Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LINER HUMERAL 36 +6C

Facility

$5,075.00

Hospital Charge Code	270672412
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 38MM +0MM

Facility

$4,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270668561
Hospital Revenue Code	278
Min. Negotiated Rate	$113.87
Max. Negotiated Rate	$2,362.50
Rate for Payer: Aetna Commercial	$1,795.50
Rate for Payer: Aetna Medicare Advantage	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,204.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,204.88
Rate for Payer: Cigna Commercial	$2,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,039.50
Rate for Payer: Qualcare PPO/HMO/WC	$708.75
Rate for Payer: UnitedHealthcare Community & State	$113.87
Rate for Payer: Wellpoint Medicaid Managed Care	$125.21

LINER HUMERAL 38MM +0MM

Facility

$4,725.00

Service Code	HCPCS C1776
Hospital Charge Code	270668561
Hospital Revenue Code	278
Min. Negotiated Rate	$708.75
Max. Negotiated Rate	$1,143.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,143.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,039.50
Rate for Payer: Qualcare PPO/HMO/WC	$708.75

LINER HUMERAL 38MM +2.5MM

Facility

$4,197.10

Service Code	HCPCS C1776
Hospital Charge Code	270668559
Hospital Revenue Code	278
Min. Negotiated Rate	$629.57
Max. Negotiated Rate	$1,015.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$839.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,015.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$923.36
Rate for Payer: Qualcare PPO/HMO/WC	$629.57

LINER HUMERAL 38MM +2.5MM

Facility

$4,197.10

Service Code	HCPCS C1776
Hospital Charge Code	270668559
Hospital Revenue Code	278
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$2,098.55
Rate for Payer: Aetna Commercial	$1,594.90
Rate for Payer: Aetna Medicare Advantage	$1,259.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,070.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,070.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$839.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,070.26
Rate for Payer: Cigna Commercial	$2,098.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,015.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$923.36
Rate for Payer: Qualcare PPO/HMO/WC	$629.57
Rate for Payer: UnitedHealthcare Community & State	$101.15
Rate for Payer: Wellpoint Medicaid Managed Care	$111.22

LINER HUMERAL 39 +3

Facility

$5,075.00

Hospital Charge Code	270672405
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 39 +3

Facility

$5,075.00

Hospital Charge Code	270672405
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 39 +3C

Facility

$5,075.00

Hospital Charge Code	270672406
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 39 +3C

Facility

$5,075.00

Hospital Charge Code	270672406
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 39 +6

Facility

$5,075.00

Hospital Charge Code	270672407
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 39 +6

Facility

$5,075.00

Hospital Charge Code	270672407
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 39 +6C

Facility

$5,075.00

Hospital Charge Code	270672408
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 39 +6C

Facility

$5,075.00

Hospital Charge Code	270672408
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 42 +3

Facility

$5,075.00

Hospital Charge Code	270672401
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 42 +3

Facility

$5,075.00

Hospital Charge Code	270672401
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 42 +3C

Facility

$5,075.00

Hospital Charge Code	270672402
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 42 +3C

Facility

$5,075.00

Hospital Charge Code	270672402
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 42 +6

Facility

$5,075.00

Hospital Charge Code	270672403
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 42 +6

Facility

$5,075.00

Hospital Charge Code	270672403
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 42 +6C

Facility

$5,075.00

Hospital Charge Code	270672404
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 42 +6C

Facility

$5,075.00

Hospital Charge Code	270672404
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 42MM SHOULDER 0

Facility

$3,694.95

Service Code	HCPCS C1776
Hospital Charge Code	270679729
Hospital Revenue Code	278
Min. Negotiated Rate	$554.24
Max. Negotiated Rate	$894.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$738.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$812.89
Rate for Payer: Qualcare PPO/HMO/WC	$554.24

LINER HUMERAL 42MM SHOULDER 0

Facility

$3,694.95

Service Code	HCPCS C1776
Hospital Charge Code	270679729
Hospital Revenue Code	278
Min. Negotiated Rate	$89.05
Max. Negotiated Rate	$1,847.47
Rate for Payer: Aetna Commercial	$1,404.08
Rate for Payer: Aetna Medicare Advantage	$1,108.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$942.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$942.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$738.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$942.21
Rate for Payer: Cigna Commercial	$1,847.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$812.89
Rate for Payer: Qualcare PPO/HMO/WC	$554.24
Rate for Payer: UnitedHealthcare Community & State	$89.05
Rate for Payer: Wellpoint Medicaid Managed Care	$97.92

LINER HUMERAL PE 36/+0mm

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270698237
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

LINER HUMERAL PE 36/+0mm

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270698237
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

Know your out-of-pocket cost for care.

All Charges