Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$42.00

Hospital Charge Code	1604446
Hospital Revenue Code	272
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

WIRE GUIDE MCV TFL .028 *****

Facility

$42.00

Hospital Charge Code	1604404
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

WIRE GUIDE MCV TFL .028 *****

Facility

$42.00

Hospital Charge Code	1604404
Hospital Revenue Code	272
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

WIRE GUIDE MT .025 46-126 ***

Facility

$195.00

Hospital Charge Code	1604420
Hospital Revenue Code	272
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

WIRE GUIDE MT .025 46-126 ***

Facility

$195.00

Hospital Charge Code	1604420
Hospital Revenue Code	272
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

WIRE GUIDE MT 46-155 ******

Facility

$135.00

Hospital Charge Code	1604412
Hospital Revenue Code	272
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

WIRE GUIDE MT 46-155 ******

Facility

$135.00

Hospital Charge Code	1604412
Hospital Revenue Code	272
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$27.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

Wire Guides

Facility

$1,135.00

Service Code	HCPCS C1769
Hospital Charge Code	270685513
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

Wire Guides

Facility

$1,135.00

Service Code	HCPCS C1769
Hospital Charge Code	270685513
Hospital Revenue Code	278
Min. Negotiated Rate	$27.35
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$431.30
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25
Rate for Payer: UnitedHealthcare Community & State	$27.35
Rate for Payer: Wellpoint Medicaid Managed Care	$30.08

Wire Guides

Facility

$1,135.00

Service Code	HCPCS C1769
Hospital Charge Code	270685512
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

Wire Guides

Facility

$1,135.00

Service Code	HCPCS C1769
Hospital Charge Code	270685512
Hospital Revenue Code	278
Min. Negotiated Rate	$27.35
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$431.30
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25
Rate for Payer: UnitedHealthcare Community & State	$27.35
Rate for Payer: Wellpoint Medicaid Managed Care	$30.08

WIRE GUIDE TEF TSCM38 145.3***

Facility

$51.00

Hospital Charge Code	1604438
Hospital Revenue Code	272
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

WIRE GUIDE TEF TSCM38 145.3***

Facility

$51.00

Hospital Charge Code	1604438
Hospital Revenue Code	272
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

WIRE GUIDE THREADED 3.2x300MM

Facility

$1,020.00

Hospital Charge Code	270648949
Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

WIRE GUIDE THREADED 3.2x300MM

Facility

$1,020.00

Hospital Charge Code	270648949
Hospital Revenue Code	272
Min. Negotiated Rate	$24.58
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$387.60
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.00
Rate for Payer: Oxford Commercial	$204.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Commercial	$204.00
Rate for Payer: UnitedHealthcare Community & State	$24.58
Rate for Payer: Wellpoint Medicaid Managed Care	$27.03

WIRE G W/ DBL TRCR TIP .45

Facility

$145.00

Hospital Charge Code	270688769
Hospital Revenue Code	272
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

WIRE G W/ DBL TRCR TIP .45

Facility

$145.00

Hospital Charge Code	270688769
Hospital Revenue Code	272
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.50
Rate for Payer: Oxford Commercial	$29.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$29.00
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

WIRE HMD GUIDE 3 750 3371-1015

Facility

$1,104.85

Hospital Charge Code	270611707
Hospital Revenue Code	278
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$419.84
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$243.07
Rate for Payer: Qualcare PPO/HMO/WC	$165.73
Rate for Payer: UnitedHealthcare Community & State	$26.63
Rate for Payer: Wellpoint Medicaid Managed Care	$29.28

WIRE HMD GUIDE 3 750 3371-1015

Facility

$1,104.85

Hospital Charge Code	270611707
Hospital Revenue Code	278
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$267.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$243.07
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

WIRE HMD K .062 9 3813-3090

Facility

$54.45

Hospital Charge Code	270619736
Hospital Revenue Code	272
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

WIRE HMD K .062 9 3813-3090

Facility

$54.45

Hospital Charge Code	270619736
Hospital Revenue Code	272
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$27.23
Rate for Payer: Aetna Commercial	$20.69
Rate for Payer: Aetna Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.88
Rate for Payer: Cigna Commercial	$27.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Oxford Commercial	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$8.17
Rate for Payer: UnitedHealthcare Commercial	$10.89
Rate for Payer: UnitedHealthcare Community & State	$1.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

WIRE HMD K 3.2 450MM 3371

Facility

$460.85

Hospital Charge Code	270611706
Hospital Revenue Code	278
Min. Negotiated Rate	$69.13
Max. Negotiated Rate	$111.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.39
Rate for Payer: Qualcare PPO/HMO/WC	$69.13

WIRE HMD K 3.2 450MM 3371

Facility

$460.85

Hospital Charge Code	270611706
Hospital Revenue Code	278
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$230.43
Rate for Payer: Aetna Commercial	$175.12
Rate for Payer: Aetna Medicare Advantage	$138.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.52
Rate for Payer: Cigna Commercial	$230.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.39
Rate for Payer: Qualcare PPO/HMO/WC	$69.13
Rate for Payer: UnitedHealthcare Community & State	$11.11
Rate for Payer: Wellpoint Medicaid Managed Care	$12.21

WIRE INSERTION TOOL 25/BX

Facility

$21.50

Hospital Charge Code	2709002685
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$3.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.23

WIRE INSERTION TOOL 25/BX

Facility

$21.50

Hospital Charge Code	2709002685
Hospital Revenue Code	272
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.75
Rate for Payer: Aetna Commercial	$8.17
Rate for Payer: Aetna Medicare Advantage	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.48
Rate for Payer: Cigna Commercial	$10.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.45
Rate for Payer: Oxford Commercial	$4.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.23
Rate for Payer: UnitedHealthcare Commercial	$4.30
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

Know your out-of-pocket cost for care.

All Charges