Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Glidewire 0.035 260cm STN STR

Facility

$250.70

Service Code	HCPCS C1769
Hospital Charge Code	270684295N
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	270684295
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

Glidewire 0.038 180cm STN ANG

Facility

$224.05

Service Code	HCPCS C1769
Hospital Charge Code	270662586
Hospital Revenue Code	278
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$54.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.29
Rate for Payer: Qualcare PPO/HMO/WC	$33.61

Glidewire 0.038 180cm STN ANG

Facility

$224.05

Service Code	HCPCS C1769
Hospital Charge Code	270662586N
Hospital Revenue Code	278
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$54.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.29
Rate for Payer: Qualcare PPO/HMO/WC	$33.61

Glidewire 0.038 180cm STN ANG

Facility

$224.05

Service Code	HCPCS C1769
Hospital Charge Code	270662586N
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.03
Rate for Payer: Aetna Commercial	$85.14
Rate for Payer: Aetna Medicare Advantage	$67.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.13
Rate for Payer: Cigna Commercial	$112.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.29
Rate for Payer: Qualcare PPO/HMO/WC	$33.61
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

Glidewire 0.038 180cm STN ANG

Facility

$224.05

Service Code	HCPCS C1769
Hospital Charge Code	270662586
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$112.03
Rate for Payer: Aetna Commercial	$85.14
Rate for Payer: Aetna Medicare Advantage	$67.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.13
Rate for Payer: Cigna Commercial	$112.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.29
Rate for Payer: Qualcare PPO/HMO/WC	$33.61
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

GLIDEWIRE .016 180cm GT D/ANGL

Facility

$1,545.00

Hospital Charge Code	270683666
Hospital Revenue Code	272
Min. Negotiated Rate	$231.75
Max. Negotiated Rate	$231.75
Rate for Payer: Qualcare PPO/HMO/WC	$231.75

GLIDEWIRE .016 180cm GT D/ANGL

Facility

$1,545.00

Hospital Charge Code	270683666
Hospital Revenue Code	272
Min. Negotiated Rate	$37.23
Max. Negotiated Rate	$772.50
Rate for Payer: Aetna Commercial	$587.10
Rate for Payer: Aetna Medicare Advantage	$463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.98
Rate for Payer: Cigna Commercial	$772.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.50
Rate for Payer: Oxford Commercial	$309.00
Rate for Payer: Qualcare PPO/HMO/WC	$231.75
Rate for Payer: UnitedHealthcare Commercial	$309.00
Rate for Payer: UnitedHealthcare Community & State	$37.23
Rate for Payer: Wellpoint Medicaid Managed Care	$40.94

GLIDEWIRE .018 180cm GT D/ANGL

Facility

$996.40

Hospital Charge Code	270638426C
Hospital Revenue Code	278
Min. Negotiated Rate	$24.01
Max. Negotiated Rate	$498.20
Rate for Payer: Aetna Commercial	$378.63
Rate for Payer: Aetna Medicare Advantage	$298.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.08
Rate for Payer: Cigna Commercial	$498.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$219.21
Rate for Payer: Qualcare PPO/HMO/WC	$149.46
Rate for Payer: UnitedHealthcare Community & State	$24.01
Rate for Payer: Wellpoint Medicaid Managed Care	$26.40

GLIDEWIRE .018 180cm GT D/ANGL

Facility

$996.40

Hospital Charge Code	270638426C
Hospital Revenue Code	278
Min. Negotiated Rate	$149.46
Max. Negotiated Rate	$241.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$219.21
Rate for Payer: Qualcare PPO/HMO/WC	$149.46

GLIDEWIRE .025 150cm SV STR

Facility

$219.58

Service Code	HCPCS C1769
Hospital Charge Code	270601258
Hospital Revenue Code	278
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$53.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.31
Rate for Payer: Qualcare PPO/HMO/WC	$32.94

GLIDEWIRE .025 150cm SV STR

Facility

$219.58

Service Code	HCPCS C1769
Hospital Charge Code	270601258
Hospital Revenue Code	278
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$109.79
Rate for Payer: Aetna Commercial	$83.44
Rate for Payer: Aetna Medicare Advantage	$65.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.99
Rate for Payer: Cigna Commercial	$109.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.31
Rate for Payer: Qualcare PPO/HMO/WC	$32.94
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: Wellpoint Medicaid Managed Care	$5.82

