Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE PROWATER 300 1493501

Facility

$425.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

GUIDEWIRE PROWATER 300 1493501

Facility

$425.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

GUIDEWIRE PTFE .023

Facility

$68.70

Hospital Charge Code	270647880
Hospital Revenue Code	278
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.35
Rate for Payer: Aetna Commercial	$26.11
Rate for Payer: Aetna Medicare Advantage	$20.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.52
Rate for Payer: Cigna Commercial	$34.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.30
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

GUIDEWIRE PTFE .023

Facility

$68.70

Hospital Charge Code	270647880
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$16.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

GUIDEWIRE PTFE .038

Facility

$68.70

Hospital Charge Code	270647881
Hospital Revenue Code	278
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$34.35
Rate for Payer: Aetna Commercial	$26.11
Rate for Payer: Aetna Medicare Advantage	$20.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.52
Rate for Payer: Cigna Commercial	$34.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.30
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

GUIDEWIRE PTFE .038

Facility

$68.70

Hospital Charge Code	270647881
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$16.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

GUIDEWIRE RD RUNR 0.18 RR18480

Facility

$601.45

Hospital Charge Code	270634356
Hospital Revenue Code	278
Min. Negotiated Rate	$90.22
Max. Negotiated Rate	$145.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.32
Rate for Payer: Qualcare PPO/HMO/WC	$90.22

GUIDEWIRE RD RUNR 0.18 RR18480

Facility

$601.45

Hospital Charge Code	270634356
Hospital Revenue Code	278
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$300.73
Rate for Payer: Aetna Commercial	$228.55
Rate for Payer: Aetna Medicare Advantage	$180.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.37
Rate for Payer: Cigna Commercial	$300.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.32
Rate for Payer: Qualcare PPO/HMO/WC	$90.22
Rate for Payer: UnitedHealthcare Community & State	$14.49
Rate for Payer: Wellpoint Medicaid Managed Care	$15.94

GUIDE WIRE REGULAR***

Facility

$150.00

Hospital Charge Code	2300788
Hospital Revenue Code	279
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

GUIDE WIRE REGULAR***

Facility

$150.00

Hospital Charge Code	2300788
Hospital Revenue Code	279
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.98
Rate for Payer: Qualcare PPO/HMO/WC	$37.48

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$124.95
Rate for Payer: Aetna Commercial	$94.96
Rate for Payer: Aetna Medicare Advantage	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.72
Rate for Payer: Cigna Commercial	$124.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.98
Rate for Payer: Qualcare PPO/HMO/WC	$37.48
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.98
Rate for Payer: Qualcare PPO/HMO/WC	$37.48

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803N
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.98
Rate for Payer: Qualcare PPO/HMO/WC	$37.48

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$124.95
Rate for Payer: Aetna Commercial	$94.96
Rate for Payer: Aetna Medicare Advantage	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.72
Rate for Payer: Cigna Commercial	$124.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.98
Rate for Payer: Qualcare PPO/HMO/WC	$37.48
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803
Hospital Revenue Code	278
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$124.95
Rate for Payer: Aetna Commercial	$94.96
Rate for Payer: Aetna Medicare Advantage	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.72
Rate for Payer: Cigna Commercial	$124.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.98
Rate for Payer: Qualcare PPO/HMO/WC	$37.48
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

GUIDEWIRE ROSEN .035 180cm

Facility

$64.60

Service Code	HCPCS C1769
Hospital Charge Code	270623262
Hospital Revenue Code	278
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$15.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.21
Rate for Payer: Qualcare PPO/HMO/WC	$9.69

GUIDEWIRE ROSEN .035 180cm

Facility

$64.60

Service Code	HCPCS C1769
Hospital Charge Code	270623262
Hospital Revenue Code	278
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$32.30
Rate for Payer: Aetna Commercial	$24.55
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.47
Rate for Payer: Cigna Commercial	$32.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.21
Rate for Payer: Qualcare PPO/HMO/WC	$9.69
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.71

GUIDEWIRE ROSEN .035 180cm

Facility

$56.80

Service Code	HCPCS C1769
Hospital Charge Code	270623888
Hospital Revenue Code	278
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$13.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.52

GUIDEWIRE ROSEN .035 180cm

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270623888S
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

GUIDEWIRE ROSEN .035 180cm

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270623888S
Hospital Revenue Code	278
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

GUIDEWIRE ROSEN .035 180cm

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270623888N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

GUIDEWIRE ROSEN .035 180cm

Facility

$56.80

Service Code	HCPCS C1769
Hospital Charge Code	270623888
Hospital Revenue Code	278
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$28.40
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna Medicare Advantage	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.48
Rate for Payer: Cigna Commercial	$28.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.52
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

GUIDEWIRE ROSEN .035 180cm

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270623888N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

GUIDEWIRE ROSEN .035 260cm

Facility

$147.50

Service Code	HCPCS C1769
Hospital Charge Code	270624343N
Hospital Revenue Code	278
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.45
Rate for Payer: Qualcare PPO/HMO/WC	$22.12

Know your out-of-pocket cost for care.

All Charges