Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHOULDER REVERSE LINER +6MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270672164
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 REVERSE LINER +6MM

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270672164
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 REVERSE LINER STD

Facility

$3,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270672165
Hospital Revenue Code	278
Min. Negotiated Rate	$87.97
Max. Negotiated Rate	$1,825.00
Rate for Payer: Aetna Commercial	$1,387.00
Rate for Payer: Aetna Medicare Advantage	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$930.75
Rate for Payer: Cigna Commercial	$1,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$803.00
Rate for Payer: Qualcare PPO/HMO/WC	$547.50
Rate for Payer: UnitedHealthcare Community & State	$87.97
Rate for Payer: Wellpoint Medicaid Managed Care	$96.72

SHOULDER REVERSE LINER STD

Facility

$3,650.00

Service Code	HCPCS C1776
Hospital Charge Code	270672165
Hospital Revenue Code	278
Min. Negotiated Rate	$547.50
Max. Negotiated Rate	$883.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$803.00
Rate for Payer: Qualcare PPO/HMO/WC	$547.50

SHOULDER SURGERY PROCEDURE

Facility

$859.60

Service Code	HCPCS 23929
Hospital Charge Code	16000546
Hospital Revenue Code	360
Min. Negotiated Rate	$128.94
Max. Negotiated Rate	$128.94
Rate for Payer: Qualcare PPO/HMO/WC	$128.94

SHOULDER SURGERY PROCEDURE

Facility

$859.60

Service Code	HCPCS 23929
Hospital Charge Code	16000546
Hospital Revenue Code	360
Min. Negotiated Rate	$20.72
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$797.10
Rate for Payer: Aetna Medicare Advantage	$949.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,057.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$293.05
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	$1,057.82
Rate for Payer: Cigna Commercial	$587.42
Rate for Payer: Cigna Medicare Advantage	$293.05
Rate for Payer: Clover Medicare Advantage	$278.40
Rate for Payer: EmblemHealth Commercial	$879.15
Rate for Payer: Humana Medicare Advantage	$301.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$293.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.88
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.94
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$20.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.05
Rate for Payer: Wellcare Medicare Advantage	$293.05
Rate for Payer: Wellpoint Medicaid Managed Care	$22.78

SHOULDER SUSPENSION KIT

Facility

$279.00

Hospital Charge Code	270335485
Hospital Revenue Code	272
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$106.02
Rate for Payer: Aetna Medicare Advantage	$83.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.14
Rate for Payer: Cigna Commercial	$139.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.70
Rate for Payer: Oxford Commercial	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$41.85
Rate for Payer: UnitedHealthcare Commercial	$55.80
Rate for Payer: UnitedHealthcare Community & State	$6.72
Rate for Payer: Wellpoint Medicaid Managed Care	$7.39

SHOULDER SUSPENSION KIT

Facility

$279.00

Hospital Charge Code	270335485
Hospital Revenue Code	272
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$41.85
Rate for Payer: Qualcare PPO/HMO/WC	$41.85

SHOULDER TISSUE ELEVATOR 15

Facility

$1,550.00

Hospital Charge Code	270656564
Hospital Revenue Code	272
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.00
Rate for Payer: Oxford Commercial	$310.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Commercial	$310.00
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$41.08

SHOULDER TISSUE ELEVATOR 15

Facility

$1,550.00

Hospital Charge Code	270656564
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$232.50
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

SHOULDER TISSUE ELEVATOR 30

Facility

$1,550.00

Hospital Charge Code	270656565
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$232.50
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

SHOULDER TISSUE ELEVATOR 30

Facility

$1,550.00

Hospital Charge Code	270656565
Hospital Revenue Code	272
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.00
Rate for Payer: Oxford Commercial	$310.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Commercial	$310.00
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$41.08

SHOULDER TM PLATE REVERSE 25MM

Facility

$18,703.10

Service Code	HCPCS C1776
Hospital Charge Code	270696092
Hospital Revenue Code	278
Min. Negotiated Rate	$450.74
Max. Negotiated Rate	$9,351.55
Rate for Payer: Aetna Commercial	$7,107.18
Rate for Payer: Aetna Medicare Advantage	$5,610.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,769.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,769.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,740.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,769.29
Rate for Payer: Cigna Commercial	$9,351.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,526.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,114.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,805.47
Rate for Payer: UnitedHealthcare Community & State	$450.74
Rate for Payer: Wellpoint Medicaid Managed Care	$495.63

SHOULDER TM PLATE REVERSE 25MM

Facility

$18,703.10

Service Code	HCPCS C1776
Hospital Charge Code	270696092
Hospital Revenue Code	278
Min. Negotiated Rate	$2,805.47
Max. Negotiated Rate	$4,526.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,740.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,526.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,114.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,805.47

SHOULDER TO HAND LONG ARM

Facility

$618.00

Service Code	HCPCS 29065
Hospital Charge Code	94186020
Hospital Revenue Code	361
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$903.80
Rate for Payer: Aetna Medicare Advantage	$1,076.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$332.28
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	$1,199.43
Rate for Payer: Cigna Commercial	$666.07
Rate for Payer: Cigna Medicare Advantage	$332.28
Rate for Payer: Clover Medicare Advantage	$315.67
Rate for Payer: EmblemHealth Commercial	$996.84
Rate for Payer: Humana Medicare Advantage	$342.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$332.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$14.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$332.28
Rate for Payer: Wellcare Medicare Advantage	$332.28
Rate for Payer: Wellpoint Medicaid Managed Care	$16.38

SHOULDER TO HAND LONG ARM

Facility

$618.00

Service Code	HCPCS 29065
Hospital Charge Code	94186020
Hospital Revenue Code	361
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$92.70
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$46,662.43

Service Code	APR-DRG 3154
Min. Negotiated Rate	$45,747.48
Max. Negotiated Rate	$46,662.43
Rate for Payer: UnitedHealthcare Community & State	$45,747.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,662.43
Rate for Payer: Wellpoint Medicaid Managed Care	$45,747.48

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$12,262.82

Service Code	APR-DRG 3151
Min. Negotiated Rate	$12,022.37
Max. Negotiated Rate	$12,262.82
Rate for Payer: UnitedHealthcare Community & State	$12,022.37
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,262.82
Rate for Payer: Wellpoint Medicaid Managed Care	$12,022.37

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$28,722.12

Service Code	APR-DRG 3153
Min. Negotiated Rate	$28,158.94
Max. Negotiated Rate	$28,722.12
Rate for Payer: UnitedHealthcare Community & State	$28,158.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$28,722.12
Rate for Payer: Wellpoint Medicaid Managed Care	$28,158.94

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$19,338.32

Service Code	APR-DRG 3152
Min. Negotiated Rate	$18,959.14
Max. Negotiated Rate	$19,338.32
Rate for Payer: UnitedHealthcare Community & State	$18,959.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,338.32
Rate for Payer: Wellpoint Medicaid Managed Care	$18,959.14

SHRIMP IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003G
Hospital Revenue Code	302
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SHRIMP IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003G
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SHROUD MORTUARY LG ADULT

Facility

$19.25

Hospital Charge Code	270301960
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

SHROUD MORTUARY LG ADULT

Facility

$19.25

Hospital Charge Code	270301960
Hospital Revenue Code	270
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

SHRT ARM SPLNT FRRM TO HN

Facility

$288.00

Service Code	HCPCS 29125
Hospital Charge Code	94186040
Hospital Revenue Code	361
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

Know your out-of-pocket cost for care.

All Charges