Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLENOSPHERE STD DIA 38MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686441
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

GLENOSPHERE STD DIA 38MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686441
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

GLENOSPHERE STD REV LAT 36MM

Facility

$34,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270700534
Hospital Revenue Code	278
Min. Negotiated Rate	$821.09
Max. Negotiated Rate	$17,035.00
Rate for Payer: Aetna Commercial	$12,946.60
Rate for Payer: Aetna Medicare Advantage	$10,221.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,687.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,687.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,814.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,687.85
Rate for Payer: Cigna Commercial	$17,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,244.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,495.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,110.50
Rate for Payer: UnitedHealthcare Community & State	$821.09
Rate for Payer: Wellpoint Medicaid Managed Care	$902.86

GLENOSPHERE STD REV LAT 36MM

Facility

$34,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270700534
Hospital Revenue Code	278
Min. Negotiated Rate	$5,110.50
Max. Negotiated Rate	$8,244.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,814.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,244.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,495.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,110.50

GLIADIN AB (IGG,A)I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990008A
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.75
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.82
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

GLIADIN AB (IGG,A)I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990008A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

GLIADIN AB (IGG,A)II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990008B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

GLIADIN AB (IGG,A)II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990008B
Hospital Revenue Code	301
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$28.75
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.82
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

GLIADIN DEAMIDATED AB,IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900332
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$10.34

GLIADIN DEAMIDATED AB,IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900332
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GLIDE ADVANTAGE .014

Facility

$1,568.00

Hospital Charge Code	270684951N
Hospital Revenue Code	272
Min. Negotiated Rate	$37.79
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$595.84
Rate for Payer: Aetna Medicare Advantage	$470.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.84
Rate for Payer: Cigna Commercial	$784.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.40
Rate for Payer: Oxford Commercial	$313.60
Rate for Payer: Qualcare PPO/HMO/WC	$235.20
Rate for Payer: UnitedHealthcare Commercial	$313.60
Rate for Payer: UnitedHealthcare Community & State	$37.79
Rate for Payer: Wellpoint Medicaid Managed Care	$41.55

GLIDE ADVANTAGE .014

Facility

$1,568.00

Hospital Charge Code	270684951N
Hospital Revenue Code	272
Min. Negotiated Rate	$235.20
Max. Negotiated Rate	$235.20
Rate for Payer: Qualcare PPO/HMO/WC	$235.20

GLIDECATH 4FR - 100 CM SIM 2

Facility

$357.50

Hospital Charge Code	270CH0087
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 100 CM SIM 2

Facility

$357.50

Hospital Charge Code	270CH0087
Hospital Revenue Code	272
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

GLIDECATH 4FR-100 CM SIM 2

Facility

$357.50

Hospital Charge Code	2709004138
Hospital Revenue Code	272
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

GLIDECATH 4FR-100 CM SIM 2

Facility

$357.50

Hospital Charge Code	2709004138
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 100 CM STRAIGH

Facility

$357.50

Hospital Charge Code	270658287
Hospital Revenue Code	272
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

GLIDECATH 4FR - 100 CM STRAIGH

Facility

$357.50

Hospital Charge Code	270658287
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 65 CM C1

Facility

$357.50

Hospital Charge Code	270CH0099
Hospital Revenue Code	272
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

GLIDECATH 4FR - 65 CM C1

Facility

$357.50

Hospital Charge Code	270CH0099
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR-65CM C1

Facility

$357.50

Hospital Charge Code	2709004216
Hospital Revenue Code	272
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

GLIDECATH 4FR-65CM C1

Facility

$357.50

Hospital Charge Code	2709004216
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 65CM STRAIGHT

Facility

$357.50

Service Code	HCPCS C1887
Hospital Charge Code	270645472
Hospital Revenue Code	278
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$86.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

GLIDECATH 4FR - 65CM STRAIGHT

Facility

$357.50

Service Code	HCPCS C1887
Hospital Charge Code	270645472
Hospital Revenue Code	278
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

GLIDECATH 4FR-65CM STRAIGHT

Facility

$357.50

Hospital Charge Code	2709004130
Hospital Revenue Code	272
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

Know your out-of-pocket cost for care.

All Charges