Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GLIDEWIRE ADVANTAGE ANGLED

Facility

$1,150.00

Service Code	HCPCS C1769
Hospital Charge Code	270658283S
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

GLIDEWIRE ADVANTAGE ANGLED

Facility

$1,150.00

Service Code	HCPCS C1769
Hospital Charge Code	270658283S
Hospital Revenue Code	278
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$253.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

GLIDEWIRE ADVANT ANG .035X260

Facility

$1,407.50

Service Code	HCPCS C1769
Hospital Charge Code	270658283
Hospital Revenue Code	279
Min. Negotiated Rate	$33.92
Max. Negotiated Rate	$703.75
Rate for Payer: Aetna Commercial	$534.85
Rate for Payer: Aetna Medicare Advantage	$422.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.91
Rate for Payer: Cigna Commercial	$703.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$422.25
Rate for Payer: Oxford Commercial	$281.50
Rate for Payer: Qualcare PPO/HMO/WC	$211.12
Rate for Payer: UnitedHealthcare Commercial	$281.50
Rate for Payer: UnitedHealthcare Community & State	$33.92
Rate for Payer: Wellpoint Medicaid Managed Care	$37.30

GLIDEWIRE ADVANT ANG .035X260

Facility

$1,407.50

Service Code	HCPCS C1769
Hospital Charge Code	270658283
Hospital Revenue Code	279
Min. Negotiated Rate	$211.12
Max. Negotiated Rate	$211.12
Rate for Payer: Qualcare PPO/HMO/WC	$211.12

GLIDEWIRE ANGLE .038

Facility

$109.79

Hospital Charge Code	270655411
Hospital Revenue Code	278
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$54.90
Rate for Payer: Aetna Commercial	$41.72
Rate for Payer: Aetna Medicare Advantage	$32.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.00
Rate for Payer: Cigna Commercial	$54.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$16.47
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

GLIDEWIRE ANGLE .038

Facility

$109.79

Hospital Charge Code	270655411
Hospital Revenue Code	278
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$16.47

GLIDEWIRE ANGLED 0.025 X 260CM

Facility

$1,625.00

Hospital Charge Code	270666812
Hospital Revenue Code	270
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$325.00
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

GLIDEWIRE ANGLED 0.025 X 260CM

Facility

$1,625.00

Hospital Charge Code	270666812
Hospital Revenue Code	270
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

GLIDEWIRE ANGLED 0.035X260CM

Facility

$300.00

Hospital Charge Code	270666808
Hospital Revenue Code	270
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

GLIDEWIRE ANGLED 0.035X260CM

Facility

$300.00

Hospital Charge Code	270666808
Hospital Revenue Code	270
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

GLIDEWIRE ANGLED .035

Facility

$320.85

Hospital Charge Code	270601267
Hospital Revenue Code	272
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$48.13
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

GLIDEWIRE ANGLED .035

Facility

$320.85

Hospital Charge Code	270601267
Hospital Revenue Code	272
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$160.43
Rate for Payer: Aetna Commercial	$121.92
Rate for Payer: Aetna Medicare Advantage	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.82
Rate for Payer: Cigna Commercial	$160.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.25
Rate for Payer: Oxford Commercial	$64.17
Rate for Payer: Qualcare PPO/HMO/WC	$48.13
Rate for Payer: UnitedHealthcare Commercial	$64.17
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$8.50

GLIDEWIRE ANGLED .035 150CM

Facility

$1,665.65

Hospital Charge Code	270605415C
Hospital Revenue Code	278
Min. Negotiated Rate	$40.14
Max. Negotiated Rate	$832.83
Rate for Payer: Aetna Commercial	$632.95
Rate for Payer: Aetna Medicare Advantage	$499.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$424.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$424.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$333.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$424.74
Rate for Payer: Cigna Commercial	$832.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$366.44
Rate for Payer: Qualcare PPO/HMO/WC	$249.85
Rate for Payer: UnitedHealthcare Community & State	$40.14
Rate for Payer: Wellpoint Medicaid Managed Care	$44.14

GLIDEWIRE ANGLED .035 150CM

Facility

$1,665.65

Hospital Charge Code	270605415C
Hospital Revenue Code	278
Min. Negotiated Rate	$249.85
Max. Negotiated Rate	$403.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$333.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$366.44
Rate for Payer: Qualcare PPO/HMO/WC	$249.85

