Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719C
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.30
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719C
Hospital Revenue Code	278
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.30
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Community & State	$2.77
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

GUIDEWIRE ASAHI GRANDSLAM 300

Facility

$2,250.00

Hospital Charge Code	270638512C
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

GUIDEWIRE ASAHI GRANDSLAM 300

Facility

$2,250.00

Hospital Charge Code	270638512C
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

GUIDEWIRE ASAHI GRNDSLM 300

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512S
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 ASAHI GRNDSLM 300

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512S
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 ASAHI MIRACLEBRO 300

Facility

$3,375.00

Hospital Charge Code	270636224C
Hospital Revenue Code	278
Min. Negotiated Rate	$81.34
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Community & State	$81.34
Rate for Payer: Wellpoint Medicaid Managed Care	$89.44

GUIDEWIRE ASAHI MIRACLEBRO 300

Facility

$3,375.00

Hospital Charge Code	270636224C
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

GUIDEWIRE ASAHI PROWATER 300CM

Facility

$2,250.00

Hospital Charge Code	270636742C
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

GUIDEWIRE ASAHI PROWATER 300CM

Facility

$2,250.00

Hospital Charge Code	270636742C
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

GUIDEWIRE ASAHI PTCA MICRACLIB

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270651834
Hospital Revenue Code	278
Min. Negotiated Rate	$16.27
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$148.50
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$16.27
Rate for Payer: Wellpoint Medicaid Managed Care	$17.89

GUIDEWIRE ASAHI PTCA MICRACLIB

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270651834
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$148.50
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASHAI ASTATO 30

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116
Hospital Revenue Code	278
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

GUIDEWIRE ASHAI ASTATO 30

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

GUIDEWIRE ASHAI TREASURE 12

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270643115C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GUIDEWIRE ASHAI TREASURE 12

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270643115C
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

GUIDEWIRE ASHI GSL 300 1494001

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512
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 ASHI GSL 300 1494001

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512
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 ATW FL0PPY MEJ 195cm

Facility

$358.75

Hospital Charge Code	290637334C
Hospital Revenue Code	278
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$179.38
Rate for Payer: Aetna Commercial	$136.32
Rate for Payer: Aetna Medicare Advantage	$107.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.48
Rate for Payer: Cigna Commercial	$179.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.92
Rate for Payer: Qualcare PPO/HMO/WC	$53.81
Rate for Payer: UnitedHealthcare Community & State	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$9.51

GUIDEWIRE ATW FL0PPY MEJ 195cm

Facility

$1,975.00

Hospital Charge Code	270637334
Hospital Revenue Code	279
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.50
Rate for Payer: Oxford Commercial	$395.00
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$395.00
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$52.34

GUIDEWIRE ATW FL0PPY MEJ 195cm

Facility

$1,975.00

Hospital Charge Code	270637334
Hospital Revenue Code	279
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

GUIDEWIRE ATW FL0PPY MEJ 195cm

Facility

$358.75

Hospital Charge Code	290637334C
Hospital Revenue Code	278
Min. Negotiated Rate	$53.81
Max. Negotiated Rate	$86.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.92
Rate for Payer: Qualcare PPO/HMO/WC	$53.81

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$1,802.50

Service Code	HCPCS C1769
Hospital Charge Code	270637325
Hospital Revenue Code	278
Min. Negotiated Rate	$43.44
Max. Negotiated Rate	$901.25
Rate for Payer: Aetna Commercial	$684.95
Rate for Payer: Aetna Medicare Advantage	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.64
Rate for Payer: Cigna Commercial	$901.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.55
Rate for Payer: Qualcare PPO/HMO/WC	$270.38
Rate for Payer: UnitedHealthcare Community & State	$43.44
Rate for Payer: Wellpoint Medicaid Managed Care	$47.77

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$414.80

Service Code	HCPCS C1769
Hospital Charge Code	270637325N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$207.40
Rate for Payer: Aetna Commercial	$157.62
Rate for Payer: Aetna Medicare Advantage	$124.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.77
Rate for Payer: Cigna Commercial	$207.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.26
Rate for Payer: Qualcare PPO/HMO/WC	$62.22
Rate for Payer: UnitedHealthcare Community & State	$10.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10.99

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$1,802.50

Service Code	HCPCS C1769
Hospital Charge Code	270637325
Hospital Revenue Code	278
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.55
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

Know your out-of-pocket cost for care.

All Charges