Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLIDE SHEATH SLENDER 6FR x 10c

Facility

$531.25

Hospital Charge Code	270665133S
Hospital Revenue Code	270
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$265.62
Rate for Payer: Aetna Commercial	$201.88
Rate for Payer: Aetna Medicare Advantage	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.47
Rate for Payer: Cigna Commercial	$265.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.38
Rate for Payer: Oxford Commercial	$106.25
Rate for Payer: Qualcare PPO/HMO/WC	$79.69
Rate for Payer: UnitedHealthcare Commercial	$106.25
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.08

GLIDE SHEET IOL 34MM LG X 5MM

Facility

$6.62

Hospital Charge Code	270655024
Hospital Revenue Code	270
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

GLIDE SHEET IOL 34MM LG X 5MM

Facility

$6.62

Hospital Charge Code	270655024
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$2.52
Rate for Payer: Aetna Medicare Advantage	$1.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.69
Rate for Payer: Cigna Commercial	$3.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.99
Rate for Payer: Oxford Commercial	$1.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$1.32
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

Glidewire 0.035 180cm STIF ANG

Facility

$1,700.00

Hospital Charge Code	270638738
Hospital Revenue Code	279
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

Glidewire 0.035 180cm STIF ANG

Facility

$1,700.00

Hospital Charge Code	270638738
Hospital Revenue Code	279
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$40.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

Glidewire 0.035 180cm STIF ANG

Facility

$264.05

Service Code	HCPCS C1769
Hospital Charge Code	270638738N
Hospital Revenue Code	278
Min. Negotiated Rate	$39.61
Max. Negotiated Rate	$63.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.09
Rate for Payer: Qualcare PPO/HMO/WC	$39.61

Glidewire 0.035 180cm STIF ANG

Facility

$264.05

Service Code	HCPCS C1769
Hospital Charge Code	270638738N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$132.03
Rate for Payer: Aetna Commercial	$100.34
Rate for Payer: Aetna Medicare Advantage	$79.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.33
Rate for Payer: Cigna Commercial	$132.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.09
Rate for Payer: Qualcare PPO/HMO/WC	$39.61
Rate for Payer: UnitedHealthcare Community & State	$6.36
Rate for Payer: Wellpoint Medicaid Managed Care	$7.00

GLIDEWIRE 0.035 180CM STIF ANG

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270638738S
Hospital Revenue Code	278
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$121.12
Rate for Payer: Aetna Commercial	$92.06
Rate for Payer: Aetna Medicare Advantage	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.77
Rate for Payer: Cigna Commercial	$121.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.34
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6.42

GLIDEWIRE 0.035 180CM STIF ANG

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270638738S
Hospital Revenue Code	278
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.34

Glidewire 0.035 180cm STIF STR

Facility

$264.05

Service Code	HCPCS C1769
Hospital Charge Code	270658279N
Hospital Revenue Code	278
Min. Negotiated Rate	$39.61
Max. Negotiated Rate	$63.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.09
Rate for Payer: Qualcare PPO/HMO/WC	$39.61

Glidewire 0.035 180cm STIF STR

Facility

$264.05

Service Code	HCPCS C1769
Hospital Charge Code	270658279N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$132.03
Rate for Payer: Aetna Commercial	$100.34
Rate for Payer: Aetna Medicare Advantage	$79.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.33
Rate for Payer: Cigna Commercial	$132.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.09
Rate for Payer: Qualcare PPO/HMO/WC	$39.61
Rate for Payer: UnitedHealthcare Community & State	$6.36
Rate for Payer: Wellpoint Medicaid Managed Care	$7.00

Glidewire 0.035 180cm STIF STR

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270658279
Hospital Revenue Code	278
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$121.12
Rate for Payer: Aetna Commercial	$92.06
Rate for Payer: Aetna Medicare Advantage	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.77
Rate for Payer: Cigna Commercial	$121.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.34
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6.42

Glidewire 0.035 180cm STIF STR

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270658279
Hospital Revenue Code	278
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.34

