Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WIRE GUIDE COPE MANDRIL 60MM

Facility

$199.70

Service Code	HCPCS C1769
Hospital Charge Code	270658312N
Hospital Revenue Code	278
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$99.85
Rate for Payer: Aetna Commercial	$75.89
Rate for Payer: Aetna Medicare Advantage	$59.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.92
Rate for Payer: Cigna Commercial	$99.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$43.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.95
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

WIRE GUIDE COPE MANDRIL 60MM

Facility

$199.70

Service Code	HCPCS C1769
Hospital Charge Code	270658312
Hospital Revenue Code	278
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$99.85
Rate for Payer: Aetna Commercial	$75.89
Rate for Payer: Aetna Medicare Advantage	$59.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.92
Rate for Payer: Cigna Commercial	$99.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$43.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.95
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

WIRE GUIDE COPE MANDRIL 60MM

Facility

$199.70

Service Code	HCPCS C1769
Hospital Charge Code	270658312S
Hospital Revenue Code	278
Min. Negotiated Rate	$29.95
Max. Negotiated Rate	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$43.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.95

WIRE GUIDE COPE MANDRIL 60MM

Facility

$199.70

Service Code	HCPCS C1769
Hospital Charge Code	270658312N
Hospital Revenue Code	278
Min. Negotiated Rate	$29.95
Max. Negotiated Rate	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$43.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.95

WIRE GUIDE COPE MANDRIL 60MM

Facility

$199.70

Service Code	HCPCS C1769
Hospital Charge Code	270658312
Hospital Revenue Code	278
Min. Negotiated Rate	$29.95
Max. Negotiated Rate	$48.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$43.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.95

WIRE GUIDE COPE MANDRIL 60MM

Facility

$199.70

Service Code	HCPCS C1769
Hospital Charge Code	270658312S
Hospital Revenue Code	278
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$99.85
Rate for Payer: Aetna Commercial	$75.89
Rate for Payer: Aetna Medicare Advantage	$59.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.92
Rate for Payer: Cigna Commercial	$99.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$43.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.95
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

WIREGUIDE CRD .035 503456MJ

Facility

$309.65

Hospital Charge Code	270622623
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$117.67
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

WIREGUIDE CRD .035 503456MJ

Facility

$309.65

Hospital Charge Code	270622623
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

WIREGUIDE CRE 18-20CM

Facility

$1,067.35

Service Code	HCPCS C1769
Hospital Charge Code	270680082
Hospital Revenue Code	278
Min. Negotiated Rate	$25.72
Max. Negotiated Rate	$533.67
Rate for Payer: Aetna Commercial	$405.59
Rate for Payer: Aetna Medicare Advantage	$320.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$213.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.17
Rate for Payer: Cigna Commercial	$533.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$234.82
Rate for Payer: Qualcare PPO/HMO/WC	$160.10
Rate for Payer: UnitedHealthcare Community & State	$25.72
Rate for Payer: Wellpoint Medicaid Managed Care	$28.28

WIREGUIDE CRE 18-20CM

Facility

$1,067.35

Service Code	HCPCS C1769
Hospital Charge Code	270680082
Hospital Revenue Code	278
Min. Negotiated Rate	$160.10
Max. Negotiated Rate	$258.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$213.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$234.82
Rate for Payer: Qualcare PPO/HMO/WC	$160.10

WIRE GUIDE DEFLECTING*****

Facility

$280.00

Hospital Charge Code	1604453
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.00
Rate for Payer: Oxford Commercial	$56.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$56.00
Rate for Payer: UnitedHealthcare Community & State	$6.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.42

WIRE GUIDE DEFLECTING*****

Facility

$280.00

Hospital Charge Code	1604453
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

WIRE GUIDE LUNDERQUIST 180cm

Facility

$2,375.00

Hospital Charge Code	270643990
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