GLIDEWIRE .025 450CM ANGLD

Facility

$186.00

Hospital Charge Code	270654329
Hospital Revenue Code	278
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

GLIDEWIRE .025 450CM ANGLD

Facility

$186.00

Hospital Charge Code	270654329
Hospital Revenue Code	278
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

GLIDEWIRE .035 150CM ANGL STF

Facility

$320.00

Service Code	HCPCS C1769
Hospital Charge Code	270655439
Hospital Revenue Code	278
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$160.00
Rate for Payer: Aetna Commercial	$121.60
Rate for Payer: Aetna Medicare Advantage	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.60
Rate for Payer: Cigna Commercial	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.40
Rate for Payer: Qualcare PPO/HMO/WC	$48.00
Rate for Payer: UnitedHealthcare Community & State	$7.71
Rate for Payer: Wellpoint Medicaid Managed Care	$8.48

GLIDEWIRE .035 150CM ANGL STF

Facility

$320.00

Service Code	HCPCS C1769
Hospital Charge Code	270655439
Hospital Revenue Code	278
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.40
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

GLIDEWIRE .035 150CM STRAIGHT

Facility

$229.99

Service Code	HCPCS C1769
Hospital Charge Code	270655401
Hospital Revenue Code	278
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$55.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

GLIDEWIRE .035 150CM STRAIGHT

Facility

$229.99

Service Code	HCPCS C1769
Hospital Charge Code	270655401
Hospital Revenue Code	278
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare Advantage	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.65
Rate for Payer: Cigna Commercial	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$34.50
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

GLIDEWIRE 035 180 ANGL GR3508

Facility

$205.75

Service Code	HCPCS C1769
Hospital Charge Code	270638087S
Hospital Revenue Code	278
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$102.88
Rate for Payer: Aetna Commercial	$78.19
Rate for Payer: Aetna Medicare Advantage	$61.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.47
Rate for Payer: Cigna Commercial	$102.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.27
Rate for Payer: Qualcare PPO/HMO/WC	$30.86
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

GLIDEWIRE 035 180 ANGL GR3508

Facility

$1,450.00

Hospital Charge Code	270638087
Hospital Revenue Code	278
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$319.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

GLIDEWIRE 035 180 ANGL GR3508

Facility

$205.75

Service Code	HCPCS C1769
Hospital Charge Code	270638087S
Hospital Revenue Code	278
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.27
Rate for Payer: Qualcare PPO/HMO/WC	$30.86

GLIDEWIRE 035 180 ANGL GR3508

Facility

$1,450.00

Hospital Charge Code	270638087
Hospital Revenue Code	278
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$350.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$319.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

GLIDEWIRE 035 180 ANGL GR3508

Facility

$1,219.00

Service Code	HCPCS C1769
Hospital Charge Code	270638087N
Hospital Revenue Code	278
Min. Negotiated Rate	$182.85
Max. Negotiated Rate	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$268.18
Rate for Payer: Qualcare PPO/HMO/WC	$182.85

GLIDEWIRE 035 180 ANGL GR3508

Facility

$1,219.00

Service Code	HCPCS C1769
Hospital Charge Code	270638087N
Hospital Revenue Code	278
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$609.50
Rate for Payer: Aetna Commercial	$463.22
Rate for Payer: Aetna Medicare Advantage	$365.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.85
Rate for Payer: Cigna Commercial	$609.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$268.18
Rate for Payer: Qualcare PPO/HMO/WC	$182.85
Rate for Payer: UnitedHealthcare Community & State	$29.38
Rate for Payer: Wellpoint Medicaid Managed Care	$32.30

GLIDEWIRE 035 260 ANGL GR3509

Facility

$230.00

Service Code	HCPCS C1769
Hospital Charge Code	270642562C
Hospital Revenue Code	278
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$55.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.60
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

Know your out-of-pocket cost for care.

All Charges