Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WIRE K SYN 1.6 150MM 492.16**

Facility

$18.00

Hospital Charge Code	1604016
Hospital Revenue Code	278
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

WIRE K SYN 1.6 150MM 492.16**

Facility

$18.00

Hospital Charge Code	1604016
Hospital Revenue Code	278
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

WIRE K SYN 2.0 150MM 492.20***

Facility

$18.00

Hospital Charge Code	1604008
Hospital Revenue Code	278
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

WIRE K SYN 2.0 150MM 492.20***

Facility

$18.00

Hospital Charge Code	1604008
Hospital Revenue Code	278
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

WIRE K TROCAR POINT BOTH ENDS

Facility

$31.25

Hospital Charge Code	270653113
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.62
Rate for Payer: Aetna Commercial	$11.88
Rate for Payer: Aetna Medicare Advantage	$9.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.97
Rate for Payer: Cigna Commercial	$15.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.38
Rate for Payer: Oxford Commercial	$6.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.69
Rate for Payer: UnitedHealthcare Commercial	$6.25
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

WIRE K TROCAR POINT BOTH ENDS

Facility

$31.25

Hospital Charge Code	270653113
Hospital Revenue Code	270
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$4.69
Rate for Payer: Qualcare PPO/HMO/WC	$4.69

WIRE K ZIM .032 .045 .062*****

Facility

$15.00

Hospital Charge Code	1601558
Hospital Revenue Code	278
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

WIRE K ZIM .032 .045 .062*****

Facility

$15.00

Hospital Charge Code	1601558
Hospital Revenue Code	278
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$3.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

WIRE K ZIM DBLED 1/32 3/64****

Facility

$16.00

Hospital Charge Code	1602192
Hospital Revenue Code	278
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.52
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

WIRE K ZIM DBLED 1/32 3/64****

Facility

$16.00

Hospital Charge Code	1602192
Hospital Revenue Code	278
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3.52
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

WIRE LAUREATE HYDROPHILIC .03

Facility

$165.00

Hospital Charge Code	270664781
Hospital Revenue Code	270
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

WIRE LAUREATE HYDROPHILIC .03

Facility

$165.00

Hospital Charge Code	270664781
Hospital Revenue Code	270
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$82.50
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.50
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Commercial	$33.00
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

WIRE LAUREATE HYDROPHILIC .03

Facility

$160.00

Hospital Charge Code	270664782
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

WIRE LAUREATE HYDROPHILIC .03

Facility

$160.00

Hospital Charge Code	270664782
Hospital Revenue Code	270
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.00
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$32.00
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

WIRE LEAD ECG BLACK

Facility

$37.65

Hospital Charge Code	270061460
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.82
Rate for Payer: Aetna Commercial	$14.31
Rate for Payer: Aetna Medicare Advantage	$11.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.60
Rate for Payer: Cigna Commercial	$18.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.29
Rate for Payer: Oxford Commercial	$7.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.65
Rate for Payer: UnitedHealthcare Commercial	$7.53
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

WIRE LEAD ECG BLACK

Facility

$37.65

Hospital Charge Code	270061460
Hospital Revenue Code	272
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

WIRE LEAD ECG RED

Facility

$37.65

Hospital Charge Code	270061455
Hospital Revenue Code	279
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.82
Rate for Payer: Aetna Commercial	$14.31
Rate for Payer: Aetna Medicare Advantage	$11.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.60
Rate for Payer: Cigna Commercial	$18.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.29
Rate for Payer: Oxford Commercial	$7.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.65
Rate for Payer: UnitedHealthcare Commercial	$7.53
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

WIRE LEAD ECG RED

Facility

$37.65

Hospital Charge Code	270061455
Hospital Revenue Code	279
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

WIRE LEAD ECG WHITE

Facility

$37.65

Hospital Charge Code	270061475
Hospital Revenue Code	279
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

WIRE LEAD ECG WHITE

Facility

$37.65

Hospital Charge Code	270061475
Hospital Revenue Code	279
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.82
Rate for Payer: Aetna Commercial	$14.31
Rate for Payer: Aetna Medicare Advantage	$11.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.60
Rate for Payer: Cigna Commercial	$18.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.29
Rate for Payer: Oxford Commercial	$7.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.65
Rate for Payer: UnitedHealthcare Commercial	$7.53
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

WIRELES EXTNL NEURO STIMULATOR

Facility

$6,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270683933
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

WIRELES EXTNL NEURO STIMULATOR

Facility

$6,500.00

Service Code	HCPCS C1767
Hospital Charge Code	270683933
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

WIRE LUQUE CERCLAGE 1.2x30MM

Facility

$194.95

Hospital Charge Code	270601381
Hospital Revenue Code	272
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$29.24
Rate for Payer: Qualcare PPO/HMO/WC	$29.24

WIRE LUQUE CERCLAGE 1.2x30MM

Facility

$194.95

Hospital Charge Code	270601381
Hospital Revenue Code	272
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.47
Rate for Payer: Aetna Commercial	$74.08
Rate for Payer: Aetna Medicare Advantage	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.71
Rate for Payer: Cigna Commercial	$97.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.48
Rate for Payer: Oxford Commercial	$38.99
Rate for Payer: Qualcare PPO/HMO/WC	$29.24
Rate for Payer: UnitedHealthcare Commercial	$38.99
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

WIRE LUQUE CERCLAGE .97x20MM

Facility

$194.95

Hospital Charge Code	270677271
Hospital Revenue Code	272
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$29.24
Rate for Payer: Qualcare PPO/HMO/WC	$29.24

Know your out-of-pocket cost for care.

All Charges