare Advantage	$2,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,836.00
Rate for Payer: Cigna Commercial	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,584.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00
Rate for Payer: UnitedHealthcare Community & State	$173.52
Rate for Payer: Wellpoint Medicaid Managed Care	$190.80

HEAD HUMERAL 18MM BF 52MM

Facility

$7,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683032
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

HEAD HUMERAL 18MM BF 52MM

Facility

$7,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683032
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

HEAD HUMERAL 18X46 43004618

Facility

$7,390.00

Hospital Charge Code	270637944
Hospital Revenue Code	278
Min. Negotiated Rate	$1,108.50
Max. Negotiated Rate	$1,788.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,788.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,625.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.50

HEAD HUMERAL 18X46 43004618

Facility

$7,390.00

Hospital Charge Code	270637944
Hospital Revenue Code	278
Min. Negotiated Rate	$178.10
Max. Negotiated Rate	$3,695.00
Rate for Payer: Aetna Commercial	$2,808.20
Rate for Payer: Aetna Medicare Advantage	$2,217.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,884.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,884.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,884.45
Rate for Payer: Cigna Commercial	$3,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,788.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,625.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.50
Rate for Payer: UnitedHealthcare Community & State	$178.10
Rate for Payer: Wellpoint Medicaid Managed Care	$195.84

HEAD HUMERAL 24X52cm 43005224

Facility

$7,390.00

Hospital Charge Code	270637580
Hospital Revenue Code	278
Min. Negotiated Rate	$178.10
Max. Negotiated Rate	$3,695.00
Rate for Payer: Aetna Commercial	$2,808.20
Rate for Payer: Aetna Medicare Advantage	$2,217.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,884.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,884.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,884.45
Rate for Payer: Cigna Commercial	$3,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,788.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,625.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.50
Rate for Payer: UnitedHealthcare Community & State	$178.10
Rate for Payer: Wellpoint Medicaid Managed Care	$195.84

HEAD HUMERAL 24X52cm 43005224

Facility

$7,390.00

Hospital Charge Code	270637580
Hospital Revenue Code	278
Min. Negotiated Rate	$1,108.50
Max. Negotiated Rate	$1,788.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,788.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,625.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.50

HEAD HUMERAL 33X46 43004633

Facility

$7,390.00

Hospital Charge Code	270637265
Hospital Revenue Code	278
Min. Negotiated Rate	$178.10
Max. Negotiated Rate	$3,695.00
Rate for Payer: Aetna Commercial	$2,808.20
Rate for Payer: Aetna Medicare Advantage	$2,217.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,884.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,884.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,884.45
Rate for Payer: Cigna Commercial	$3,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,788.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,625.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.50
Rate for Payer: UnitedHealthcare Community & State	$178.10
Rate for Payer: Wellpoint Medicaid Managed Care	$195.84

HEAD HUMERAL 33X46 43004633

Facility

$7,390.00

Hospital Charge Code	270637265
Hospital Revenue Code	278
Min. Negotiated Rate	$1,108.50
Max. Negotiated Rate	$1,788.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,788.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,625.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.50

HEAD HUMERAL 42MM

Facility

$5,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270672315
Hospital Revenue Code	278
Min. Negotiated Rate	$140.99
Max. Negotiated Rate	$2,925.00
Rate for Payer: Aetna Commercial	$2,223.00
Rate for Payer: Aetna Medicare Advantage	$1,755.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,491.75
Rate for Payer: Cigna Commercial	$2,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,287.00
Rate for Payer: Qualcare PPO/HMO/WC	$877.50
Rate for Payer: UnitedHealthcare Community & State	$140.99
Rate for Payer: Wellpoint Medicaid Managed Care	$155.03

HEAD HUMERAL 42MM

Facility

$5,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270672315
Hospital Revenue Code	278
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$1,415.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,287.00
Rate for Payer: Qualcare PPO/HMO/WC	$877.50

HEAD HUMERAL 44 MM

Facility

$8,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270666203
Hospital Revenue Code	278
Min. Negotiated Rate	$196.90
Max. Negotiated Rate	$4,085.00
Rate for Payer: Aetna Commercial	$3,104.60
Rate for Payer: Aetna Medicare Advantage	$2,451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,083.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,083.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,634.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,083.35
Rate for Payer: Cigna Commercial	$4,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,977.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,797.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,225.50
Rate for Payer: UnitedHealthcare Community & State	$196.90
Rate for Payer: Wellpoint Medicaid Managed Care	$216.50

HEAD HUMERAL 44 MM

Facility

$8,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270666203
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.50
Max. Negotiated Rate	$1,977.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,634.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,977.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,797.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,225.50

HEAD HUMERAL 48MMDx27MM 113771

Facility

$7,180.00

Hospital Charge Code	270647569
Hospital Revenue Code	278
Min. Negotiated Rate	$1,077.00
Max. Negotiated Rate	$1,737.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,436.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,737.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,579.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,077.00

HEAD HUMERAL 48MMDx27MM 113771

Facility

$7,180.00

Hospital Charge Code	270647569
Hospital Revenue Code	278
Min. Negotiated Rate	$173.04
Max. Negotiated Rate	$3,590.00
Rate for Payer: Aetna Commercial	$2,728.40
Rate for Payer: Aetna Medicare Advantage	$2,154.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,830.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,830.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,436.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,830.90
Rate for Payer: Cigna Commercial	$3,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,737.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,579.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,077.00
Rate for Payer: UnitedHealthcare Community & State	$173.04
Rate for Payer: Wellpoint Medicaid Managed Care	$190.27

HEAD HUMERAL 50MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678170
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

HEAD HUMERAL 50MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678170
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

Know your out-of-pocket cost for care.

All Charges