Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE AMPLZ 038 260c 46520

Facility

$220.85

Hospital Charge Code	270624318
Hospital Revenue Code	278
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$53.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.59
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

GUIDEWIRE AMPLZ 038 260c 46520

Facility

$220.85

Hospital Charge Code	270624318
Hospital Revenue Code	278
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$110.42
Rate for Payer: Aetna Commercial	$83.92
Rate for Payer: Aetna Medicare Advantage	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.32
Rate for Payer: Cigna Commercial	$110.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.59
Rate for Payer: Qualcare PPO/HMO/WC	$33.13
Rate for Payer: UnitedHealthcare Community & State	$5.32
Rate for Payer: Wellpoint Medicaid Managed Care	$5.85

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$135.85

Service Code	HCPCS C1769
Hospital Charge Code	270656080
Hospital Revenue Code	278
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$67.92
Rate for Payer: Aetna Commercial	$51.62
Rate for Payer: Aetna Medicare Advantage	$40.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.64
Rate for Payer: Cigna Commercial	$67.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.38
Rate for Payer: UnitedHealthcare Community & State	$3.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.60

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270601254
Hospital Revenue Code	278
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.30
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270601254
Hospital Revenue Code	278
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$47.30
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$135.85

Service Code	HCPCS C1769
Hospital Charge Code	270656080
Hospital Revenue Code	278
Min. Negotiated Rate	$20.38
Max. Negotiated Rate	$32.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.38

GUIDEWIRE ANGLE .035 5FR 15

Facility

$155.00

Hospital Charge Code	270655080
Hospital Revenue Code	278
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

GUIDEWIRE ANGLE .035 5FR 15

Facility

$155.00

Hospital Charge Code	270655080
Hospital Revenue Code	278
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$58.90
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

GUIDEWIRE ANGLED .035X 120CM

Facility

$422.00

Hospital Charge Code	270331884
Hospital Revenue Code	278
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$211.00
Rate for Payer: Aetna Commercial	$160.36
Rate for Payer: Aetna Medicare Advantage	$126.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.61
Rate for Payer: Cigna Commercial	$211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.84
Rate for Payer: Qualcare PPO/HMO/WC	$63.30
Rate for Payer: UnitedHealthcare Community & State	$10.17
Rate for Payer: Wellpoint Medicaid Managed Care	$11.18

GUIDEWIRE ANGLED .035X 120CM

Facility

$422.00

Hospital Charge Code	270331884
Hospital Revenue Code	278
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$102.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.84
Rate for Payer: Qualcare PPO/HMO/WC	$63.30

GUIDEWIRE ANGLED .035 X 150CM

Facility

$422.00

Hospital Charge Code	270332352
Hospital Revenue Code	278
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$211.00
Rate for Payer: Aetna Commercial	$160.36
Rate for Payer: Aetna Medicare Advantage	$126.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.61
Rate for Payer: Cigna Commercial	$211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.84
Rate for Payer: Qualcare PPO/HMO/WC	$63.30
Rate for Payer: UnitedHealthcare Community & State	$10.17
Rate for Payer: Wellpoint Medicaid Managed Care	$11.18

GUIDEWIRE ANGLED .035 X 150CM

Facility

$422.00

Hospital Charge Code	270332352
Hospital Revenue Code	278
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$102.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.84
Rate for Payer: Qualcare PPO/HMO/WC	$63.30

GUIDEWIRE APPROACH 25G.014x300

Facility

$765.00

Service Code	HCPCS C1769
Hospital Charge Code	270677086N
Hospital Revenue Code	278
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$168.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Community & State	$18.44
Rate for Payer: Wellpoint Medicaid Managed Care	$20.27

GUIDEWIRE APPROACH 25G.014x300

Facility

$765.00

Service Code	HCPCS C1769
Hospital Charge Code	270677086N
Hospital Revenue Code	278
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$185.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$168.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

GUIDEWIRE APPROACH 25G.014x300

Facility

$765.00

Service Code	HCPCS C1769
Hospital Charge Code	270677086
Hospital Revenue Code	278
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$185.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$168.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

