Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE HIQUE COMD ES 208175

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270659350S
Hospital Revenue Code	278
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

GUIDEWIRE HIQUE COMD ES 208175

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270659350S
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

GUIDEWIRE HIQUE COMD ES 208175

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270659350
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

GUIDEWIRE HIQUE COMD ES 208175

Facility

$900.00

Service Code	HCPCS C1769
Hospital Charge Code	270659350N
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

GUIDEWIRE HIQUE COMD ES 208175

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270659350
Hospital Revenue Code	278
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

GUIDEWIRE HIQUE COMD ES 208175

Facility

$900.00

Service Code	HCPCS C1769
Hospital Charge Code	270659350N
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

GUIDEWIRE HI-T COMMAND 18 ST 2

Facility

$815.00

Service Code	HCPCS C1769
Hospital Charge Code	270687204
Hospital Revenue Code	278
Min. Negotiated Rate	$19.64
Max. Negotiated Rate	$407.50
Rate for Payer: Aetna Commercial	$309.70
Rate for Payer: Aetna Medicare Advantage	$244.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.82
Rate for Payer: Cigna Commercial	$407.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.30
Rate for Payer: Qualcare PPO/HMO/WC	$122.25
Rate for Payer: UnitedHealthcare Community & State	$19.64
Rate for Payer: Wellpoint Medicaid Managed Care	$21.60

GUIDEWIRE HI-T COMMAND 18 ST 2

Facility

$815.00

Service Code	HCPCS C1769
Hospital Charge Code	270687204
Hospital Revenue Code	278
Min. Negotiated Rate	$122.25
Max. Negotiated Rate	$197.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.30
Rate for Payer: Qualcare PPO/HMO/WC	$122.25

GUIDEWIRE HI-T COMMAND 18 ST 3

Facility

$815.00

Service Code	HCPCS C1769
Hospital Charge Code	270687203
Hospital Revenue Code	278
Min. Negotiated Rate	$19.64
Max. Negotiated Rate	$407.50
Rate for Payer: Aetna Commercial	$309.70
Rate for Payer: Aetna Medicare Advantage	$244.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.82
Rate for Payer: Cigna Commercial	$407.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.30
Rate for Payer: Qualcare PPO/HMO/WC	$122.25
Rate for Payer: UnitedHealthcare Community & State	$19.64
Rate for Payer: Wellpoint Medicaid Managed Care	$21.60

GUIDEWIRE HI-T COMMAND 18 ST 3

Facility

$815.00

Service Code	HCPCS C1769
Hospital Charge Code	270687203
Hospital Revenue Code	278
Min. Negotiated Rate	$122.25
Max. Negotiated Rate	$197.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.30
Rate for Payer: Qualcare PPO/HMO/WC	$122.25

GUIDEWIRE HI-T COMMAND 18 ST 3

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270687203S
Hospital Revenue Code	278
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

GUIDEWIRE HI-T COMMAND 18 ST 3

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270687203S
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

GUIDEWIRE HIWIRE .025 STR

Facility

$154.70

Hospital Charge Code	270647875
Hospital Revenue Code	278
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$58.79
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.10

GUIDEWIRE HIWIRE .025 STR

Facility

$154.70

Hospital Charge Code	270647875
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .035 180cm.

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270654229
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 HIWIRE .035 180cm.

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270654229
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 HIWIRE .035 ANGL

Facility

$154.70

Service Code	HCPCS C1769
Hospital Charge Code	270647876
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .035 ANGL

Facility

$154.70

Service Code	HCPCS C1769
Hospital Charge Code	270647876
Hospital Revenue Code	278
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$58.79
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.10

GUIDEWIRE HIWIRE .038 STR

Facility

$154.70

Hospital Charge Code	270647879
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .038 STR

Facility

$154.70

Hospital Charge Code	270647879
Hospital Revenue Code	278
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$58.79
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.10

GUIDEWIRE HIWIRE .35 STR

Facility

$154.70

Hospital Charge Code	270647877
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .35 STR

Facility

$154.70

Hospital Charge Code	270647877
Hospital Revenue Code	278
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$58.79
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.20
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.10

GUIDEWIRE HT FLOPPY 0.14 190CM

Facility

$450.00

Hospital Charge Code	270632556C
Hospital Revenue Code	278
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

GUIDEWIRE HT FLOPPY 0.14 190CM

Facility

$450.00

Hospital Charge Code	270632556C
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GUIDEWIRE HT FLOPPY 0.14 300CM

Facility

$450.00

Hospital Charge Code	270632557C
Hospital Revenue Code	278
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

Know your out-of-pocket cost for care.

All Charges