Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE W/TROCAR TIP 2MM

Facility

$250.00

Service Code	HCPCS C1769
Hospital Charge Code	270673451
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

GUIDEWIRE W/TROCAR TIP LAZER

Facility

$100.00

Service Code	HCPCS C1769
Hospital Charge Code	270679304
Hospital Revenue Code	278
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

GUIDEWIRE W/TROCAR TIP LAZER

Facility

$100.00

Service Code	HCPCS C1769
Hospital Charge Code	270679304
Hospital Revenue Code	278
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$24.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

GUIDE WIRE ZEBRA EXCH .025****

Facility

$442.00

Hospital Charge Code	270600944
Hospital Revenue Code	272
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$167.96
Rate for Payer: Aetna Medicare Advantage	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.71
Rate for Payer: Cigna Commercial	$221.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.60
Rate for Payer: Oxford Commercial	$88.40
Rate for Payer: Qualcare PPO/HMO/WC	$66.30
Rate for Payer: UnitedHealthcare Commercial	$88.40
Rate for Payer: UnitedHealthcare Community & State	$10.65
Rate for Payer: Wellpoint Medicaid Managed Care	$11.71

GUIDE WIRE ZEBRA EXCH .025****

Facility

$442.00

Hospital Charge Code	270600944
Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$66.30
Rate for Payer: Qualcare PPO/HMO/WC	$66.30

GUIDEWR ASAHI 6X300CM 14938-01

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270636224
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

GUIDEWR ASAHI 6X300CM 14938-01

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270636224
Hospital Revenue Code	278
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

GUIDEWRE ASH AST 30 PAGH18M371

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116C
Hospital Revenue Code	278
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

GUIDEWRE ASH AST 30 PAGH18M371

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116C
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

GUIDEWRE AZ 260 THSCF352603AES

Facility

$149.65

Hospital Charge Code	270624718
Hospital Revenue Code	278
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$74.83
Rate for Payer: Aetna Commercial	$56.87
Rate for Payer: Aetna Medicare Advantage	$44.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.16
Rate for Payer: Cigna Commercial	$74.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.92
Rate for Payer: Qualcare PPO/HMO/WC	$22.45
Rate for Payer: UnitedHealthcare Community & State	$3.61
Rate for Payer: Wellpoint Medicaid Managed Care	$3.97

GUIDEWRE AZ 260 THSCF352603AES

Facility

$149.65

Hospital Charge Code	270624718
Hospital Revenue Code	278
Min. Negotiated Rate	$22.45
Max. Negotiated Rate	$36.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.92
Rate for Payer: Qualcare PPO/HMO/WC	$22.45

GUIDEWRE CHOICE PT 300 1215401

Facility

$475.00

Service Code	HCPCS C1769
Hospital Charge Code	270637189N
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

GUIDEWRE CHOICE PT 300 1215401

Facility

$475.00

Service Code	HCPCS C1769
Hospital Charge Code	270637189N
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

GUIDEWRE CHOICE PT 300 1215401

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270637189
Hospital Revenue Code	278
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$163.40
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$64.50
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.39

GUIDEWRE CHOICE PT 300 1215401

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270637189
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.60
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWRE CR XT200 300 103313H

Facility

$775.00

Hospital Charge Code	270636704
Hospital Revenue Code	278
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

GUIDEWRE CR XT200 300 103313H

Facility

$775.00

Hospital Charge Code	270636704
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

GUIDEWRE HBS 1.0x125mm 2635100

Facility

$225.00

Hospital Charge Code	270643921
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

GUIDEWRE HBS 1.0x125mm 2635100

Facility

$225.00

Hospital Charge Code	270643921
Hospital Revenue Code	278
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

GUIDEWR STAR 035 150 3J 49182

Facility

$68.65

Hospital Charge Code	270626619V
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

GUIDEWR STAR 035 150 3J 49182

Facility

$68.65

Hospital Charge Code	270626619V
Hospital Revenue Code	278
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$34.33
Rate for Payer: Aetna Commercial	$26.09
Rate for Payer: Aetna Medicare Advantage	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.51
Rate for Payer: Cigna Commercial	$34.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15.10
Rate for Payer: Qualcare PPO/HMO/WC	$10.30
Rate for Payer: UnitedHealthcare Community & State	$1.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1.82

GUIDEWR WHISP 014 300 1005359H

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638395C
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

GUIDEWR WHISP 014 300 1005359H

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638395C
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

GUIDWIRE THREDED 2.0x250 27590

Facility

$625.00

Hospital Charge Code	270639193
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

GUIDWIRE THREDED 2.0x250 27590

Facility

$625.00

Hospital Charge Code	270639193
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

Know your out-of-pocket cost for care.

All Charges