GLIDEWIRE ANGLE TIP .035X

Facility

$753.00

Hospital Charge Code	270330564
Hospital Revenue Code	278
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$376.50
Rate for Payer: Aetna Commercial	$286.14
Rate for Payer: Aetna Medicare Advantage	$225.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.01
Rate for Payer: Cigna Commercial	$376.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.66
Rate for Payer: Qualcare PPO/HMO/WC	$112.95
Rate for Payer: UnitedHealthcare Community & State	$18.15
Rate for Payer: Wellpoint Medicaid Managed Care	$19.95

GLIDEWIRE ANGLE TIP .035X

Facility

$753.00

Hospital Charge Code	270330564
Hospital Revenue Code	278
Min. Negotiated Rate	$112.95
Max. Negotiated Rate	$182.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.66
Rate for Payer: Qualcare PPO/HMO/WC	$112.95

GLIDEWIRE GM 45 DEG 300CM

Facility

$956.25

Service Code	HCPCS C1769
Hospital Charge Code	270663285
Hospital Revenue Code	278
Min. Negotiated Rate	$143.44
Max. Negotiated Rate	$231.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.38
Rate for Payer: Qualcare PPO/HMO/WC	$143.44

GLIDEWIRE GM 45 DEG 300CM

Facility

$956.25

Service Code	HCPCS C1769
Hospital Charge Code	270663285
Hospital Revenue Code	278
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$478.12
Rate for Payer: Aetna Commercial	$363.38
Rate for Payer: Aetna Medicare Advantage	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.84
Rate for Payer: Cigna Commercial	$478.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.38
Rate for Payer: Qualcare PPO/HMO/WC	$143.44
Rate for Payer: UnitedHealthcare Community & State	$23.05
Rate for Payer: Wellpoint Medicaid Managed Care	$25.34

GLIDEWIRE GM 45 DEG 300CM

Facility

$956.25

Service Code	HCPCS C1769
Hospital Charge Code	270663285S
Hospital Revenue Code	278
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$478.12
Rate for Payer: Aetna Commercial	$363.38
Rate for Payer: Aetna Medicare Advantage	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.84
Rate for Payer: Cigna Commercial	$478.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.38
Rate for Payer: Qualcare PPO/HMO/WC	$143.44
Rate for Payer: UnitedHealthcare Community & State	$23.05
Rate for Payer: Wellpoint Medicaid Managed Care	$25.34

GLIDEWIRE GM 45 DEG 300CM

Facility

$956.25

Service Code	HCPCS C1769
Hospital Charge Code	270663285S
Hospital Revenue Code	278
Min. Negotiated Rate	$143.44
Max. Negotiated Rate	$231.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.38
Rate for Payer: Qualcare PPO/HMO/WC	$143.44

GLIDEWIRE GM 45 DEG 300CM

Facility

$1,125.00

Service Code	HCPCS C1769
Hospital Charge Code	270663285N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

GLIDEWIRE GM 45 DEG 300CM

Facility

$1,125.00

Service Code	HCPCS C1769
Hospital Charge Code	270663285N
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

GLIDEWIRE GM 45 GED 180CM

Facility

$662.50

Service Code	HCPCS C1769
Hospital Charge Code	270663283S
Hospital Revenue Code	278
Min. Negotiated Rate	$99.38
Max. Negotiated Rate	$160.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.75
Rate for Payer: Qualcare PPO/HMO/WC	$99.38

GLIDEWIRE GM 45 GED 180CM

Facility

$895.00

Service Code	HCPCS C1769
Hospital Charge Code	270663283N
Hospital Revenue Code	278
Min. Negotiated Rate	$21.57
Max. Negotiated Rate	$447.50
Rate for Payer: Aetna Commercial	$340.10
Rate for Payer: Aetna Medicare Advantage	$268.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$228.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$228.22
Rate for Payer: Cigna Commercial	$447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.90
Rate for Payer: Qualcare PPO/HMO/WC	$134.25
Rate for Payer: UnitedHealthcare Community & State	$21.57
Rate for Payer: Wellpoint Medicaid Managed Care	$23.72

GLIDEWIRE GM 45 GED 180CM

Facility

$895.00

Service Code	HCPCS C1769
Hospital Charge Code	270663283N
Hospital Revenue Code	278
Min. Negotiated Rate	$134.25
Max. Negotiated Rate	$216.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$179.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.90
Rate for Payer: Qualcare PPO/HMO/WC	$134.25

Know your out-of-pocket cost for care.

All Charges