Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE V-18 .018 200CM

Facility

$435.00

Service Code	HCPCS C1769
Hospital Charge Code	270653649N
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$105.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

GUIDE WIRE V-18 .018 200CM

Facility

$435.00

Service Code	HCPCS C1769
Hospital Charge Code	270653649N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$165.30
Rate for Payer: Aetna Medicare Advantage	$130.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.92
Rate for Payer: Cigna Commercial	$217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$65.25
Rate for Payer: UnitedHealthcare Community & State	$10.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.53

GUIDEWIRE V-18 8x200cm

Facility

$375.00

Hospital Charge Code	270638880C
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE V-18 8x200cm

Facility

$17,975.00

Hospital Charge Code	270641201C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,696.25
Max. Negotiated Rate	$4,349.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,349.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,954.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25

GUIDEWIRE V-18 8x200cm

Facility

$375.00

Hospital Charge Code	270638880C
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

GUIDEWIRE V-18 8x200cm

Facility

$17,975.00

Hospital Charge Code	270641201C
Hospital Revenue Code	278
Min. Negotiated Rate	$433.20
Max. Negotiated Rate	$8,987.50
Rate for Payer: Aetna Commercial	$6,830.50
Rate for Payer: Aetna Medicare Advantage	$5,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,583.62
Rate for Payer: Cigna Commercial	$8,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,349.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,954.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25
Rate for Payer: UnitedHealthcare Community & State	$433.20
Rate for Payer: Wellpoint Medicaid Managed Care	$476.34

GUIDEWIRE V-18 8x200cm

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

GUIDEWIRE V-18 8x200cm

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V-18 8X200CM

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048C
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V-18 8X200CM

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048N
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE V-18 8X200CM

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048C
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

GUIDEWIRE V-18 8X200CM

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048N
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

GUIDEWIRE V-18 8x300cm

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270623260
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

GUIDEWIRE V-18 8x300cm

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270623260
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V18 8X300CM

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270623260S
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V18 8X300CM

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270623260S
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.40
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

GUIDEWIRE VASC .014IN 185CM

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270696459S
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 VASC .014IN 185CM

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270696459S
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 VASC.038IN150CM1.5MM

Facility

$43.00

Service Code	HCPCS C1769
Hospital Charge Code	270646396
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

GUIDEWIRE VASC.038IN150CM1.5MM

Facility

$43.00

Service Code	HCPCS C1769
Hospital Charge Code	270646396
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

GUIDEWIRE VERSACORE MOD J 145

Facility

$550.00

Hospital Charge Code	270644641C
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

GUIDEWIRE VERSACORE MOD J 145

Facility

$550.00

Hospital Charge Code	270644640C
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

GUIDEWIRE VERSACORE MOD J 145

Facility

$550.00

Hospital Charge Code	270644640C
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

GUIDEWIRE VERSACORE MOD J 145

Facility

$550.00

Hospital Charge Code	270644641C
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

GUIDEWIRE VERSACORE MOD J 300

Facility

$4,625.00

Hospital Charge Code	270643991C
Hospital Revenue Code	278
Min. Negotiated Rate	$111.46
Max. Negotiated Rate	$2,312.50
Rate for Payer: Aetna Commercial	$1,757.50
Rate for Payer: Aetna Medicare Advantage	$1,387.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,179.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,179.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,179.38
Rate for Payer: Cigna Commercial	$2,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,017.50
Rate for Payer: Qualcare PPO/HMO/WC	$693.75
Rate for Payer: UnitedHealthcare Community & State	$111.46
Rate for Payer: Wellpoint Medicaid Managed Care	$122.56

Know your out-of-pocket cost for care.

All Charges