Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE ALL STAR 300cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651832
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

GUIDEWIRE ALL STAR 300cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651832
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

GUIDE WIRE ALL STAR 300CM

Facility

$375.00

Hospital Charge Code	2709001140
Hospital Revenue Code	272
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

GUIDE WIRE ALL STAR 300CM

Facility

$375.00

Hospital Charge Code	2709001140
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE AMPLATZ .035 145cm

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270630612
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

GUIDEWIRE AMPLATZ .035 145cm

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270630612
Hospital Revenue Code	278
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

GUIDEWIRE AMPLATZ .035 180cm

Facility

$107.50

Service Code	HCPCS C1769
Hospital Charge Code	270624725N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.12

GUIDEWIRE AMPLATZ .035 180cm

Facility

$107.50

Service Code	HCPCS C1769
Hospital Charge Code	270624725N
Hospital Revenue Code	278
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare Advantage	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.41
Rate for Payer: Cigna Commercial	$53.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23.65
Rate for Payer: Qualcare PPO/HMO/WC	$16.12
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.85

GUIDEWIRE AMPLATZ .035 180cm

Facility

$207.10

Service Code	HCPCS C1769
Hospital Charge Code	270624725S
Hospital Revenue Code	278
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$50.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.56
Rate for Payer: Qualcare PPO/HMO/WC	$31.07

GUIDEWIRE AMPLATZ .035 180cm

Facility

$207.10

Service Code	HCPCS C1769
Hospital Charge Code	270624725
Hospital Revenue Code	278
Min. Negotiated Rate	$31.07
Max. Negotiated Rate	$50.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.56
Rate for Payer: Qualcare PPO/HMO/WC	$31.07

GUIDEWIRE AMPLATZ .035 180cm

Facility

$207.10

Service Code	HCPCS C1769
Hospital Charge Code	270624725S
Hospital Revenue Code	278
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$103.55
Rate for Payer: Aetna Commercial	$78.70
Rate for Payer: Aetna Medicare Advantage	$62.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.81
Rate for Payer: Cigna Commercial	$103.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.56
Rate for Payer: Qualcare PPO/HMO/WC	$31.07
Rate for Payer: UnitedHealthcare Community & State	$4.99
Rate for Payer: Wellpoint Medicaid Managed Care	$5.49

GUIDEWIRE AMPLATZ .035 180cm

Facility

$207.10

Service Code	HCPCS C1769
Hospital Charge Code	270624725
Hospital Revenue Code	278
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$103.55
Rate for Payer: Aetna Commercial	$78.70
Rate for Payer: Aetna Medicare Advantage	$62.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.81
Rate for Payer: Cigna Commercial	$103.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.56
Rate for Payer: Qualcare PPO/HMO/WC	$31.07
Rate for Payer: UnitedHealthcare Community & State	$4.99
Rate for Payer: Wellpoint Medicaid Managed Care	$5.49

GUIDEWIRE AMPLATZ .035 260cm

Facility

$112.50

Service Code	HCPCS C1769
Hospital Charge Code	270623264N
Hospital Revenue Code	278
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna Commercial	$42.75
Rate for Payer: Aetna Medicare Advantage	$33.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.69
Rate for Payer: Cigna Commercial	$56.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$16.88
Rate for Payer: UnitedHealthcare Community & State	$2.71
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

GUIDEWIRE AMPLATZ .035 260cm

Facility

$216.60

Service Code	HCPCS C1769
Hospital Charge Code	270623264S
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.65
Rate for Payer: Qualcare PPO/HMO/WC	$32.49

GUIDEWIRE AMPLATZ .035 260cm

Facility

$112.50

Service Code	HCPCS C1769
Hospital Charge Code	270623264N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$16.88

GUIDEWIRE AMPLATZ .035 260cm

Facility

$216.60

Service Code	HCPCS C1769
Hospital Charge Code	270623264
Hospital Revenue Code	278
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.65
Rate for Payer: Qualcare PPO/HMO/WC	$32.49

GUIDEWIRE AMPLATZ .035 260cm

Facility

$216.60

Service Code	HCPCS C1769
Hospital Charge Code	270623264
Hospital Revenue Code	278
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$108.30
Rate for Payer: Aetna Commercial	$82.31
Rate for Payer: Aetna Medicare Advantage	$64.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$108.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.65
Rate for Payer: Qualcare PPO/HMO/WC	$32.49
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$5.74

GUIDEWIRE AMPLATZ .035 260cm

Facility

$216.60

Service Code	HCPCS C1769
Hospital Charge Code	270623264S
Hospital Revenue Code	278
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$108.30
Rate for Payer: Aetna Commercial	$82.31
Rate for Payer: Aetna Medicare Advantage	$64.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$108.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.65
Rate for Payer: Qualcare PPO/HMO/WC	$32.49
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$5.74

GUIDEWIRE AMPLATZ .035 260cm

Facility

$235.00

Service Code	HCPCS C1769
Hospital Charge Code	270623296
Hospital Revenue Code	278
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$56.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$51.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

GUIDEWIRE AMPLATZ .035 260cm

Facility

$235.00

Service Code	HCPCS C1769
Hospital Charge Code	270623296
Hospital Revenue Code	278
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$51.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.23

GUIDEWIRE AMPLATZ 035 75cm

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270652344O
Hospital Revenue Code	278
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

GUIDEWIRE AMPLATZ 035 75cm

Facility

$1,525.00

Service Code	HCPCS C1769
Hospital Charge Code	270652344
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$579.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.41

GUIDEWIRE AMPLATZ 035 75cm

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270652344S
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

GUIDEWIRE AMPLATZ 035 75cm

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270652344O
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

GUIDEWIRE AMPLATZ 035 75cm

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270652344N
Hospital Revenue Code	278
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

Know your out-of-pocket cost for care.

All Charges