Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHORT ARM SPLINT DYNAMIC

Facility

$468.75

Service Code	HCPCS 29126
Hospital Charge Code	5780130
Hospital Revenue Code	450
Min. Negotiated Rate	$12.42
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$12.42

SHORT COLON***

Facility

$221.00

Hospital Charge Code	2300051
Hospital Revenue Code	361
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$83.98
Rate for Payer: Aetna Medicare Advantage	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.35
Rate for Payer: Cigna Commercial	$110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.15
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

SHORT COLON***

Facility

$221.00

Hospital Charge Code	2300051
Hospital Revenue Code	361
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$33.15

SHORTEN PHALANGE ANY TOE

Facility

$19,998.60

Service Code	HCPCS 28312
Hospital Charge Code	16000909
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

SHORTEN PHALANGE ANY TOE

Facility

$19,998.60

Service Code	HCPCS 28312
Hospital Charge Code	16000909
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

SHORT FLIP CUTTER II,10.5

Facility

$3,475.00

Hospital Charge Code	270679792
Hospital Revenue Code	272
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$521.25
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

SHORT FLIP CUTTER II,10.5

Facility

$3,475.00

Hospital Charge Code	270679792
Hospital Revenue Code	272
Min. Negotiated Rate	$83.75
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.50
Rate for Payer: Oxford Commercial	$695.00
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Commercial	$695.00
Rate for Payer: UnitedHealthcare Community & State	$83.75
Rate for Payer: Wellpoint Medicaid Managed Care	$92.09

SHORT POST

Facility

$890.00

Hospital Charge Code	270339501
Hospital Revenue Code	272
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$445.00
Rate for Payer: Aetna Commercial	$338.20
Rate for Payer: Aetna Medicare Advantage	$267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.95
Rate for Payer: Cigna Commercial	$445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.00
Rate for Payer: Oxford Commercial	$178.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.50
Rate for Payer: UnitedHealthcare Commercial	$178.00
Rate for Payer: UnitedHealthcare Community & State	$21.45
Rate for Payer: Wellpoint Medicaid Managed Care	$23.59

SHORT POST

Facility

$890.00

Hospital Charge Code	270339501
Hospital Revenue Code	272
Min. Negotiated Rate	$133.50
Max. Negotiated Rate	$133.50
Rate for Payer: Qualcare PPO/HMO/WC	$133.50

SHORT STOP NEEDLE HOLDER SS20

Facility

$301.25

Hospital Charge Code	270646069
Hospital Revenue Code	279
Min. Negotiated Rate	$7.26
Max. Negotiated Rate	$150.62
Rate for Payer: Aetna Commercial	$114.47
Rate for Payer: Aetna Medicare Advantage	$90.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.82
Rate for Payer: Cigna Commercial	$150.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.38
Rate for Payer: Oxford Commercial	$60.25
Rate for Payer: Qualcare PPO/HMO/WC	$45.19
Rate for Payer: UnitedHealthcare Commercial	$60.25
Rate for Payer: UnitedHealthcare Community & State	$7.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

SHORT STOP NEEDLE HOLDER SS20

Facility

$12.50

Hospital Charge Code	270646069C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

SHORT STOP NEEDLE HOLDER SS20

Facility

$301.25

Hospital Charge Code	270646069
Hospital Revenue Code	279
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$45.19
Rate for Payer: Qualcare PPO/HMO/WC	$45.19

SHORT STOP NEEDLE HOLDER SS20

Facility

$12.50

Hospital Charge Code	270646069C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.25
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare Advantage	$3.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.19
Rate for Payer: Cigna Commercial	$6.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.75
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.50
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

SHOULD COMP RVS CNTRL 6.5X20MM

Facility

$300.00

Service Code	HCPCS C1776
Hospital Charge Code	270693794
Hospital Revenue Code	278
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

SHOULD COMP RVS CNTRL 6.5X20MM

Facility

$300.00

Service Code	HCPCS C1776
Hospital Charge Code	270693794
Hospital Revenue Code	278
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

SHOULDER 1 VIEW-BILAT

Facility

$250.00

Service Code	HCPCS 7302050
Hospital Charge Code	94061213
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

SHOULDER 1 VIEW-BILAT

Facility

$250.00

Service Code	HCPCS 7302050
Hospital Charge Code	94061213
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SHOULDER 1 VIEW-LT

Facility

$250.00

Service Code	HCPCS 73020LT
Hospital Charge Code	94061285
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

SHOULDER 1 VIEW-LT

Facility

$250.00

Service Code	HCPCS 73020LT
Hospital Charge Code	94061285
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SHOULDER 1 VIEW-RT

Facility

$6,601.19

Service Code	HCPCS 73020RT
Hospital Charge Code	94061287
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

SHOULDER 1 VIEW-RT

Facility

$6,601.19

Service Code	HCPCS 73020RT
Hospital Charge Code	94061287
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

SHOULDER 36MM GLENOSPHERE

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270680625
Hospital Revenue Code	278
Min. Negotiated Rate	$301.85
Max. Negotiated Rate	$6,262.50
Rate for Payer: Aetna Commercial	$4,759.50
Rate for Payer: Aetna Medicare Advantage	$3,757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,193.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,193.88
Rate for Payer: Cigna Commercial	$6,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,755.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75
Rate for Payer: UnitedHealthcare Community & State	$301.85
Rate for Payer: Wellpoint Medicaid Managed Care	$331.91

SHOULDER 36MM GLENOSPHERE

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270680625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,878.75
Max. Negotiated Rate	$3,031.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,031.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,755.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,878.75

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$31,880.74

Service Code	APR-DRG 3223
Min. Negotiated Rate	$31,255.63
Max. Negotiated Rate	$31,880.74
Rate for Payer: UnitedHealthcare Community & State	$31,255.63
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$31,880.74
Rate for Payer: Wellpoint Medicaid Managed Care	$31,255.63

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$45,872.19

Service Code	APR-DRG 3224
Min. Negotiated Rate	$44,972.74
Max. Negotiated Rate	$45,872.19
Rate for Payer: UnitedHealthcare Community & State	$44,972.74
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$45,872.19
Rate for Payer: Wellpoint Medicaid Managed Care	$44,972.74

Know your out-of-pocket cost for care.

All Charges