Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE VERSACORE MOD J 300

Facility

$4,625.00

Hospital Charge Code	270643991C
Hospital Revenue Code	278
Min. Negotiated Rate	$693.75
Max. Negotiated Rate	$1,119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$925.00
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

GUIDEWIRE VICTORY .014X300MM

Facility

$1,055.75

Service Code	HCPCS C1769
Hospital Charge Code	270670087
Hospital Revenue Code	278
Min. Negotiated Rate	$158.36
Max. Negotiated Rate	$255.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$232.26
Rate for Payer: Qualcare PPO/HMO/WC	$158.36

GUIDEWIRE VICTORY .014X300MM

Facility

$1,055.75

Service Code	HCPCS C1769
Hospital Charge Code	270670087
Hospital Revenue Code	278
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$527.88
Rate for Payer: Aetna Commercial	$401.19
Rate for Payer: Aetna Medicare Advantage	$316.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.22
Rate for Payer: Cigna Commercial	$527.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$232.26
Rate for Payer: Qualcare PPO/HMO/WC	$158.36
Rate for Payer: UnitedHealthcare Community & State	$25.44
Rate for Payer: Wellpoint Medicaid Managed Care	$27.98

GUIDEWIRE VICTORY 18 300CM 30G

Facility

$1,004.25

Service Code	HCPCS C1769
Hospital Charge Code	270670165
Hospital Revenue Code	278
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$502.12
Rate for Payer: Aetna Commercial	$381.62
Rate for Payer: Aetna Medicare Advantage	$301.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.08
Rate for Payer: Cigna Commercial	$502.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.94
Rate for Payer: Qualcare PPO/HMO/WC	$150.64
Rate for Payer: UnitedHealthcare Community & State	$24.20
Rate for Payer: Wellpoint Medicaid Managed Care	$26.61

GUIDEWIRE VICTORY 18 300CM 30G

Facility

$1,004.25

Service Code	HCPCS C1769
Hospital Charge Code	270670165
Hospital Revenue Code	278
Min. Negotiated Rate	$150.64
Max. Negotiated Rate	$243.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.94
Rate for Payer: Qualcare PPO/HMO/WC	$150.64

GUIDEWIRE VICTORY 4FR .14x300

Facility

$849.75

Hospital Charge Code	270676381
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$424.88
Rate for Payer: Aetna Commercial	$322.90
Rate for Payer: Aetna Medicare Advantage	$254.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.69
Rate for Payer: Cigna Commercial	$424.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$186.94
Rate for Payer: Qualcare PPO/HMO/WC	$127.46
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

GUIDEWIRE VICTORY 4FR .14x300

Facility

$849.75

Hospital Charge Code	270676381
Hospital Revenue Code	278
Min. Negotiated Rate	$127.46
Max. Negotiated Rate	$205.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$186.94
Rate for Payer: Qualcare PPO/HMO/WC	$127.46

GUIDEWIRE VIPER FLEX TIP .014

Facility

$850.00

Service Code	HCPCS C1769
Hospital Charge Code	270676797S
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

GUIDEWIRE VIPER FLEX TIP .014

Facility

$850.00

Hospital Charge Code	270676797
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

GUIDEWIRE VIPER FLEX TIP .014

Facility

$850.00

Service Code	HCPCS C1769
Hospital Charge Code	270676797S
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

GUIDEWIRE VIPER FLEX TIP .014

Facility

$850.00

Hospital Charge Code	270676797
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

GUIDEWIRE VIPER FLEX TIP .017

Facility

$850.00

Hospital Charge Code	270676798
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

GUIDEWIRE VIPER FLEX TIP .017

Facility

$850.00

Hospital Charge Code	270676798
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106S
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$850.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106N
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$850.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106N
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106A
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106C
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106S
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GUIDEWIRE VIPERWIRE ADVANCE

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270645106A
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

GUIDEWIREW .86

Facility

$50.00

Service Code	HCPCS C1769
Hospital Charge Code	270656518
Hospital Revenue Code	278
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$12.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

GUIDEWIREW .86

Facility

$50.00

Service Code	HCPCS C1769
Hospital Charge Code	270656518
Hospital Revenue Code	278
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

Know your out-of-pocket cost for care.

All Charges