Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL STEM STD SHORTSZ3

Facility

$47,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270700532
Hospital Revenue Code	278
Min. Negotiated Rate	$1,153.67
Max. Negotiated Rate	$23,935.00
Rate for Payer: Aetna Commercial	$18,190.60
Rate for Payer: Aetna Medicare Advantage	$14,361.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,206.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,206.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,206.85
Rate for Payer: Cigna Commercial	$23,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,584.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,531.40
Rate for Payer: Qualcare PPO/HMO/WC	$7,180.50
Rate for Payer: UnitedHealthcare Community & State	$1,153.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1,268.56

HUMERAL STEM STD SHORTSZ3

Facility

$47,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270700532
Hospital Revenue Code	278
Min. Negotiated Rate	$7,180.50
Max. Negotiated Rate	$11,584.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,574.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,584.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,531.40
Rate for Payer: Qualcare PPO/HMO/WC	$7,180.50

HUMERAL TRAY #110031406

Facility

$10,500.00

Hospital Charge Code	270702533
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

HUMERAL TRAY #110031406

Facility

$10,500.00

Hospital Charge Code	270702533
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

HUMERAL TRAY +5 44MM

Facility

$7,500.00

Hospital Charge Code	270671258
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

HUMERAL TRAY +5 44MM

Facility

$7,500.00

Hospital Charge Code	270671258
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

HUMERAL X3 INSERT 36x2MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671583
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

HUMERAL X3 INSERT 36x2MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270671583
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

HUMER DIAPH SH CEMENTLESS SZ9

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693055
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

HUMER DIAPH SH CEMENTLESS SZ9

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693055
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

HUMER DIAPHY SHORT NO CEMENT 8

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270696753
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

HUMER DIAPHY SHORT NO CEMENT 8

Facility

$17,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270696753
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

HUMERUS 2 VIEWS-BILAT

Facility

$250.00

Service Code	HCPCS 7306050
Hospital Charge Code	94061217
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HUMERUS 2 VIEWS-BILAT

Facility

$250.00

Service Code	HCPCS 7306050
Hospital Charge Code	94061217
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

HUMERUS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 73060LT
Hospital Charge Code	94061293
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HUMERUS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 73060LT
Hospital Charge Code	94061293
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

HUMERUS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 73060RT
Hospital Charge Code	94061295
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

HUMERUS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 73060RT
Hospital Charge Code	94061295
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HUM HEAD 40Mx18M SOLAR53504018

Facility

$8,220.00

Hospital Charge Code	270640741
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.00
Max. Negotiated Rate	$1,989.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,644.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,989.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,808.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.00

HUM HEAD 40Mx18M SOLAR53504018

Facility

$8,220.00

Hospital Charge Code	270640741
Hospital Revenue Code	278
Min. Negotiated Rate	$198.10
Max. Negotiated Rate	$4,110.00
Rate for Payer: Aetna Commercial	$3,123.60
Rate for Payer: Aetna Medicare Advantage	$2,466.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,096.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,096.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,644.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,096.10
Rate for Payer: Cigna Commercial	$4,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,989.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,808.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.00
Rate for Payer: UnitedHealthcare Community & State	$198.10
Rate for Payer: Wellpoint Medicaid Managed Care	$217.83

HUMIDFIER 02***

Facility

$9.90

Hospital Charge Code	9500091
Hospital Revenue Code	279
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.49

HUMIDFIER 02***

Facility

$9.90

Hospital Charge Code	9500091
Hospital Revenue Code	279
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.95
Rate for Payer: Aetna Commercial	$3.76
Rate for Payer: Aetna Medicare Advantage	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.52
Rate for Payer: Cigna Commercial	$4.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.97
Rate for Payer: Oxford Commercial	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.49
Rate for Payer: UnitedHealthcare Commercial	$1.98
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

HUMIDIFiER BALLARD FLEX HME

Facility

$9.20

Hospital Charge Code	270643318
Hospital Revenue Code	272
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.38

HUMIDIFiER BALLARD FLEX HME

Facility

$9.20

Hospital Charge Code	270643318
Hospital Revenue Code	272
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.60
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna Medicare Advantage	$2.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.35
Rate for Payer: Cigna Commercial	$4.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.76
Rate for Payer: Oxford Commercial	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.38
Rate for Payer: UnitedHealthcare Commercial	$1.84
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

HUMIDIFIER BUBBLE

Facility

$40.00

Hospital Charge Code	270639795
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

Know your out-of-pocket cost for care.

All Charges