Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL HEAD TALL 41X20MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270670756
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

HUMERAL HEAD TALL 41X20MM

Facility

$7,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270670756
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

HUMERAL HEAD TALL 50MM

Facility

$7,725.00

Hospital Charge Code	270675724
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

HUMERAL HEAD TALL 50MM

Facility

$7,725.00

Hospital Charge Code	270675724
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

HUMERAL INSERT RVRS SZ3/436MM

Facility

$20,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270700533
Hospital Revenue Code	278
Min. Negotiated Rate	$498.87
Max. Negotiated Rate	$10,350.00
Rate for Payer: Aetna Commercial	$7,866.00
Rate for Payer: Aetna Medicare Advantage	$6,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,278.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,278.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,278.50
Rate for Payer: Cigna Commercial	$10,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,009.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,554.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,105.00
Rate for Payer: UnitedHealthcare Community & State	$498.87
Rate for Payer: Wellpoint Medicaid Managed Care	$548.55

HUMERAL INSERT RVRS SZ3/436MM

Facility

$20,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270700533
Hospital Revenue Code	278
Min. Negotiated Rate	$3,105.00
Max. Negotiated Rate	$5,009.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,009.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,554.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,105.00

HUMERAL MIDDLE SEGMENT 25MM

Facility

$47,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679730
Hospital Revenue Code	278
Min. Negotiated Rate	$1,144.75
Max. Negotiated Rate	$23,750.00
Rate for Payer: Aetna Commercial	$18,050.00
Rate for Payer: Aetna Medicare Advantage	$14,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,112.50
Rate for Payer: Cigna Commercial	$23,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,495.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,450.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,125.00
Rate for Payer: UnitedHealthcare Community & State	$1,144.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1,258.75

HUMERAL MIDDLE SEGMENT 25MM

Facility

$47,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679730
Hospital Revenue Code	278
Min. Negotiated Rate	$7,125.00
Max. Negotiated Rate	$11,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,495.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,450.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,125.00

HUMERAL MINI 10 MMX 83MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688026
Hospital Revenue Code	278
Min. Negotiated Rate	$349.45
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$349.45
Rate for Payer: Wellpoint Medicaid Managed Care	$384.25

HUMERAL MINI 10 MMX 83MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688026
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

HUMERAL NAIL 8X22.5MM

Facility

$13,364.25

Service Code	HCPCS C1713
Hospital Charge Code	270705900
Hospital Revenue Code	278
Min. Negotiated Rate	$2,004.64
Max. Negotiated Rate	$3,234.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,672.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,234.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,940.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,004.64

HUMERAL NAIL 8X22.5MM

Facility

$13,364.25

Service Code	HCPCS C1713
Hospital Charge Code	270705900
Hospital Revenue Code	278
Min. Negotiated Rate	$322.08
Max. Negotiated Rate	$6,682.12
Rate for Payer: Aetna Commercial	$5,078.41
Rate for Payer: Aetna Medicare Advantage	$4,009.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,407.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,407.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,672.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,407.88
Rate for Payer: Cigna Commercial	$6,682.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,234.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,940.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,004.64
Rate for Payer: UnitedHealthcare Community & State	$322.08
Rate for Payer: Wellpoint Medicaid Managed Care	$354.15

HUMERAL NAIL T2 PRX LF 8X240MM

Facility

$14,690.00

Hospital Charge Code	270671182
Hospital Revenue Code	278
Min. Negotiated Rate	$2,203.50
Max. Negotiated Rate	$3,554.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,938.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,554.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,231.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,203.50

HUMERAL NAIL T2 PRX LF 8X240MM

Facility

$14,690.00

Hospital Charge Code	270671182
Hospital Revenue Code	278
Min. Negotiated Rate	$354.03
Max. Negotiated Rate	$7,345.00
Rate for Payer: Aetna Commercial	$5,582.20
Rate for Payer: Aetna Medicare Advantage	$4,407.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,745.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,745.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,938.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,745.95
Rate for Payer: Cigna Commercial	$7,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,554.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,231.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,203.50
Rate for Payer: UnitedHealthcare Community & State	$354.03
Rate for Payer: Wellpoint Medicaid Managed Care	$389.29

HUMERAL PE HC LINER 30.0MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699730
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

HUMERAL PE HC LINER 30.0MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699730
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

HUMERAL PROX BDY COMPSRS 48MM

Facility

$22,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270697380
Hospital Revenue Code	278
Min. Negotiated Rate	$552.37
Max. Negotiated Rate	$11,460.00
Rate for Payer: Aetna Commercial	$8,709.60
Rate for Payer: Aetna Medicare Advantage	$6,876.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,844.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,844.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,844.60
Rate for Payer: Cigna Commercial	$11,460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,546.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,042.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,438.00
Rate for Payer: UnitedHealthcare Community & State	$552.37
Rate for Payer: Wellpoint Medicaid Managed Care	$607.38

HUMERAL PROX BDY COMPSRS 48MM

Facility

$22,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270697380
Hospital Revenue Code	278
Min. Negotiated Rate	$3,438.00
Max. Negotiated Rate	$5,546.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,584.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,546.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,042.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,438.00

HUMERAL REVERSE HC LINER A 36/

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687837
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

HUMERAL REVERSE HC LINER A 36/

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687837
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

HUMERAL REVRS HC LINER 039X3MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699528
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

HUMERAL REVRS HC LINER 039X3MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699528
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

HUMERAL REVRS METAPHYSIS 9MM0D

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699527
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

HUMERAL REVRS METAPHYSIS 9MM0D

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699527
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

HUMERAL ROD 8X200MM

Facility

$10,245.00

Hospital Charge Code	270671057
Hospital Revenue Code	278
Min. Negotiated Rate	$1,536.75
Max. Negotiated Rate	$2,479.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,479.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,253.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,536.75

Know your out-of-pocket cost for care.

All Charges