Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WIRE EMBOSHIELD WORKHORSE 315

Facility

$625.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423
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

WIRE EMBOSHIELD WORKHORSE 315

Facility

$625.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423
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

WIRE EMBOSHIELD WORKHORSE 315

Facility

$625.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423S
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

WIRE EMBOSHIELD WORKHORSE 315

Facility

$140.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423N
Hospital Revenue Code	278
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

WIRE EMBOSHIELD WORKHORSE 315

Facility

$140.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423N
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

WIRE EMBOSHIELD WORKHORSE 315

Facility

$625.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423S
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

WIRE ENTRY GUIDE 3.2X320MM

Facility

$800.00

Hospital Charge Code	270678876
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

WIRE ENTRY GUIDE 3.2X320MM

Facility

$800.00

Hospital Charge Code	270678876
Hospital Revenue Code	272
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) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

WIRE EXT W OLIVE TIP 1.8X450MM

Facility

$652.70

Service Code	HCPCS C1713
Hospital Charge Code	270699598
Hospital Revenue Code	278
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$326.35
Rate for Payer: Aetna Commercial	$248.03
Rate for Payer: Aetna Medicare Advantage	$195.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.44
Rate for Payer: Cigna Commercial	$326.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.59
Rate for Payer: Qualcare PPO/HMO/WC	$97.91
Rate for Payer: UnitedHealthcare Community & State	$15.73
Rate for Payer: Wellpoint Medicaid Managed Care	$17.30

WIRE EXT W OLIVE TIP 1.8X450MM

Facility

$652.70

Service Code	HCPCS C1713
Hospital Charge Code	270699598
Hospital Revenue Code	278
Min. Negotiated Rate	$97.91
Max. Negotiated Rate	$157.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.59
Rate for Payer: Qualcare PPO/HMO/WC	$97.91

WIRE EXT W OLIVE TIP 2.0X450MM

Facility

$674.05

Service Code	HCPCS C1713
Hospital Charge Code	270699599
Hospital Revenue Code	278
Min. Negotiated Rate	$16.24
Max. Negotiated Rate	$337.02
Rate for Payer: Aetna Commercial	$256.14
Rate for Payer: Aetna Medicare Advantage	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.88
Rate for Payer: Cigna Commercial	$337.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$148.29
Rate for Payer: Qualcare PPO/HMO/WC	$101.11
Rate for Payer: UnitedHealthcare Community & State	$16.24
Rate for Payer: Wellpoint Medicaid Managed Care	$17.86

WIRE EXT W OLIVE TIP 2.0X450MM

Facility

$674.05

Service Code	HCPCS C1713
Hospital Charge Code	270699599
Hospital Revenue Code	278
Min. Negotiated Rate	$101.11
Max. Negotiated Rate	$163.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$148.29
Rate for Payer: Qualcare PPO/HMO/WC	$101.11

WIRE FIBER SIZE #2

Facility

$110.00

Hospital Charge Code	270624619
Hospital Revenue Code	272
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.00
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

WIRE FIBER SIZE #2

Facility

$110.00

Hospital Charge Code	270624619
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

WIRE FIBER SIZE #5 AR7211

Facility

$200.00

Hospital Charge Code	270642317
Hospital Revenue Code	272
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

WIRE FIBER SIZE #5 AR7211

Facility

$200.00

Hospital Charge Code	270642317
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

WIRE FIBER SZ1

Facility

$105.00

Hospital Charge Code	270676891
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

WIRE FIBER SZ1

Facility

$105.00

Hospital Charge Code	270676891
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

WIRE FILTER 190cm 19503-190

Facility

$6,423.25

Hospital Charge Code	270633492
Hospital Revenue Code	278
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$3,211.62
Rate for Payer: Aetna Commercial	$2,440.84
Rate for Payer: Aetna Medicare Advantage	$1,926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,637.93
Rate for Payer: Cigna Commercial	$3,211.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,413.12
Rate for Payer: Qualcare PPO/HMO/WC	$963.49
Rate for Payer: UnitedHealthcare Community & State	$154.80
Rate for Payer: Wellpoint Medicaid Managed Care	$170.22

WIRE FILTER 190cm 19503-190

Facility

$6,423.25

Hospital Charge Code	270633492
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$1,554.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,413.12
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

WIRE FILTER EZ 190cc 20100190

Facility

$6,423.25

Hospital Charge Code	270633783
Hospital Revenue Code	278
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$3,211.62
Rate for Payer: Aetna Commercial	$2,440.84
Rate for Payer: Aetna Medicare Advantage	$1,926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,637.93
Rate for Payer: Cigna Commercial	$3,211.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,413.12
Rate for Payer: Qualcare PPO/HMO/WC	$963.49
Rate for Payer: UnitedHealthcare Community & State	$154.80
Rate for Payer: Wellpoint Medicaid Managed Care	$170.22

WIRE FILTER EZ 190cc 20100190

Facility

$6,423.25

Hospital Charge Code	270633783
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$1,554.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,413.12
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

WIRE GLIDE MCV .38 ********

Facility

$673.00

Hospital Charge Code	1604560
Hospital Revenue Code	272
Min. Negotiated Rate	$100.95
Max. Negotiated Rate	$100.95
Rate for Payer: Qualcare PPO/HMO/WC	$100.95

WIRE GLIDE MCV .38 ********

Facility

$673.00

Hospital Charge Code	1604560
Hospital Revenue Code	272
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$336.50
Rate for Payer: Aetna Commercial	$255.74
Rate for Payer: Aetna Medicare Advantage	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.62
Rate for Payer: Cigna Commercial	$336.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: Oxford Commercial	$134.60
Rate for Payer: Qualcare PPO/HMO/WC	$100.95
Rate for Payer: UnitedHealthcare Commercial	$134.60
Rate for Payer: UnitedHealthcare Community & State	$16.22
Rate for Payer: Wellpoint Medicaid Managed Care	$17.83

WIREGUARD PAPILLOTON***

Facility

$942.00

Hospital Charge Code	2300564
Hospital Revenue Code	279
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

Know your out-of-pocket cost for care.

All Charges