Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE .025 J TIP FIXEDCORE

Facility

$32.50

Service Code	HCPCS C1769
Hospital Charge Code	270657705
Hospital Revenue Code	278
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$12.35
Rate for Payer: Aetna Medicare Advantage	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7.15
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

GUIDEWIRE .025 J TIP FIXEDCORE

Facility

$6.50

Service Code	HCPCS C1769
Hospital Charge Code	270657705N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

GUIDEWIRE .025 J TIP FIXEDCORE

Facility

$32.50

Service Code	HCPCS C1769
Hospital Charge Code	270657705
Hospital Revenue Code	278
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$7.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7.15
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

GUIDE WIRE .025x150 ANGLED

Facility

$209.00

Hospital Charge Code	270650900
Hospital Revenue Code	272
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$31.35
Rate for Payer: Qualcare PPO/HMO/WC	$31.35

GUIDE WIRE .025x150 ANGLED

Facility

$209.00

Hospital Charge Code	270650900
Hospital Revenue Code	272
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$104.50
Rate for Payer: Aetna Commercial	$79.42
Rate for Payer: Aetna Medicare Advantage	$62.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.30
Rate for Payer: Cigna Commercial	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.70
Rate for Payer: Oxford Commercial	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.35
Rate for Payer: UnitedHealthcare Commercial	$41.80
Rate for Payer: UnitedHealthcare Community & State	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

GUIDEWIRE 028x125 230281

Facility

$50.00

Hospital Charge Code	270631392
Hospital Revenue Code	272
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

GUIDEWIRE 028x125 230281

Facility

$50.00

Hospital Charge Code	270631392
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

GUIDEWIRE .035 145cm

Facility

$51.50

Hospital Charge Code	270626851
Hospital Revenue Code	270
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$7.72

GUIDEWIRE .035 145cm

Facility

$51.50

Hospital Charge Code	270626851
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.75
Rate for Payer: Aetna Commercial	$19.57
Rate for Payer: Aetna Medicare Advantage	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.13
Rate for Payer: Cigna Commercial	$25.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.45
Rate for Payer: Oxford Commercial	$10.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.72
Rate for Payer: UnitedHealthcare Commercial	$10.30
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

GUIDEWIRE 0.35 260cm

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270645893
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

GUIDEWIRE 0.35 260cm

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270645893
Hospital Revenue Code	278
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

GUIDEWIRE.035 260cm 3mm EXCH J

Facility

$318.75

Hospital Charge Code	270616019
Hospital Revenue Code	279
Min. Negotiated Rate	$47.81
Max. Negotiated Rate	$47.81
Rate for Payer: Qualcare PPO/HMO/WC	$47.81

GUIDEWIRE.035 260cm 3mm EXCH J

Facility

$318.75

Hospital Charge Code	270616019
Hospital Revenue Code	279
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$159.38
Rate for Payer: Aetna Commercial	$121.12
Rate for Payer: Aetna Medicare Advantage	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.28
Rate for Payer: Cigna Commercial	$159.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.62
Rate for Payer: Oxford Commercial	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$47.81
Rate for Payer: UnitedHealthcare Commercial	$63.75
Rate for Payer: UnitedHealthcare Community & State	$7.68
Rate for Payer: Wellpoint Medicaid Managed Care	$8.45

GUIDEWIRE .035 260CM ANGL

Facility

$1,612.50

Hospital Charge Code	270642562
Hospital Revenue Code	278
Min. Negotiated Rate	$241.88
Max. Negotiated Rate	$390.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.75
Rate for Payer: Qualcare PPO/HMO/WC	$241.88

GUIDEWIRE .035 260CM ANGL

Facility

$230.00

Service Code	HCPCS C1769
Hospital Charge Code	270642562S
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

GUIDEWIRE .035 260CM ANGL

Facility

$230.00

Service Code	HCPCS C1769
Hospital Charge Code	270642562S
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

GUIDEWIRE .035 260CM ANGL

Facility

$1,612.50

Hospital Charge Code	270642562
Hospital Revenue Code	278
Min. Negotiated Rate	$38.86
Max. Negotiated Rate	$806.25
Rate for Payer: Aetna Commercial	$612.75
Rate for Payer: Aetna Medicare Advantage	$483.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.19
Rate for Payer: Cigna Commercial	$806.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.75
Rate for Payer: Qualcare PPO/HMO/WC	$241.88
Rate for Payer: UnitedHealthcare Community & State	$38.86
Rate for Payer: Wellpoint Medicaid Managed Care	$42.73

GUIDEWIRE .035 DUAL FLEX STR

Facility

$374.66

Service Code	HCPCS C1769
Hospital Charge Code	270625399
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

GUIDEWIRE .035 DUAL FLEX STR

Facility

$374.66

Service Code	HCPCS C1769
Hospital Charge Code	270625399
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

GUIDEWIRE .035 J TIP FIXED

Facility

$55.75

Hospital Charge Code	270657662
Hospital Revenue Code	278
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$13.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.27
Rate for Payer: Qualcare PPO/HMO/WC	$8.36

GUIDEWIRE .035 J TIP FIXED

Facility

$55.75

Hospital Charge Code	270657662
Hospital Revenue Code	278
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$27.88
Rate for Payer: Aetna Commercial	$21.18
Rate for Payer: Aetna Medicare Advantage	$16.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.22
Rate for Payer: Cigna Commercial	$27.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.27
Rate for Payer: Qualcare PPO/HMO/WC	$8.36
Rate for Payer: UnitedHealthcare Community & State	$1.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

GUIDEWIRE .035 MM

Facility

$95.00

Service Code	HCPCS C1769
Hospital Charge Code	270682455
Hospital Revenue Code	278
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$22.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.90
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

GUIDEWIRE .035 MM

Facility

$95.00

Service Code	HCPCS C1769
Hospital Charge Code	270682455
Hospital Revenue Code	278
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.90
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

GUIDEWIRE .035x150CM

Facility

$300.00

Service Code	HCPCS C1769
Hospital Charge Code	270676578
Hospital Revenue Code	278
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

GUIDEWIRE .035x150CM

Facility

$300.00

Service Code	HCPCS C1769
Hospital Charge Code	270676578N
Hospital Revenue Code	278
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) NJ Health	$60.00
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	$72.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

Know your out-of-pocket cost for care.

All Charges