Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE.8MM 100MMLEN TRO TIP

Facility

$280.80

Service Code	HCPCS C1713
Hospital Charge Code	270691909
Hospital Revenue Code	278
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$67.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.16
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

GUIDEWIRE ACCESS KIT 5F 10CM

Facility

$250.00

Service Code	HCPCS C1769
Hospital Charge Code	270697737S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

GUIDEWIRE ACCESS KIT 5F 10CM

Facility

$250.00

Service Code	HCPCS C1769
Hospital Charge Code	270697737S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

GUIDEWIRE AD JTIP 3MM 5500601

Facility

$52.85

Hospital Charge Code	270623761
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.43
Rate for Payer: Aetna Commercial	$20.08
Rate for Payer: Aetna Medicare Advantage	$15.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.48
Rate for Payer: Cigna Commercial	$26.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.86
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.93
Rate for Payer: UnitedHealthcare Commercial	$10.57
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

GUIDEWIRE AD JTIP 3MM 5500601

Facility

$52.85

Hospital Charge Code	270623761
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.93

GUIDEWIRE ADVANT .018 X 180CM

Facility

$1,662.50

Hospital Charge Code	270665131
Hospital Revenue Code	279
Min. Negotiated Rate	$249.38
Max. Negotiated Rate	$249.38
Rate for Payer: Qualcare PPO/HMO/WC	$249.38

GUIDEWIRE ADVANT .018 X 180CM

Facility

$1,662.50

Hospital Charge Code	270665131
Hospital Revenue Code	279
Min. Negotiated Rate	$40.07
Max. Negotiated Rate	$831.25
Rate for Payer: Aetna Commercial	$631.75
Rate for Payer: Aetna Medicare Advantage	$498.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.94
Rate for Payer: Cigna Commercial	$831.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$498.75
Rate for Payer: Oxford Commercial	$332.50
Rate for Payer: Qualcare PPO/HMO/WC	$249.38
Rate for Payer: UnitedHealthcare Commercial	$332.50
Rate for Payer: UnitedHealthcare Community & State	$40.07
Rate for Payer: Wellpoint Medicaid Managed Care	$44.06

GUIDEWIRE ADVANTAGE .018 X 18

Facility

$1,100.00

Service Code	HCPCS C1769
Hospital Charge Code	270665131N
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$266.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

GUIDEWIRE ADVANTAGE .018 X 18

Facility

$1,100.00

Service Code	HCPCS C1769
Hospital Charge Code	270665131N
Hospital Revenue Code	278
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

GUIDEWIRE ADVANTAGE .018 X 18

Facility

$1,380.00

Service Code	HCPCS C1769
Hospital Charge Code	270665131S
Hospital Revenue Code	278
Min. Negotiated Rate	$33.26
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$524.40
Rate for Payer: Aetna Medicare Advantage	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.90
Rate for Payer: Cigna Commercial	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$303.60
Rate for Payer: Qualcare PPO/HMO/WC	$207.00
Rate for Payer: UnitedHealthcare Community & State	$33.26
Rate for Payer: Wellpoint Medicaid Managed Care	$36.57

GUIDEWIRE ADVANTAGE .018 X 18

Facility

$1,380.00

Service Code	HCPCS C1769
Hospital Charge Code	270665131S
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$303.60
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

GUIDEWIRE ADVANTAGE .018 X 300

Facility

$1,810.00

Service Code	HCPCS C1769
Hospital Charge Code	270665130
Hospital Revenue Code	279
Min. Negotiated Rate	$271.50
Max. Negotiated Rate	$271.50
Rate for Payer: Qualcare PPO/HMO/WC	$271.50

