Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE 3.2 THREADED 409595

Facility

$400.00

Hospital Charge Code	270637571
Hospital Revenue Code	272
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

GUIDEWIRE 3.2 THREADED 409595

Facility

$400.00

Hospital Charge Code	270637571
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

GUIDE WIRE 3.2X230MM SINGLE

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	270673600
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

GUIDE WIRE 3.2X230MM SINGLE

Facility

$190.00

Service Code	HCPCS C1769
Hospital Charge Code	270662003
Hospital Revenue Code	278
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$45.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

GUIDE WIRE 3.2X230MM SINGLE

Facility

$190.00

Service Code	HCPCS C1769
Hospital Charge Code	270662003
Hospital Revenue Code	278
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$72.20
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

GUIDE WIRE 3.2X230MM SINGLE

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	270673600
Hospital Revenue Code	278
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

GUIDEWIRE 3.2x400MM

Facility

$1,270.00

Service Code	HCPCS C1769
Hospital Charge Code	270633464
Hospital Revenue Code	278
Min. Negotiated Rate	$190.50
Max. Negotiated Rate	$307.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$279.40
Rate for Payer: Qualcare PPO/HMO/WC	$190.50

GUIDEWIRE 3.2x400MM

Facility

$578.45

Service Code	HCPCS C1769
Hospital Charge Code	270660158
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 3.2x400MM

Facility

$1,270.00

Service Code	HCPCS C1769
Hospital Charge Code	270633464
Hospital Revenue Code	278
Min. Negotiated Rate	$30.61
Max. Negotiated Rate	$635.00
Rate for Payer: Aetna Commercial	$482.60
Rate for Payer: Aetna Medicare Advantage	$381.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$323.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$323.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$323.85
Rate for Payer: Cigna Commercial	$635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$279.40
Rate for Payer: Qualcare PPO/HMO/WC	$190.50
Rate for Payer: UnitedHealthcare Community & State	$30.61
Rate for Payer: Wellpoint Medicaid Managed Care	$33.66

GUIDEWIRE 3.2x400MM

Facility

$578.45

Service Code	HCPCS C1769
Hospital Charge Code	270660158
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 3.2X400MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693266
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 3.2X400MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693266
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

GUIDEWIRE .38 3MMJ 150CM

Facility

$35.00

Hospital Charge Code	270646432
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

GUIDEWIRE .38 3MMJ 150CM

Facility

$35.00

Hospital Charge Code	270646432
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.50
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

GUIDEWIRE 3MM J .035/150CM

Facility

$32.50

Hospital Charge Code	2709000373
Hospital Revenue Code	272
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) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Commercial	$6.50
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

GUIDEWIRE 3MM J .035/150CM

Facility

$32.50

Hospital Charge Code	2709000373
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

GUIDE WIRE 3x800 1806-0080S

Facility

$935.00

Hospital Charge Code	270638646
Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$140.25
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

GUIDE WIRE 3x800 1806-0080S

Facility

$935.00

Hospital Charge Code	270638646
Hospital Revenue Code	272
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.50
Rate for Payer: Oxford Commercial	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Commercial	$187.00
Rate for Payer: UnitedHealthcare Community & State	$22.53
Rate for Payer: Wellpoint Medicaid Managed Care	$24.78

GUIDEWIRE .86MM LASER LINE

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270689954
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 .86MM LASER LINE

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270689954
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 .86MM W/LASER LINE

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270662158
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 .86MM W/LASER LINE

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270662158
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 .8MM

Facility

$4,240.00

Service Code	HCPCS C1713
Hospital Charge Code	270700824
Hospital Revenue Code	278
Min. Negotiated Rate	$102.18
Max. Negotiated Rate	$2,120.00
Rate for Payer: Aetna Commercial	$1,611.20
Rate for Payer: Aetna Medicare Advantage	$1,272.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,081.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,081.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,081.20
Rate for Payer: Cigna Commercial	$2,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$932.80
Rate for Payer: Qualcare PPO/HMO/WC	$636.00
Rate for Payer: UnitedHealthcare Community & State	$102.18
Rate for Payer: Wellpoint Medicaid Managed Care	$112.36

GUIDEWIRE .8MM

Facility

$4,240.00

Service Code	HCPCS C1713
Hospital Charge Code	270700824
Hospital Revenue Code	278
Min. Negotiated Rate	$636.00
Max. Negotiated Rate	$1,026.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$932.80
Rate for Payer: Qualcare PPO/HMO/WC	$636.00

GUIDEWIRE.8MM 100MMLEN TRO TIP

Facility

$280.80

Service Code	HCPCS C1713
Hospital Charge Code	270691909
Hospital Revenue Code	278
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Commercial	$106.70
Rate for Payer: Aetna Medicare Advantage	$84.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.60
Rate for Payer: Cigna Commercial	$140.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.78
Rate for Payer: Qualcare PPO/HMO/WC	$42.12
Rate for Payer: UnitedHealthcare Community & State	$6.77
Rate for Payer: Wellpoint Medicaid Managed Care	$7.44

Know your out-of-pocket cost for care.

All Charges