Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE HT FLOPPY 0.14 300CM

Facility

$450.00

Hospital Charge Code	270632557C
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 HYBRID .007 DBL ANG

Facility

$3,400.00

Service Code	HCPCS C1769
Hospital Charge Code	270697724S
Hospital Revenue Code	278
Min. Negotiated Rate	$81.94
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,292.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$748.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00
Rate for Payer: UnitedHealthcare Community & State	$81.94
Rate for Payer: Wellpoint Medicaid Managed Care	$90.10

GUIDEWIRE HYBRID .007 DBL ANG

Facility

$3,400.00

Service Code	HCPCS C1769
Hospital Charge Code	270697724S
Hospital Revenue Code	278
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$822.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$748.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

GUIDEWIRE HYBRID .007 STR

Facility

$3,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270697723S
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

GUIDEWIRE HYBRID .007 STR

Facility

$3,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270697723S
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

GUIDEWIRE HYBRID .008 DBL ANG

Facility

$3,400.00

Service Code	HCPCS C1769
Hospital Charge Code	270697726S
Hospital Revenue Code	278
Min. Negotiated Rate	$81.94
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,292.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$748.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00
Rate for Payer: UnitedHealthcare Community & State	$81.94
Rate for Payer: Wellpoint Medicaid Managed Care	$90.10

GUIDEWIRE HYBRID .008 DBL ANG

Facility

$3,400.00

Service Code	HCPCS C1769
Hospital Charge Code	270697726S
Hospital Revenue Code	278
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$822.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$748.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

GUIDEWIREHYBRID.012/.014DBLANG

Facility

$2,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270697725S
Hospital Revenue Code	278
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

GUIDEWIREHYBRID.012/.014DBLANG

Facility

$2,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270697725S
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

GUIDEWIRE HYBRID .012/.014 ST

Facility

$2,350.00

Service Code	HCPCS C1769
Hospital Charge Code	270697722S
Hospital Revenue Code	278
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$893.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$517.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Community & State	$56.63
Rate for Payer: Wellpoint Medicaid Managed Care	$62.27

GUIDEWIRE HYBRID .012/.014 ST

Facility

$2,350.00

Service Code	HCPCS C1769
Hospital Charge Code	270697722S
Hospital Revenue Code	278
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$568.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$517.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

GUIDEWIRE HYDRO ST 300CM

Facility

$860.00

Service Code	HCPCS C1769
Hospital Charge Code	270662852
Hospital Revenue Code	278
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$430.00
Rate for Payer: Aetna Commercial	$326.80
Rate for Payer: Aetna Medicare Advantage	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.30
Rate for Payer: Cigna Commercial	$430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Community & State	$20.73
Rate for Payer: Wellpoint Medicaid Managed Care	$22.79

GUIDEWIRE HYDRO ST 300CM

Facility

$997.50

Service Code	HCPCS C1769
Hospital Charge Code	270662852N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.62
Max. Negotiated Rate	$241.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$219.45
Rate for Payer: Qualcare PPO/HMO/WC	$149.62

GUIDEWIRE HYDRO ST 300CM

Facility

$860.00

Service Code	HCPCS C1769
Hospital Charge Code	270662852S
Hospital Revenue Code	278
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$430.00
Rate for Payer: Aetna Commercial	$326.80
Rate for Payer: Aetna Medicare Advantage	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.30
Rate for Payer: Cigna Commercial	$430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Community & State	$20.73
Rate for Payer: Wellpoint Medicaid Managed Care	$22.79

GUIDEWIRE HYDRO ST 300CM

Facility

$860.00

Service Code	HCPCS C1769
Hospital Charge Code	270662852S
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

GUIDEWIRE HYDRO ST 300CM

Facility

$997.50

Service Code	HCPCS C1769
Hospital Charge Code	270662852N
Hospital Revenue Code	278
Min. Negotiated Rate	$24.04
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$379.05
Rate for Payer: Aetna Medicare Advantage	$299.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.36
Rate for Payer: Cigna Commercial	$498.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$219.45
Rate for Payer: Qualcare PPO/HMO/WC	$149.62
Rate for Payer: UnitedHealthcare Community & State	$24.04
Rate for Payer: Wellpoint Medicaid Managed Care	$26.43

GUIDEWIRE HYDRO ST 300CM

Facility

$860.00

Service Code	HCPCS C1769
Hospital Charge Code	270662852
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

GUIDEWIRE IRONMAN 190 1001309

Facility

$500.00

Hospital Charge Code	270636705
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GUIDEWIRE IRONMAN 190 1001309

Facility

$500.00

Hospital Charge Code	270636705
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

GUIDEWIRE IRONMAN 300C 1001311

Facility

$2,175.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706
Hospital Revenue Code	278
Min. Negotiated Rate	$326.25
Max. Negotiated Rate	$526.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$478.50
Rate for Payer: Qualcare PPO/HMO/WC	$326.25

GUIDEWIRE IRONMAN 300C 1001311

Facility

$500.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706N
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

GUIDEWIRE IRONMAN 300C 1001311

Facility

$2,175.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706
Hospital Revenue Code	278
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$1,087.50
Rate for Payer: Aetna Commercial	$826.50
Rate for Payer: Aetna Medicare Advantage	$652.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$554.62
Rate for Payer: Cigna Commercial	$1,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$478.50
Rate for Payer: Qualcare PPO/HMO/WC	$326.25
Rate for Payer: UnitedHealthcare Community & State	$52.42
Rate for Payer: Wellpoint Medicaid Managed Care	$57.64

GUIDEWIRE IRONMAN 300C 1001311

Facility

$500.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706N
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GUIDEWIRE J 3MM .035/150CM

Facility

$30.90

Service Code	HCPCS C1769
Hospital Charge Code	270653785N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.45
Rate for Payer: Aetna Commercial	$11.74
Rate for Payer: Aetna Medicare Advantage	$9.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.88
Rate for Payer: Cigna Commercial	$15.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.63
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

GUIDEWIRE J 3MM .035/150CM

Facility

$366.00

Hospital Charge Code	270653785
Hospital Revenue Code	279
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$139.08
Rate for Payer: Aetna Medicare Advantage	$109.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.33
Rate for Payer: Cigna Commercial	$183.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.80
Rate for Payer: Oxford Commercial	$73.20
Rate for Payer: Qualcare PPO/HMO/WC	$54.90
Rate for Payer: UnitedHealthcare Commercial	$73.20
Rate for Payer: UnitedHealthcare Community & State	$8.82
Rate for Payer: Wellpoint Medicaid Managed Care	$9.70

Know your out-of-pocket cost for care.

All Charges