Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE B/U MEIER JTIP 300cm

Facility

$159.65

Service Code	HCPCS C1769
Hospital Charge Code	270631344
Hospital Revenue Code	278
Min. Negotiated Rate	$23.95
Max. Negotiated Rate	$38.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.12
Rate for Payer: Qualcare PPO/HMO/WC	$23.95

GUIDEWIRE B/U MEIER JTIP 300cm

Facility

$159.65

Service Code	HCPCS C1769
Hospital Charge Code	270631344
Hospital Revenue Code	278
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$79.83
Rate for Payer: Aetna Commercial	$60.67
Rate for Payer: Aetna Medicare Advantage	$47.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.71
Rate for Payer: Cigna Commercial	$79.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.12
Rate for Payer: Qualcare PPO/HMO/WC	$23.95
Rate for Payer: UnitedHealthcare Community & State	$3.85
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634
Hospital Revenue Code	278
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$163.40
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$64.50
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.39

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634N
Hospital Revenue Code	278
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$100.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.30
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Commercial	$157.70
Rate for Payer: Aetna Medicare Advantage	$124.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.83
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.30
Rate for Payer: Qualcare PPO/HMO/WC	$62.25
Rate for Payer: UnitedHealthcare Community & State	$10.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.00

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634S
Hospital Revenue Code	278
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$163.40
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$64.50
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.39

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634S
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWIRE CHIKAI 10 MM

Facility

$2,745.00

Service Code	HCPCS C1769
Hospital Charge Code	270696455S
Hospital Revenue Code	278
Min. Negotiated Rate	$411.75
Max. Negotiated Rate	$664.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$603.90
Rate for Payer: Qualcare PPO/HMO/WC	$411.75

GUIDEWIRE CHIKAI 10 MM

Facility

$2,745.00

Service Code	HCPCS C1769
Hospital Charge Code	270696455S
Hospital Revenue Code	278
Min. Negotiated Rate	$66.15
Max. Negotiated Rate	$1,372.50
Rate for Payer: Aetna Commercial	$1,043.10
Rate for Payer: Aetna Medicare Advantage	$823.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.98
Rate for Payer: Cigna Commercial	$1,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$603.90
Rate for Payer: Qualcare PPO/HMO/WC	$411.75
Rate for Payer: UnitedHealthcare Community & State	$66.15
Rate for Payer: Wellpoint Medicaid Managed Care	$72.74

GUIDEWIRE CHOICE 182cm 1216001

Facility

$595.25

Hospital Charge Code	270629663
Hospital Revenue Code	278
Min. Negotiated Rate	$14.35
Max. Negotiated Rate	$297.62
Rate for Payer: Aetna Commercial	$226.19
Rate for Payer: Aetna Medicare Advantage	$178.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.79
Rate for Payer: Cigna Commercial	$297.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.96
Rate for Payer: Qualcare PPO/HMO/WC	$89.29
Rate for Payer: UnitedHealthcare Community & State	$14.35
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

GUIDEWIRE CHOICE 182cm 1216001

Facility

$595.25

Hospital Charge Code	270629663
Hospital Revenue Code	278
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$144.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.96
Rate for Payer: Qualcare PPO/HMO/WC	$89.29

GUIDEWIRE CHOIC PT 300 1215501

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270637306
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWIRE CHOIC PT 300 1215501

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270637306
Hospital Revenue Code	278
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$163.40
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$64.50
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.39

GUIDEWIRE CLEVER CUT V

Facility

$810.00

Service Code	HCPCS C1769
Hospital Charge Code	270684736
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$196.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$178.20
Rate for Payer: Qualcare PPO/HMO/WC	$121.50

GUIDEWIRE CLEVER CUT V

Facility

$810.00

Service Code	HCPCS C1769
Hospital Charge Code	270684736
Hospital Revenue Code	278
Min. Negotiated Rate	$19.52
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna Commercial	$307.80
Rate for Payer: Aetna Medicare Advantage	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.55
Rate for Payer: Cigna Commercial	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$178.20
Rate for Payer: Qualcare PPO/HMO/WC	$121.50
Rate for Payer: UnitedHealthcare Community & State	$19.52
Rate for Payer: Wellpoint Medicaid Managed Care	$21.46

GUIDEWIRE CONTROL 8x300CM STR

Facility

$798.25

Service Code	HCPCS C1769
Hospital Charge Code	270670509
Hospital Revenue Code	278
Min. Negotiated Rate	$119.74
Max. Negotiated Rate	$193.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.62
Rate for Payer: Qualcare PPO/HMO/WC	$119.74

GUIDEWIRE CONTROL 8x300CM STR

Facility

$798.25

Service Code	HCPCS C1769
Hospital Charge Code	270670509
Hospital Revenue Code	278
Min. Negotiated Rate	$19.24
Max. Negotiated Rate	$399.12
Rate for Payer: Aetna Commercial	$303.33
Rate for Payer: Aetna Medicare Advantage	$239.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.55
Rate for Payer: Cigna Commercial	$399.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.62
Rate for Payer: Qualcare PPO/HMO/WC	$119.74
Rate for Payer: UnitedHealthcare Community & State	$19.24
Rate for Payer: Wellpoint Medicaid Managed Care	$21.15

GUIDEWIRE COPE MANDRIL 60cm

Facility

$241.45

Service Code	HCPCS C1769
Hospital Charge Code	270632089
Hospital Revenue Code	278
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$120.72
Rate for Payer: Aetna Commercial	$91.75
Rate for Payer: Aetna Medicare Advantage	$72.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.57
Rate for Payer: Cigna Commercial	$120.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.12
Rate for Payer: Qualcare PPO/HMO/WC	$36.22
Rate for Payer: UnitedHealthcare Community & State	$5.82
Rate for Payer: Wellpoint Medicaid Managed Care	$6.40

GUIDEWIRE COPE MANDRIL 60cm

Facility

$241.45

Service Code	HCPCS C1769
Hospital Charge Code	270632089
Hospital Revenue Code	278
Min. Negotiated Rate	$36.22
Max. Negotiated Rate	$58.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.12
Rate for Payer: Qualcare PPO/HMO/WC	$36.22

GUIDEWIRE COPE NITINOL 218125

Facility

$251.45

Service Code	HCPCS C1769
Hospital Charge Code	270630862
Hospital Revenue Code	278
Min. Negotiated Rate	$6.06
Max. Negotiated Rate	$125.72
Rate for Payer: Aetna Commercial	$95.55
Rate for Payer: Aetna Medicare Advantage	$75.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.12
Rate for Payer: Cigna Commercial	$125.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.32
Rate for Payer: Qualcare PPO/HMO/WC	$37.72
Rate for Payer: UnitedHealthcare Community & State	$6.06
Rate for Payer: Wellpoint Medicaid Managed Care	$6.66

GUIDEWIRE COPE NITINOL 218125

Facility

$251.45

Service Code	HCPCS C1769
Hospital Charge Code	270630862
Hospital Revenue Code	278
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$60.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.32
Rate for Payer: Qualcare PPO/HMO/WC	$37.72

GUIDE WIRE COPILOT

Facility

$250.00

Service Code	HCPCS C1789
Hospital Charge Code	270682243N
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

GUIDE WIRE COPILOT

Facility

$325.00

Service Code	HCPCS C1769
Hospital Charge Code	270682243
Hospital Revenue Code	278
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

GUIDE WIRE COPILOT

Facility

$325.00

Service Code	HCPCS C1769
Hospital Charge Code	270682243
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

Know your out-of-pocket cost for care.

All Charges