Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER GD BN L

Facility

$5,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692333
Hospital Revenue Code	278
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,379.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,254.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

SHOULDER GD BN L

Facility

$5,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692333
Hospital Revenue Code	278
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$1,379.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,379.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,254.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

SHOULDER GD COMPRIT

Facility

$5,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692396
Hospital Revenue Code	278
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$1,379.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,379.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,254.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

SHOULDER GD COMPRIT

Facility

$5,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270692396
Hospital Revenue Code	278
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,379.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,254.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

SHOULDER GD COMPRIT R

Facility

$5,700.00

Service Code	HCPCS A4649
Hospital Charge Code	270693243
Hospital Revenue Code	272
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

SHOULDER GD COMPRIT R

Facility

$5,700.00

Service Code	HCPCS A4649
Hospital Charge Code	270693243
Hospital Revenue Code	272
Min. Negotiated Rate	$137.37
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,710.00
Rate for Payer: Oxford Commercial	$1,140.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$1,140.00
Rate for Payer: UnitedHealthcare Community & State	$137.37
Rate for Payer: Wellpoint Medicaid Managed Care	$151.05

SHOULDER GLENOID BASEPLATE SM-

Facility

$6,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270685158
Hospital Revenue Code	278
Min. Negotiated Rate	$151.83
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$945.00
Rate for Payer: UnitedHealthcare Community & State	$151.83
Rate for Payer: Wellpoint Medicaid Managed Care	$166.95

SHOULDER GLENOID BASEPLATE SM-

Facility

$6,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270685158
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

SHOULDER GLENOID FOSSA TM 12MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696615
Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$747.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$679.25
Rate for Payer: Qualcare PPO/HMO/WC	$463.12

SHOULDER GLENOID FOSSA TM 12MM

Facility

$3,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270696615
Hospital Revenue Code	278
Min. Negotiated Rate	$74.41
Max. Negotiated Rate	$1,543.75
Rate for Payer: Aetna Commercial	$1,173.25
Rate for Payer: Aetna Medicare Advantage	$926.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$787.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$787.31
Rate for Payer: Cigna Commercial	$1,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$679.25
Rate for Payer: Qualcare PPO/HMO/WC	$463.12
Rate for Payer: UnitedHealthcare Community & State	$74.41
Rate for Payer: Wellpoint Medicaid Managed Care	$81.82

SHOULDER GLENOID PEG TT SM-R

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270658159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT SM-R

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270658159
Hospital Revenue Code	278
Min. Negotiated Rate	$185.57
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,926.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$185.57
Rate for Payer: Wellpoint Medicaid Managed Care	$204.05

SHOULDER GLENOID PEG TT SM-R

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685159
Hospital Revenue Code	278
Min. Negotiated Rate	$185.57
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,926.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$185.57
Rate for Payer: Wellpoint Medicaid Managed Care	$204.05

SHOULDER GLENOID PEG TT SM-R

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685159
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT SM-R 4

Facility

$6,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270685178
Hospital Revenue Code	278
Min. Negotiated Rate	$151.83
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$945.00
Rate for Payer: UnitedHealthcare Community & State	$151.83
Rate for Payer: Wellpoint Medicaid Managed Care	$166.95

SHOULDER GLENOID PEG TT SM-R 4

Facility

$6,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270685178
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

SHOULDER GLENOID PEG TT X-LONG

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685177
Hospital Revenue Code	278
Min. Negotiated Rate	$185.57
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,926.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$185.57
Rate for Payer: Wellpoint Medicaid Managed Care	$204.05

SHOULDER GLENOID PEG TT X-LONG

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685204
Hospital Revenue Code	278
Min. Negotiated Rate	$185.57
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,926.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$185.57
Rate for Payer: Wellpoint Medicaid Managed Care	$204.05

SHOULDER GLENOID PEG TT X-LONG

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685204
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOID PEG TT X-LONG

Facility

$7,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270685177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

SHOULDER GLENOSPHERE 36MM

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270676750
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 GLENOSPHERE 36MM

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270676750
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 GLENOSPHERE SM-R

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270672169
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 GLENOSPHERE SM-R

Facility

$12,525.00

Service Code	HCPCS C1776
Hospital Charge Code	270672169
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 IMMOBILIZER LG

Facility

$33.25

Hospital Charge Code	270649542
Hospital Revenue Code	272
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.99

Know your out-of-pocket cost for care.

All Charges