GUIDEWIRE ADVANTAGE .018 X 300

Facility

$1,810.00

Service Code	HCPCS C1769
Hospital Charge Code	270665130
Hospital Revenue Code	279
Min. Negotiated Rate	$43.62
Max. Negotiated Rate	$905.00
Rate for Payer: Aetna Commercial	$687.80
Rate for Payer: Aetna Medicare Advantage	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.55
Rate for Payer: Cigna Commercial	$905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.00
Rate for Payer: Oxford Commercial	$362.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.50
Rate for Payer: UnitedHealthcare Commercial	$362.00
Rate for Payer: UnitedHealthcare Community & State	$43.62
Rate for Payer: Wellpoint Medicaid Managed Care	$47.97

GUIDEWIRE ADVANTAGE .018 X 300

Facility

$1,200.00

Service Code	HCPCS C1769
Hospital Charge Code	270665130N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

GUIDEWIRE ADVANTAGE .018 X 300

Facility

$1,200.00

Service Code	HCPCS C1769
Hospital Charge Code	270665130N
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

GUIDEWIRE AG .038 150 05500801

Facility

$66.45

Hospital Charge Code	270626419
Hospital Revenue Code	272
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.97

GUIDEWIRE AG .038 150 05500801

Facility

$66.45

Hospital Charge Code	270626419
Hospital Revenue Code	272
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.23
Rate for Payer: Aetna Commercial	$25.25
Rate for Payer: Aetna Medicare Advantage	$19.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.94
Rate for Payer: Cigna Commercial	$33.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.93
Rate for Payer: Oxford Commercial	$13.29
Rate for Payer: Qualcare PPO/HMO/WC	$9.97
Rate for Payer: UnitedHealthcare Commercial	$13.29
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

GUIDEWIRE AIMING ANT POST ORIN

Facility

$4,557.80

Service Code	HCPCS C1769
Hospital Charge Code	270691501
Hospital Revenue Code	278
Min. Negotiated Rate	$109.84
Max. Negotiated Rate	$2,278.90
Rate for Payer: Aetna Commercial	$1,731.96
Rate for Payer: Aetna Medicare Advantage	$1,367.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,162.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,162.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$911.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,162.24
Rate for Payer: Cigna Commercial	$2,278.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,102.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,002.72
Rate for Payer: Qualcare PPO/HMO/WC	$683.67
Rate for Payer: UnitedHealthcare Community & State	$109.84
Rate for Payer: Wellpoint Medicaid Managed Care	$120.78

GUIDEWIRE AIMING ANT POST ORIN

Facility

$4,557.80

Service Code	HCPCS C1769
Hospital Charge Code	270691501
Hospital Revenue Code	278
Min. Negotiated Rate	$683.67
Max. Negotiated Rate	$1,102.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$911.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,102.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,002.72
Rate for Payer: Qualcare PPO/HMO/WC	$683.67

GUIDEWIRE AIMING DEVICE OFFSE

Facility

$1,924.30

Service Code	HCPCS C1769
Hospital Charge Code	270691502
Hospital Revenue Code	278
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$962.15
Rate for Payer: Aetna Commercial	$731.23
Rate for Payer: Aetna Medicare Advantage	$577.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$384.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.70
Rate for Payer: Cigna Commercial	$962.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$423.35
Rate for Payer: Qualcare PPO/HMO/WC	$288.64
Rate for Payer: UnitedHealthcare Community & State	$46.38
Rate for Payer: Wellpoint Medicaid Managed Care	$50.99

GUIDEWIRE AIMING DEVICE OFFSE

Facility

$1,924.30

Service Code	HCPCS C1769
Hospital Charge Code	270691502
Hospital Revenue Code	278
Min. Negotiated Rate	$288.64
Max. Negotiated Rate	$465.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$384.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$423.35
Rate for Payer: Qualcare PPO/HMO/WC	$288.64

GUIDEWIRE ALL STAR 190cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651776
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

GUIDEWIRE ALL STAR 190cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651776
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDE WIRE ALL STAR 190CM

Facility

$450.00

Hospital Charge Code	2709001139
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GUIDE WIRE ALL STAR 190CM

Facility

$450.00

Hospital Charge Code	2709001139
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

Know your out-of-pocket cost for care.

All Charges