Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLIDEWIRE 035 260 ANGL GR3509

Facility

$230.00

Service Code	HCPCS C1769
Hospital Charge Code	270642562C
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 035 260 STF GS3509

Facility

$1,800.00

Hospital Charge Code	270637622
Hospital Revenue Code	279
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

GLIDEWIRE 035 260 STF GS3509

Facility

$1,800.00

Hospital Charge Code	270637622
Hospital Revenue Code	279
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.00
Rate for Payer: Oxford Commercial	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$360.00
Rate for Payer: UnitedHealthcare Community & State	$43.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.70

GLIDEWIRE 035 260 STF GS3509

Facility

$281.50

Service Code	HCPCS C1769
Hospital Charge Code	270637622S
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 035 260 STF GS3509

Facility

$281.50

Service Code	HCPCS C1769
Hospital Charge Code	270637622S
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 .035 450CM SS ANGLED

Facility

$186.00

Hospital Charge Code	270654320
Hospital Revenue Code	270
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) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.80
Rate for Payer: Oxford Commercial	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Commercial	$37.20
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.93

GLIDEWIRE .035 450CM SS ANGLED

Facility

$186.00

Hospital Charge Code	270654320
Hospital Revenue Code	270
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

GLIDEWIRE .038 150CM STRAIGHT

Facility

$320.00

Service Code	HCPCS C1769
Hospital Charge Code	270658605
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 .038 150CM STRAIGHT

Facility

$320.00

Service Code	HCPCS C1769
Hospital Charge Code	270658605
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 .038 180 CM STN ANG

Facility

$224.25

Hospital Charge Code	270684296
Hospital Revenue Code	272
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) PPO	$57.18
Rate for Payer: Cigna Commercial	$112.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.28
Rate for Payer: Oxford Commercial	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$33.64
Rate for Payer: UnitedHealthcare Commercial	$44.85
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

GLIDEWIRE .038 180 CM STN ANG

Facility

$224.25

Hospital Charge Code	270684296
Hospital Revenue Code	272
Min. Negotiated Rate	$33.64
Max. Negotiated Rate	$33.64
Rate for Payer: Qualcare PPO/HMO/WC	$33.64

GLIDEWIRE .038 180 CM STN ANG

Facility

$224.25

Hospital Charge Code	270684296N
Hospital Revenue Code	272
Min. Negotiated Rate	$33.64
Max. Negotiated Rate	$33.64
Rate for Payer: Qualcare PPO/HMO/WC	$33.64

GLIDEWIRE .038 180 CM STN ANG

Facility

$224.25

Hospital Charge Code	270684296N
Hospital Revenue Code	272
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) PPO	$57.18
Rate for Payer: Cigna Commercial	$112.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.28
Rate for Payer: Oxford Commercial	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$33.64
Rate for Payer: UnitedHealthcare Commercial	$44.85
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

GLIDEWIRE .038X150CM BENTS STF

Facility

$270.00

Service Code	HCPCS C1769
Hospital Charge Code	270658529
Hospital Revenue Code	278
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$59.40
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

GLIDEWIRE .038X150CM BENTS STF

Facility

$270.00

Service Code	HCPCS C1769
Hospital Charge Code	270658529
Hospital Revenue Code	278
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$59.40
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Community & State	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

GLIDEWIRE .038X150CM DUAL FLEX

Facility

$374.66

Service Code	HCPCS C1769
Hospital Charge Code	270684750
Hospital Revenue Code	278
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$187.33
Rate for Payer: Aetna Commercial	$142.37
Rate for Payer: Aetna Medicare Advantage	$112.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.54
Rate for Payer: Cigna Commercial	$187.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.43
Rate for Payer: Qualcare PPO/HMO/WC	$56.20
Rate for Payer: UnitedHealthcare Community & State	$9.03
Rate for Payer: Wellpoint Medicaid Managed Care	$9.93

GLIDEWIRE .038X150CM DUAL FLEX

Facility

$374.66

Service Code	HCPCS C1769
Hospital Charge Code	270684750
Hospital Revenue Code	278
Min. Negotiated Rate	$56.20
Max. Negotiated Rate	$90.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.43
Rate for Payer: Qualcare PPO/HMO/WC	$56.20

GLIDEWIRE 150CM 18MM

Facility

$191.25

Hospital Charge Code	270664201
Hospital Revenue Code	270
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$95.62
Rate for Payer: Aetna Commercial	$72.67
Rate for Payer: Aetna Medicare Advantage	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.77
Rate for Payer: Cigna Commercial	$95.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.38
Rate for Payer: Oxford Commercial	$38.25
Rate for Payer: Qualcare PPO/HMO/WC	$28.69
Rate for Payer: UnitedHealthcare Commercial	$38.25
Rate for Payer: UnitedHealthcare Community & State	$4.61
Rate for Payer: Wellpoint Medicaid Managed Care	$5.07

GLIDEWIRE 150CM 18MM

Facility

$191.25

Hospital Charge Code	270664201
Hospital Revenue Code	270
Min. Negotiated Rate	$28.69
Max. Negotiated Rate	$28.69
Rate for Payer: Qualcare PPO/HMO/WC	$28.69

GLIDEWIRE ADVAN ANG .014X180MM

Facility

$1,700.00

Hospital Charge Code	270701893
Hospital Revenue Code	279
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

GLIDEWIRE ADVAN ANG .014X180MM

Facility

$1,700.00

Hospital Charge Code	270701893
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 ADVAN ANG .035X180MM

Facility

$1,265.00

Hospital Charge Code	270701894
Hospital Revenue Code	279
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$632.50
Rate for Payer: Aetna Commercial	$480.70
Rate for Payer: Aetna Medicare Advantage	$379.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$322.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$322.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$322.57
Rate for Payer: Cigna Commercial	$632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$379.50
Rate for Payer: Oxford Commercial	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$189.75
Rate for Payer: UnitedHealthcare Commercial	$253.00
Rate for Payer: UnitedHealthcare Community & State	$30.49
Rate for Payer: Wellpoint Medicaid Managed Care	$33.52

GLIDEWIRE ADVAN ANG .035X180MM

Facility

$1,265.00

Hospital Charge Code	270701894
Hospital Revenue Code	279
Min. Negotiated Rate	$189.75
Max. Negotiated Rate	$189.75
Rate for Payer: Qualcare PPO/HMO/WC	$189.75

GLIDEWIRE ADVANTAGE ANGLED

Facility

$245.00

Service Code	HCPCS C1769
Hospital Charge Code	270658283N
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$59.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.90
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

GLIDEWIRE ADVANTAGE ANGLED

Facility

$245.00

Service Code	HCPCS C1769
Hospital Charge Code	270658283N
Hospital Revenue Code	278
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.90
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Community & State	$5.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

Know your out-of-pocket cost for care.

All Charges