Glidewire 0.035 180cm STN STR

Facility

$224.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275N
Hospital Revenue Code	278
Min. Negotiated Rate	$33.64
Max. Negotiated Rate	$54.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.34
Rate for Payer: Qualcare PPO/HMO/WC	$33.64

Glidewire 0.035 180cm STN STR

Facility

$224.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275N
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.12
Rate for Payer: Aetna Commercial	$85.22
Rate for Payer: Aetna Medicare Advantage	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.18
Rate for Payer: Cigna Commercial	$112.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.34
Rate for Payer: Qualcare PPO/HMO/WC	$33.64
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

Glidewire 0.035 180cm STN STR

Facility

$258.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275
Hospital Revenue Code	278
Min. Negotiated Rate	$38.74
Max. Negotiated Rate	$62.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.74

Glidewire 0.035 180cm STN STR

Facility

$258.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275
Hospital Revenue Code	278
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$129.12
Rate for Payer: Aetna Commercial	$98.14
Rate for Payer: Aetna Medicare Advantage	$77.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.85
Rate for Payer: Cigna Commercial	$129.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.74
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

GLIDEWIRE 0.035 180CM STN STR

Facility

$258.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$129.12
Rate for Payer: Aetna Commercial	$98.14
Rate for Payer: Aetna Medicare Advantage	$77.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.85
Rate for Payer: Cigna Commercial	$129.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.74
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

GLIDEWIRE 0.035 180CM STN STR

Facility

$258.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275S
Hospital Revenue Code	278
Min. Negotiated Rate	$38.74
Max. Negotiated Rate	$62.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$38.74

Glidewire 0.035 260cm STIF STR

Facility

$281.50

Service Code	HCPCS C1769
Hospital Charge Code	270658277N
Hospital Revenue Code	278
Min. Negotiated Rate	$42.23
Max. Negotiated Rate	$68.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$42.23

Glidewire 0.035 260cm STIF STR

Facility

$281.50

Service Code	HCPCS C1769
Hospital Charge Code	270658277
Hospital Revenue Code	278
Min. Negotiated Rate	$42.23
Max. Negotiated Rate	$68.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$42.23

Glidewire 0.035 260cm STIF STR

Facility

$281.50

Service Code	HCPCS C1769
Hospital Charge Code	270658277
Hospital Revenue Code	278
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$140.75
Rate for Payer: Aetna Commercial	$106.97
Rate for Payer: Aetna Medicare Advantage	$84.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.78
Rate for Payer: Cigna Commercial	$140.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$42.23
Rate for Payer: UnitedHealthcare Community & State	$6.78
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

Glidewire 0.035 260cm STIF STR

Facility

$281.50

Service Code	HCPCS C1769
Hospital Charge Code	270658277N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$140.75
Rate for Payer: Aetna Commercial	$106.97
Rate for Payer: Aetna Medicare Advantage	$84.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.78
Rate for Payer: Cigna Commercial	$140.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$42.23
Rate for Payer: UnitedHealthcare Community & State	$6.78
Rate for Payer: Wellpoint Medicaid Managed Care	$7.46

Glidewire 0.035 260cm STN STR

Facility

$250.70

Service Code	HCPCS C1769
Hospital Charge Code	270684295
Hospital Revenue Code	278
Min. Negotiated Rate	$37.60
Max. Negotiated Rate	$60.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.15
Rate for Payer: Qualcare PPO/HMO/WC	$37.60

Glidewire 0.035 260cm STN STR

Facility

$250.70

Service Code	HCPCS C1769
Hospital Charge Code	270684295N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$125.35
Rate for Payer: Aetna Commercial	$95.27
Rate for Payer: Aetna Medicare Advantage	$75.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.93
Rate for Payer: Cigna Commercial	$125.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.15
Rate for Payer: Qualcare PPO/HMO/WC	$37.60
Rate for Payer: UnitedHealthcare Community & State	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$6.64

Know your out-of-pocket cost for care.

All Charges