Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEAD HUMERAL 52MM

Facility

$5,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270680037
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 52MM

Facility

$5,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270680037
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 54MM

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270676518
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

HEAD HUMERAL 54MM

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270676518
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

HEAD HUMERAL 54x21MM

Facility

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270672693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

HEAD HUMERAL 54x21MM

Facility

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270672693
Hospital Revenue Code	278
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

HEAD HUMERAL SHORT 41 x 16MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270681774
Hospital Revenue Code	278
Min. Negotiated Rate	$186.17
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$186.17
Rate for Payer: Wellpoint Medicaid Managed Care	$204.71

HEAD HUMERAL SHORT 41 x 16MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270681774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

HEAD HUMERAL SHORT 41 x 17MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270682810
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

HEAD HUMERAL SHORT 41 x 17MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270682810
Hospital Revenue Code	278
Min. Negotiated Rate	$186.17
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$186.17
Rate for Payer: Wellpoint Medicaid Managed Care	$204.71

HEAD HUMERAL SHORT 50 x19 MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270686662
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

HEAD HUMERAL SHORT 50 x19 MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270686662
Hospital Revenue Code	278
Min. Negotiated Rate	$186.17
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$186.17
Rate for Payer: Wellpoint Medicaid Managed Care	$204.71

HEAD HUMRAL 21mX 52m 43005221

Facility

$6,105.85

Hospital Charge Code	270635866
Hospital Revenue Code	278
Min. Negotiated Rate	$147.15
Max. Negotiated Rate	$3,052.93
Rate for Payer: Aetna Commercial	$2,320.22
Rate for Payer: Aetna Medicare Advantage	$1,831.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,556.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,556.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,221.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,556.99
Rate for Payer: Cigna Commercial	$3,052.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,477.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,343.29
Rate for Payer: Qualcare PPO/HMO/WC	$915.88
Rate for Payer: UnitedHealthcare Community & State	$147.15
Rate for Payer: Wellpoint Medicaid Managed Care	$161.81

HEAD HUMRAL 21mX 52m 43005221

Facility

$6,105.85

Hospital Charge Code	270635866
Hospital Revenue Code	278
Min. Negotiated Rate	$915.88
Max. Negotiated Rate	$1,477.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,221.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,477.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,343.29
Rate for Payer: Qualcare PPO/HMO/WC	$915.88

HEAD HUMRL 48x19 BIOMOD 113769

Facility

$4,622.75

Hospital Charge Code	270632547
Hospital Revenue Code	278
Min. Negotiated Rate	$693.41
Max. Negotiated Rate	$1,118.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$924.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,118.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,017.00
Rate for Payer: Qualcare PPO/HMO/WC	$693.41

HEAD HUMRL 48x19 BIOMOD 113769

Facility

$4,622.75

Hospital Charge Code	270632547
Hospital Revenue Code	278
Min. Negotiated Rate	$111.41
Max. Negotiated Rate	$2,311.38
Rate for Payer: Aetna Commercial	$1,756.64
Rate for Payer: Aetna Medicare Advantage	$1,386.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,178.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,178.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$924.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,178.80
Rate for Payer: Cigna Commercial	$2,311.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,118.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,017.00
Rate for Payer: Qualcare PPO/HMO/WC	$693.41
Rate for Payer: UnitedHealthcare Community & State	$111.41
Rate for Payer: Wellpoint Medicaid Managed Care	$122.50

HEAD HUM VERADIAL 38X19X39MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687324
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

HEAD HUM VERADIAL 38X19X39MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687324
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

HEAD HUM VERSA DIAL COMP 54MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692397
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

HEAD HUM VERSA DIAL COMP 54MM

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692397
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

HEAD IMPACTOR

Facility

$1,600.00

Hospital Charge Code	270688837
Hospital Revenue Code	278
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$352.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Community & State	$38.56
Rate for Payer: Wellpoint Medicaid Managed Care	$42.40

HEAD IMPACTOR

Facility

$1,600.00

Hospital Charge Code	270688837
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$387.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$352.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

HEAD IMPLANT 10x22mm 11-210031

Facility

$7,415.00

Hospital Charge Code	270661180
Hospital Revenue Code	278
Min. Negotiated Rate	$1,112.25
Max. Negotiated Rate	$1,794.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,483.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,794.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,631.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,112.25

HEAD IMPLANT 10x22mm 11-210031

Facility

$7,415.00

Hospital Charge Code	270661180
Hospital Revenue Code	278
Min. Negotiated Rate	$178.70
Max. Negotiated Rate	$3,707.50
Rate for Payer: Aetna Commercial	$2,817.70
Rate for Payer: Aetna Medicare Advantage	$2,224.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,890.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,890.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,483.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,890.83
Rate for Payer: Cigna Commercial	$3,707.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,794.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,631.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,112.25
Rate for Payer: UnitedHealthcare Community & State	$178.70
Rate for Payer: Wellpoint Medicaid Managed Care	$196.50

HEAD LEFT 24 MM TR

Facility

$17,775.00

Service Code	HCPCS C1776
Hospital Charge Code	270682763
Hospital Revenue Code	278
Min. Negotiated Rate	$428.38
Max. Negotiated Rate	$8,887.50
Rate for Payer: Aetna Commercial	$6,754.50
Rate for Payer: Aetna Medicare Advantage	$5,332.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,532.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,532.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,532.62
Rate for Payer: Cigna Commercial	$8,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,301.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,910.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,666.25
Rate for Payer: UnitedHealthcare Community & State	$428.38
Rate for Payer: Wellpoint Medicaid Managed Care	$471.04

Know your out-of-pocket cost for care.

All Charges