GUIDEWIRE APPROACH 25G.014x300

Facility

$765.00

Service Code	HCPCS C1769
Hospital Charge Code	270677086
Hospital Revenue Code	278
Min. Negotiated Rate	$18.44
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$168.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Community & State	$18.44
Rate for Payer: Wellpoint Medicaid Managed Care	$20.27

GUIDEWIRE AQUALINER .035 180cm

Facility

$260.50

Hospital Charge Code	270638838
Hospital Revenue Code	272
Min. Negotiated Rate	$39.08
Max. Negotiated Rate	$39.08
Rate for Payer: Qualcare PPO/HMO/WC	$39.08

GUIDEWIRE AQUALINER .035 180cm

Facility

$260.50

Hospital Charge Code	270638838
Hospital Revenue Code	272
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$130.25
Rate for Payer: Aetna Commercial	$98.99
Rate for Payer: Aetna Medicare Advantage	$78.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.43
Rate for Payer: Cigna Commercial	$130.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.15
Rate for Payer: Oxford Commercial	$52.10
Rate for Payer: Qualcare PPO/HMO/WC	$39.08
Rate for Payer: UnitedHealthcare Commercial	$52.10
Rate for Payer: UnitedHealthcare Community & State	$6.28
Rate for Payer: Wellpoint Medicaid Managed Care	$6.90

GUIDEWIRE ARIST14SFTEXCH300CM

Facility

$2,775.00

Service Code	HCPCS C1769
Hospital Charge Code	270694238S
Hospital Revenue Code	278
Min. Negotiated Rate	$66.88
Max. Negotiated Rate	$1,387.50
Rate for Payer: Aetna Commercial	$1,054.50
Rate for Payer: Aetna Medicare Advantage	$832.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$707.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$707.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$707.62
Rate for Payer: Cigna Commercial	$1,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$610.50
Rate for Payer: Qualcare PPO/HMO/WC	$416.25
Rate for Payer: UnitedHealthcare Community & State	$66.88
Rate for Payer: Wellpoint Medicaid Managed Care	$73.54

GUIDEWIRE ARIST14SFTEXCH300CM

Facility

$2,775.00

Service Code	HCPCS C1769
Hospital Charge Code	270694238S
Hospital Revenue Code	278
Min. Negotiated Rate	$416.25
Max. Negotiated Rate	$671.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$610.50
Rate for Payer: Qualcare PPO/HMO/WC	$416.25

GUIDEWIRE ARIST14STDEXCH300CM

Facility

$2,775.00

Service Code	HCPCS C1769
Hospital Charge Code	270694239S
Hospital Revenue Code	278
Min. Negotiated Rate	$416.25
Max. Negotiated Rate	$671.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$610.50
Rate for Payer: Qualcare PPO/HMO/WC	$416.25

GUIDEWIRE ARIST14STDEXCH300CM

Facility

$2,775.00

Service Code	HCPCS C1769
Hospital Charge Code	270694239S
Hospital Revenue Code	278
Min. Negotiated Rate	$66.88
Max. Negotiated Rate	$1,387.50
Rate for Payer: Aetna Commercial	$1,054.50
Rate for Payer: Aetna Medicare Advantage	$832.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$707.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$707.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$707.62
Rate for Payer: Cigna Commercial	$1,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$610.50
Rate for Payer: Qualcare PPO/HMO/WC	$416.25
Rate for Payer: UnitedHealthcare Community & State	$66.88
Rate for Payer: Wellpoint Medicaid Managed Care	$73.54

GUIDEWIRE ARISTOT 14 SFT 200CM

Facility

$2,625.00

Service Code	HCPCS C1769
Hospital Charge Code	270694054S
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

GUIDEWIRE ARISTOT 14 SFT 200CM

Facility

$2,625.00

Service Code	HCPCS C1769
Hospital Charge Code	270694054S
Hospital Revenue Code	278
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

GUIDEWIRE ARISTOT 14 STD 200CM

Facility

$2,625.00

Service Code	HCPCS C1769
Hospital Charge Code	270694237S
Hospital Revenue Code	278
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

Know your out-of-pocket cost for care.

All Charges