WIRE GUIDE LUNDERQUIST 180cm

Facility

$2,375.00

Hospital Charge Code	270643990
Hospital Revenue Code	272
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.50
Rate for Payer: Oxford Commercial	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$475.00
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

WIRE GUIDE LUNDERQUIST 180cm

Facility

$340.00

Hospital Charge Code	270643990C
Hospital Revenue Code	272
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

WIRE GUIDE LUNDERQUIST 180cm

Facility

$340.00

Hospital Charge Code	270643990C
Hospital Revenue Code	272
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.00
Rate for Payer: Oxford Commercial	$68.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Commercial	$68.00
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

WIRE GUIDE LUNDERQUIST 260CM

Facility

$468.75

Service Code	HCPCS C1769
Hospital Charge Code	270623285N
Hospital Revenue Code	278
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$113.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$103.12
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

WIRE GUIDE LUNDERQUIST 260CM

Facility

$468.75

Service Code	HCPCS C1769
Hospital Charge Code	270623285N
Hospital Revenue Code	278
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$234.38
Rate for Payer: Aetna Commercial	$178.12
Rate for Payer: Aetna Medicare Advantage	$140.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.53
Rate for Payer: Cigna Commercial	$234.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$103.12
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Community & State	$11.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12.42

WIRE GUIDE LUNDERQUIST 260CM

Facility

$592.00

Service Code	HCPCS C1769
Hospital Charge Code	270623285C
Hospital Revenue Code	278
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$143.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.24
Rate for Payer: Qualcare PPO/HMO/WC	$88.80

WIRE GUIDE LUNDERQUIST 260CM

Facility

$592.00

Service Code	HCPCS C1769
Hospital Charge Code	270623285C
Hospital Revenue Code	278
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$296.00
Rate for Payer: Aetna Commercial	$224.96
Rate for Payer: Aetna Medicare Advantage	$177.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.96
Rate for Payer: Cigna Commercial	$296.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.24
Rate for Payer: Qualcare PPO/HMO/WC	$88.80
Rate for Payer: UnitedHealthcare Community & State	$14.27
Rate for Payer: Wellpoint Medicaid Managed Care	$15.69

WIRE GUIDE LUNDERQUIST 300CM

Facility

$556.00

Hospital Charge Code	270677134
Hospital Revenue Code	278
Min. Negotiated Rate	$83.40
Max. Negotiated Rate	$134.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$111.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$122.32
Rate for Payer: Qualcare PPO/HMO/WC	$83.40

WIRE GUIDE LUNDERQUIST 300CM

Facility

$556.00

Hospital Charge Code	270677134
Hospital Revenue Code	278
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$278.00
Rate for Payer: Aetna Commercial	$211.28
Rate for Payer: Aetna Medicare Advantage	$166.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$111.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.78
Rate for Payer: Cigna Commercial	$278.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$122.32
Rate for Payer: Qualcare PPO/HMO/WC	$83.40
Rate for Payer: UnitedHealthcare Community & State	$13.40
Rate for Payer: Wellpoint Medicaid Managed Care	$14.73

WIRE GUIDE MARK SPG AD AW04432

Facility

$87.31

Service Code	HCPCS C1769
Hospital Charge Code	270629902
Hospital Revenue Code	278
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$21.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.21
Rate for Payer: Qualcare PPO/HMO/WC	$13.10

WIRE GUIDE MARK SPG AD AW04432

Facility

$87.31

Service Code	HCPCS C1769
Hospital Charge Code	270629902
Hospital Revenue Code	278
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$43.66
Rate for Payer: Aetna Commercial	$33.18
Rate for Payer: Aetna Medicare Advantage	$26.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.26
Rate for Payer: Cigna Commercial	$43.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.21
Rate for Payer: Qualcare PPO/HMO/WC	$13.10
Rate for Payer: UnitedHealthcare Community & State	$2.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

WIRE GUIDE MCV .038 *******

Facility

$42.00

Hospital Charge Code	1604446
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

Know your out-of-pocket cost for care.

All Charges