Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE SYNCHRO 200CM

Facility

$3,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270685069
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

GUIDEWIRE SYNCHRO 200CM

Facility

$3,000.00

Service Code	HCPCS C1769
Hospital Charge Code	270685069S
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

GUIDEWIRE SYNCHRO 200CM

Facility

$3,000.00

Service Code	HCPCS C1769
Hospital Charge Code	270685069S
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

GUIDEWIRE SYNCHRO 300CM

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270685070
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270685070S
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

GUIDEWIRE SYNCHRO 300CM

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270685070S
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270685070
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

GUIDEWIRE SYNCHRO 300CM STAND

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270685071S
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

GUIDEWIRE SYNCHRO 300CM STAND

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270685071S
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM STAND

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270685071
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

GUIDEWIRE SYNCHRO 300CM STAND

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270685071
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRON 300CM

Facility

$3,562.50

Service Code	HCPCS C1769
Hospital Charge Code	270685071C
Hospital Revenue Code	278
Min. Negotiated Rate	$85.86
Max. Negotiated Rate	$1,781.25
Rate for Payer: Aetna Commercial	$1,353.75
Rate for Payer: Aetna Medicare Advantage	$1,068.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$908.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$908.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$908.44
Rate for Payer: Cigna Commercial	$1,781.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$862.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$783.75
Rate for Payer: Qualcare PPO/HMO/WC	$534.38
Rate for Payer: UnitedHealthcare Community & State	$85.86
Rate for Payer: Wellpoint Medicaid Managed Care	$94.41

GUIDEWIRE SYNCHRON 300CM

Facility

$3,562.50

Service Code	HCPCS C1769
Hospital Charge Code	270685071C
Hospital Revenue Code	278
Min. Negotiated Rate	$534.38
Max. Negotiated Rate	$862.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$862.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$783.75
Rate for Payer: Qualcare PPO/HMO/WC	$534.38

GUIDE WIRE TEAR DROP 3.2X100CM

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270698024
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

GUIDE WIRE TEAR DROP 3.2X100CM

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270698024
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 TEARDROP 3MMX100CM

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	270698027
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 TEARDROP 3MMX100CM

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	270698027
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

GUIDE WIRE THD 1.25x150MM

Facility

$129.70

Service Code	HCPCS C1769
Hospital Charge Code	270642840
Hospital Revenue Code	278
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$64.85
Rate for Payer: Aetna Commercial	$49.29
Rate for Payer: Aetna Medicare Advantage	$38.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.07
Rate for Payer: Cigna Commercial	$64.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.53
Rate for Payer: Qualcare PPO/HMO/WC	$19.45
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

GUIDE WIRE THD 1.25x150MM

Facility

$129.70

Service Code	HCPCS C1769
Hospital Charge Code	270642840
Hospital Revenue Code	278
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$31.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.53
Rate for Payer: Qualcare PPO/HMO/WC	$19.45

GUIDE WIRE THD 1.4x150MM STER

Facility

$57.08

Hospital Charge Code	270665827
Hospital Revenue Code	278
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$28.54
Rate for Payer: Aetna Commercial	$21.69
Rate for Payer: Aetna Medicare Advantage	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.56
Rate for Payer: Cigna Commercial	$28.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.56
Rate for Payer: Qualcare PPO/HMO/WC	$8.56
Rate for Payer: UnitedHealthcare Community & State	$1.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.51

GUIDE WIRE THD 1.4x150MM STER

Facility

$57.08

Hospital Charge Code	270665827
Hospital Revenue Code	278
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.56
Rate for Payer: Qualcare PPO/HMO/WC	$8.56

GUIDEWIRE THD 2.5x230mm

Facility

$205.50

Service Code	HCPCS C1769
Hospital Charge Code	270652340
Hospital Revenue Code	278
Min. Negotiated Rate	$30.82
Max. Negotiated Rate	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.21
Rate for Payer: Qualcare PPO/HMO/WC	$30.82

GUIDEWIRE THD 2.5x230mm

Facility

$205.50

Service Code	HCPCS C1769
Hospital Charge Code	270652340
Hospital Revenue Code	278
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna Commercial	$78.09
Rate for Payer: Aetna Medicare Advantage	$61.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.40
Rate for Payer: Cigna Commercial	$102.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.21
Rate for Payer: Qualcare PPO/HMO/WC	$30.82
Rate for Payer: UnitedHealthcare Community & State	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

GUIDEWIRE THD W/TROCAR TIP

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270672351
Hospital Revenue Code	278
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

GUIDEWIRE THD W/TROCAR TIP

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270672351
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

Know your out-of-pocket cost for care.

All Charges