Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE 22.MM X 28IN

Facility

$600.00

Service Code	HCPCS C1769
Hospital Charge Code	270685087
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

GUIDEWIRE 2.3X200MM

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270659330
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GUIDEWIRE 2.3X200MM

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270659330
Hospital Revenue Code	278
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

GUIDEWIRE 2 4X70 BUTIP 2255008

Facility

$460.00

Hospital Charge Code	270638046
Hospital Revenue Code	272
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$174.80
Rate for Payer: Aetna Medicare Advantage	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.30
Rate for Payer: Cigna Commercial	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.00
Rate for Payer: Oxford Commercial	$92.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Commercial	$92.00
Rate for Payer: UnitedHealthcare Community & State	$11.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.19

GUIDEWIRE 2 4X70 BUTIP 2255008

Facility

$460.00

Hospital Charge Code	270638046
Hospital Revenue Code	272
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

GUIDEWIRE 2.8

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270690801
Hospital Revenue Code	278
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

GUIDEWIRE 2.8

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270690801
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

GUIDE WIRE 2.8MM X 300MM

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270680279
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

GUIDE WIRE 2.8MM X 300MM

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270680279
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

GUIDEWIRE 2.8X220MM

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270695400
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

GUIDEWIRE 2.8X220MM

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270695400
Hospital Revenue Code	278
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$72.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.16

GUIDEWIRE 2.8x450 THRD 900726

Facility

$275.00

Hospital Charge Code	270632483
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

GUIDEWIRE 2.8x450 THRD 900726

Facility

$275.00

Hospital Charge Code	270632483
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

GUIDEWIRE 2X200mm

Facility

$700.00

Service Code	HCPCS C1769
Hospital Charge Code	270681218
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

GUIDEWIRE 2X200mm

Facility

$700.00

Service Code	HCPCS C1769
Hospital Charge Code	270681218
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

GUIDE WIRE 3.0X100 47225500801

Facility

$700.00

Hospital Charge Code	270634681
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

GUIDE WIRE 3.0X100 47225500801

Facility

$700.00

Hospital Charge Code	270634681
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

GUIDE WIRE 3.2

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270687656
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

GUIDE WIRE 3.2

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270687656
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

GUIDE WIRE 3.2MM

Facility

$578.45

Hospital Charge Code	270659946
Hospital Revenue Code	278
Min. Negotiated Rate	$86.77
Max. Negotiated Rate	$139.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.26
Rate for Payer: Qualcare PPO/HMO/WC	$86.77

GUIDE WIRE 3.2MM

Facility

$578.45

Hospital Charge Code	270659946
Hospital Revenue Code	278
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$289.23
Rate for Payer: Aetna Commercial	$219.81
Rate for Payer: Aetna Medicare Advantage	$173.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.50
Rate for Payer: Cigna Commercial	$289.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.26
Rate for Payer: Qualcare PPO/HMO/WC	$86.77
Rate for Payer: UnitedHealthcare Community & State	$13.94
Rate for Payer: Wellpoint Medicaid Managed Care	$15.33

GUIDEWIRE 3.2MM

Facility

$1,031.25

Service Code	HCPCS C1769
Hospital Charge Code	270696027
Hospital Revenue Code	278
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$515.62
Rate for Payer: Aetna Commercial	$391.88
Rate for Payer: Aetna Medicare Advantage	$309.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.97
Rate for Payer: Cigna Commercial	$515.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.88
Rate for Payer: Qualcare PPO/HMO/WC	$154.69
Rate for Payer: UnitedHealthcare Community & State	$24.85
Rate for Payer: Wellpoint Medicaid Managed Care	$27.33

GUIDEWIRE 3.2MM

Facility

$1,031.25

Service Code	HCPCS C1769
Hospital Charge Code	270696027
Hospital Revenue Code	278
Min. Negotiated Rate	$154.69
Max. Negotiated Rate	$249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.88
Rate for Payer: Qualcare PPO/HMO/WC	$154.69

GUIDE WIRE 3.2mm X290MM

Facility

$413.75

Service Code	HCPCS C1769
Hospital Charge Code	270675117
Hospital Revenue Code	278
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$206.88
Rate for Payer: Aetna Commercial	$157.22
Rate for Payer: Aetna Medicare Advantage	$124.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.51
Rate for Payer: Cigna Commercial	$206.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.03
Rate for Payer: Qualcare PPO/HMO/WC	$62.06
Rate for Payer: UnitedHealthcare Community & State	$9.97
Rate for Payer: Wellpoint Medicaid Managed Care	$10.96

GUIDE WIRE 3.2mm X290MM

Facility

$413.75

Service Code	HCPCS C1769
Hospital Charge Code	270675117
Hospital Revenue Code	278
Min. Negotiated Rate	$62.06
Max. Negotiated Rate	$100.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.03
Rate for Payer: Qualcare PPO/HMO/WC	$62.06

Know your out-of-pocket cost for care.

All Charges