Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SMOOTH LOCK PEG 2.2MM X 20MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681157
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$113.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.96
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

SMOOTH LOCK PEG 2.2MM X 20MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681157
Hospital Revenue Code	278
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$177.84
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.96
Rate for Payer: Qualcare PPO/HMO/WC	$70.20
Rate for Payer: UnitedHealthcare Community & State	$11.28
Rate for Payer: Wellpoint Medicaid Managed Care	$12.40

SMOOTH LOCK PEG 2.2MM X 22MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681158
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$113.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.96
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

SMOOTH LOCK PEG 2.2MM X 22MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681158
Hospital Revenue Code	278
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$177.84
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.96
Rate for Payer: Qualcare PPO/HMO/WC	$70.20
Rate for Payer: UnitedHealthcare Community & State	$11.28
Rate for Payer: Wellpoint Medicaid Managed Care	$12.40

SMOOTH MOD + PROF XTRA 465CC

Facility

$7,625.00

Hospital Charge Code	270703175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.75
Max. Negotiated Rate	$1,845.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,677.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75

SMOOTH MOD + PROF XTRA 465CC

Facility

$7,625.00

Hospital Charge Code	270703175
Hospital Revenue Code	278
Min. Negotiated Rate	$183.76
Max. Negotiated Rate	$3,812.50
Rate for Payer: Aetna Commercial	$2,897.50
Rate for Payer: Aetna Medicare Advantage	$2,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,944.38
Rate for Payer: Cigna Commercial	$3,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,677.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75
Rate for Payer: UnitedHealthcare Community & State	$183.76
Rate for Payer: Wellpoint Medicaid Managed Care	$202.06

SMOOTH MUSCLE AB SCRN

Facility

$187.25

Service Code	HCPCS 83516
Hospital Charge Code	3003639
Hospital Revenue Code	302
Min. Negotiated Rate	$28.09
Max. Negotiated Rate	$28.09
Rate for Payer: Qualcare PPO/HMO/WC	$28.09

SMOOTH MUSCLE AB SCRN

Facility

$187.25

Service Code	HCPCS 83516
Hospital Charge Code	3003639
Hospital Revenue Code	302
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$93.62
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.17
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.09
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.96

SMOOTH MUSCLE AB WITH REFLEX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900366
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.28
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$17.69

SMOOTH MUSCLE AB WITH REFLEX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900366
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SMOOTH MUSCLE ANTIBODIES

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38476066
Hospital Revenue Code	302
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

SMOOTH MUSCLE ANTIBODIES

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38476066
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$210.50
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$210.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.16

SMOOTH MUSCLE ANTIBODY SCREEN

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38479408
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$210.50
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$210.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.30
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.16

SMOOTH MUSCLE ANTIBODY SCREEN

Facility

$421.00

Service Code	HCPCS 86255
Hospital Charge Code	38479408
Hospital Revenue Code	302
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

SMOOTH PEG LOCKING 2.0X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664354
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

SMOOTH PEG LOCKING 2.0X18

Facility

$495.00

Service Code	HCPCS C1713
Hospital Charge Code	270664354
Hospital Revenue Code	278
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$119.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

SMOOTH PINS PAK

Facility

$1,432.75

Hospital Charge Code	270685072
Hospital Revenue Code	272
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$214.91
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

SMOOTH PINS PAK

Facility

$1,432.75

Hospital Charge Code	270685072
Hospital Revenue Code	272
Min. Negotiated Rate	$34.53
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$544.45
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.82
Rate for Payer: Oxford Commercial	$286.55
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Commercial	$286.55
Rate for Payer: UnitedHealthcare Community & State	$34.53
Rate for Payer: Wellpoint Medicaid Managed Care	$37.97

SMR RT SHOULDER LINER SM

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270675949
Hospital Revenue Code	278
Min. Negotiated Rate	$64.71
Max. Negotiated Rate	$1,342.50
Rate for Payer: Aetna Commercial	$1,020.30
Rate for Payer: Aetna Medicare Advantage	$805.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.67
Rate for Payer: Cigna Commercial	$1,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.70
Rate for Payer: Qualcare PPO/HMO/WC	$402.75
Rate for Payer: UnitedHealthcare Community & State	$64.71
Rate for Payer: Wellpoint Medicaid Managed Care	$71.15

SMR RT SHOULDER LINER SM

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270675949
Hospital Revenue Code	278
Min. Negotiated Rate	$402.75
Max. Negotiated Rate	$649.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.70
Rate for Payer: Qualcare PPO/HMO/WC	$402.75

SMR SHOULDER HUMERAL BODY

Facility

$9,955.00

Service Code	HCPCS C1776
Hospital Charge Code	270673175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.25
Max. Negotiated Rate	$2,409.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,991.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,409.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,190.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,493.25

SMR SHOULDER HUMERAL BODY

Facility

$9,955.00

Service Code	HCPCS C1776
Hospital Charge Code	270673175
Hospital Revenue Code	278
Min. Negotiated Rate	$239.92
Max. Negotiated Rate	$4,977.50
Rate for Payer: Aetna Commercial	$3,782.90
Rate for Payer: Aetna Medicare Advantage	$2,986.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,538.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,538.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,991.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,538.53
Rate for Payer: Cigna Commercial	$4,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,409.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,190.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,493.25
Rate for Payer: UnitedHealthcare Community & State	$239.92
Rate for Payer: Wellpoint Medicaid Managed Care	$263.81

SMR SHOULDER REVERSE LINER

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270673176
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

SMR SHOULDER REVERSE LINER

Facility

$5,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270673176
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

SMR SHOULDER /SPALLA

Facility

$18,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678828
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

Know your out-of-pocket cost for care.

All Charges