Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER IMMOBILIZER LG

Facility

$33.25

Hospital Charge Code	270649542
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$12.63
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.48
Rate for Payer: Cigna Commercial	$16.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Oxford Commercial	$6.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.99
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

SHOULDER IMMOBILIZER MEDIUM

Facility

$33.25

Hospital Charge Code	270649543
Hospital Revenue Code	272
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.99

SHOULDER IMMOBILIZER MEDIUM

Facility

$33.25

Hospital Charge Code	270649543
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$12.63
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.48
Rate for Payer: Cigna Commercial	$16.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Oxford Commercial	$6.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.99
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

SHOULDER IMMOBILIZER SMALL

Facility

$33.25

Hospital Charge Code	270649544
Hospital Revenue Code	272
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.99

SHOULDER IMMOBILIZER SMALL

Facility

$33.25

Hospital Charge Code	270649544
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$12.63
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.48
Rate for Payer: Cigna Commercial	$16.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Oxford Commercial	$6.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.99
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

SHOULDER IMMOBILIZER X-LARGE

Facility

$33.25

Hospital Charge Code	270649545
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.62
Rate for Payer: Aetna Commercial	$12.63
Rate for Payer: Aetna Medicare Advantage	$9.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.48
Rate for Payer: Cigna Commercial	$16.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Oxford Commercial	$6.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.99
Rate for Payer: UnitedHealthcare Commercial	$6.65
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

SHOULDER IMMOBILIZER X-LARGE

Facility

$33.25

Hospital Charge Code	270649545
Hospital Revenue Code	272
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$4.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.99

SHOULDER INSTRUMENT CASE

Facility

$5,250.00

Hospital Charge Code	270656562
Hospital Revenue Code	272
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

SHOULDER INSTRUMENT CASE

Facility

$5,250.00

Hospital Charge Code	270656562
Hospital Revenue Code	272
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,575.00
Rate for Payer: Oxford Commercial	$1,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

SHOULDER LINER 3MM DIA 40MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270685175
Hospital Revenue Code	278
Min. Negotiated Rate	$124.11
Max. Negotiated Rate	$2,575.00
Rate for Payer: Aetna Commercial	$1,957.00
Rate for Payer: Aetna Medicare Advantage	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.25
Rate for Payer: Cigna Commercial	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,133.00
Rate for Payer: Qualcare PPO/HMO/WC	$772.50
Rate for Payer: UnitedHealthcare Community & State	$124.11
Rate for Payer: Wellpoint Medicaid Managed Care	$136.47

SHOULDER LINER 3MM DIA 40MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270685175
Hospital Revenue Code	278
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,246.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,133.00
Rate for Payer: Qualcare PPO/HMO/WC	$772.50

SHOULDER METAL BACK GLEN. SM-R

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672172
Hospital Revenue Code	278
Min. Negotiated Rate	$903.00
Max. Negotiated Rate	$1,456.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,324.40
Rate for Payer: Qualcare PPO/HMO/WC	$903.00

SHOULDER METAL BACK GLEN. SM-R

Facility

$6,020.00

Service Code	HCPCS C1776
Hospital Charge Code	270672172
Hospital Revenue Code	278
Min. Negotiated Rate	$145.08
Max. Negotiated Rate	$3,010.00
Rate for Payer: Aetna Commercial	$2,287.60
Rate for Payer: Aetna Medicare Advantage	$1,806.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,535.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,535.10
Rate for Payer: Cigna Commercial	$3,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,456.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,324.40
Rate for Payer: Qualcare PPO/HMO/WC	$903.00
Rate for Payer: UnitedHealthcare Community & State	$145.08
Rate for Payer: Wellpoint Medicaid Managed Care	$159.53

SHOULDER MIN 2 VW-LT

Facility

$6,601.19

Service Code	HCPCS 73030LT
Hospital Charge Code	94061289
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

SHOULDER MIN 2 VW-LT

Facility

$6,601.19

Service Code	HCPCS 73030LT
Hospital Charge Code	94061289
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 MIN 2 VW-RT

Facility

$6,601.19

Service Code	HCPCS 73030RT
Hospital Charge Code	94061291
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

SHOULDER MIN 2 VW-RT

Facility

$6,601.19

Service Code	HCPCS 73030RT
Hospital Charge Code	94061291
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 MIN 2 VWS-BI

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	94061215
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

SHOULDER MIN 2 VWS-BI

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	94061215
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 MUMFORD PROC-

Facility

$50,586.00

Service Code	HCPCS 29824
Hospital Charge Code	16000228
Hospital Revenue Code	360
Min. Negotiated Rate	$7,587.90
Max. Negotiated Rate	$7,587.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90

SHOULDER MUMFORD PROC-

Facility

$50,586.00

Service Code	HCPCS 29824
Hospital Charge Code	16000228
Hospital Revenue Code	360
Min. Negotiated Rate	$1,219.12
Max. Negotiated Rate	$15,175.80
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	$1,742.00
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	$15,175.80
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,587.90
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,219.12
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	$1,340.53

SHOULDER POSITIONER

Facility

$125.00

Hospital Charge Code	270335714
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

SHOULDER POSITIONER

Facility

$125.00

Hospital Charge Code	270335714
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SHOULDER REVERSE 38MM

Facility

$7,393.10

Service Code	HCPCS C1776
Hospital Charge Code	270668553
Hospital Revenue Code	278
Min. Negotiated Rate	$178.17
Max. Negotiated Rate	$3,696.55
Rate for Payer: Aetna Commercial	$2,809.38
Rate for Payer: Aetna Medicare Advantage	$2,217.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,885.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,885.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,885.24
Rate for Payer: Cigna Commercial	$3,696.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,789.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,626.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.96
Rate for Payer: UnitedHealthcare Community & State	$178.17
Rate for Payer: Wellpoint Medicaid Managed Care	$195.92

SHOULDER REVERSE 38MM

Facility

$7,393.10

Service Code	HCPCS C1776
Hospital Charge Code	270668553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,108.96
Max. Negotiated Rate	$1,789.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,478.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,789.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,626.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,108.96

Know your out-of-pocket cost for care.

All Charges