Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE AMPLATZ 035 75cm

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270652344S
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	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
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

GUIDEWIRE AMPLATZ 035 75cm

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270652344N
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

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Service Code	HCPCS C1769
Hospital Charge Code	270650770
Hospital Revenue Code	278
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Hospital Charge Code	270657419
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Service Code	HCPCS C1769
Hospital Charge Code	270650770
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Hospital Charge Code	270657419
Hospital Revenue Code	270
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.00
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$32.00
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

GUIDEWIRE AMPLATZ SS .035/260

Facility

$116.25

Hospital Charge Code	270633268
Hospital Revenue Code	272
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$58.12
Rate for Payer: Aetna Commercial	$44.17
Rate for Payer: Aetna Medicare Advantage	$34.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.64
Rate for Payer: Cigna Commercial	$58.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.88
Rate for Payer: Oxford Commercial	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.44
Rate for Payer: UnitedHealthcare Commercial	$23.25
Rate for Payer: UnitedHealthcare Community & State	$2.80
Rate for Payer: Wellpoint Medicaid Managed Care	$3.08

GUIDEWIRE AMPLATZ SS .035/260

Facility

$116.25

Hospital Charge Code	270633268
Hospital Revenue Code	272
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$17.44
Rate for Payer: Qualcare PPO/HMO/WC	$17.44

GUIDE WIRE AMPLATZ SUPER STIFF

Facility

$212.04

Hospital Charge Code	2703111088
Hospital Revenue Code	272
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$106.02
Rate for Payer: Aetna Commercial	$80.58
Rate for Payer: Aetna Medicare Advantage	$63.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.07
Rate for Payer: Cigna Commercial	$106.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.61
Rate for Payer: Oxford Commercial	$42.41
Rate for Payer: Qualcare PPO/HMO/WC	$31.81
Rate for Payer: UnitedHealthcare Commercial	$42.41
Rate for Payer: UnitedHealthcare Community & State	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

GUIDE WIRE AMPLATZ SUPER STIFF

Facility

$212.04

Hospital Charge Code	270CH0136
Hospital Revenue Code	272
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$106.02
Rate for Payer: Aetna Commercial	$80.58
Rate for Payer: Aetna Medicare Advantage	$63.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.07
Rate for Payer: Cigna Commercial	$106.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.61
Rate for Payer: Oxford Commercial	$42.41
Rate for Payer: Qualcare PPO/HMO/WC	$31.81
Rate for Payer: UnitedHealthcare Commercial	$42.41
Rate for Payer: UnitedHealthcare Community & State	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

GUIDE WIRE AMPLATZ SUPER STIFF

Facility

$212.04

Hospital Charge Code	270CH0136
Hospital Revenue Code	272
Min. Negotiated Rate	$31.81
Max. Negotiated Rate	$31.81
Rate for Payer: Qualcare PPO/HMO/WC	$31.81

GUIDE WIRE AMPLATZ SUPER STIFF

Facility

$212.04

Hospital Charge Code	2703111088
Hospital Revenue Code	272
Min. Negotiated Rate	$31.81
Max. Negotiated Rate	$31.81
Rate for Payer: Qualcare PPO/HMO/WC	$31.81

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395S
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395S
Hospital Revenue Code	278
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

GUIDE WIRE AMPLATZ TORQUE

Facility

$67.50

Service Code	HCPCS C1769
Hospital Charge Code	270655395N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna Commercial	$25.65
Rate for Payer: Aetna Medicare Advantage	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.21
Rate for Payer: Cigna Commercial	$33.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.12
Rate for Payer: UnitedHealthcare Community & State	$1.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.79

GUIDE WIRE AMPLATZ TORQUE

Facility

$67.50

Service Code	HCPCS C1769
Hospital Charge Code	270655395N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.12

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395
Hospital Revenue Code	278
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

GUIDE WIRE AMPLATZ TORQUE .035

Facility

$142.29

Hospital Charge Code	270CH0072
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$71.14
Rate for Payer: Aetna Commercial	$54.07
Rate for Payer: Aetna Medicare Advantage	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.28
Rate for Payer: Cigna Commercial	$71.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.69
Rate for Payer: Oxford Commercial	$28.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.34
Rate for Payer: UnitedHealthcare Commercial	$28.46
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: Wellpoint Medicaid Managed Care	$3.77

GUIDE WIRE AMPLATZ TORQUE .035

Facility

$142.29

Hospital Charge Code	270CH0072
Hospital Revenue Code	272
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$21.34
Rate for Payer: Qualcare PPO/HMO/WC	$21.34

GUIDE WIRE AMPLATZ TORQUE .035

Facility

$142.29

Hospital Charge Code	2706000538
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$71.14
Rate for Payer: Aetna Commercial	$54.07
Rate for Payer: Aetna Medicare Advantage	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.28
Rate for Payer: Cigna Commercial	$71.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.69
Rate for Payer: Oxford Commercial	$28.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.34
Rate for Payer: UnitedHealthcare Commercial	$28.46
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: Wellpoint Medicaid Managed Care	$3.77

GUIDE WIRE AMPLATZ TORQUE .035

Facility

$142.29

Hospital Charge Code	2706000538
Hospital Revenue Code	272
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$21.34
Rate for Payer: Qualcare PPO/HMO/WC	$21.34

GUIDEWIRE AMPLZ 035 260c 46526

Facility

$221.95

Hospital Charge Code	270623264C
Hospital Revenue Code	278
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$110.97
Rate for Payer: Aetna Commercial	$84.34
Rate for Payer: Aetna Medicare Advantage	$66.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.60
Rate for Payer: Cigna Commercial	$110.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.83
Rate for Payer: Qualcare PPO/HMO/WC	$33.29
Rate for Payer: UnitedHealthcare Community & State	$5.35
Rate for Payer: Wellpoint Medicaid Managed Care	$5.88

GUIDEWIRE AMPLZ 035 260c 46526

Facility

$221.95

Hospital Charge Code	270623264C
Hospital Revenue Code	278
Min. Negotiated Rate	$33.29
Max. Negotiated Rate	$53.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.83
Rate for Payer: Qualcare PPO/HMO/WC	$33.29

Know your out-of-pocket cost for care.

All Charges