Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WIRE MCV ZEBRA 450CM 5168

Facility

$500.00

Service Code	HCPCS C1769
Hospital Charge Code	270604746
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

WIRE MCV ZEBRA 450CM 5168

Facility

$500.00

Service Code	HCPCS C1769
Hospital Charge Code	270604746
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

WIRE MCV ZEBRA 450CM 5169

Facility

$1,021.65

Hospital Charge Code	270604747
Hospital Revenue Code	278
Min. Negotiated Rate	$153.25
Max. Negotiated Rate	$247.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$224.76
Rate for Payer: Qualcare PPO/HMO/WC	$153.25

WIRE MCV ZEBRA 450CM 5169

Facility

$1,021.65

Hospital Charge Code	270604747
Hospital Revenue Code	278
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$510.82
Rate for Payer: Aetna Commercial	$388.23
Rate for Payer: Aetna Medicare Advantage	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.52
Rate for Payer: Cigna Commercial	$510.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$224.76
Rate for Payer: Qualcare PPO/HMO/WC	$153.25
Rate for Payer: UnitedHealthcare Community & State	$24.62
Rate for Payer: Wellpoint Medicaid Managed Care	$27.07

WIRE NCT GUIDE ENDBRONC 083029

Facility

$53.80

Hospital Charge Code	270600831
Hospital Revenue Code	270
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

WIRE NCT GUIDE ENDBRONC 083029

Facility

$53.80

Hospital Charge Code	270600831
Hospital Revenue Code	270
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

WIRE NITIROL 1.0mm 234-030-027

Facility

$128.85

Hospital Charge Code	270626965
Hospital Revenue Code	278
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$64.42
Rate for Payer: Aetna Commercial	$48.96
Rate for Payer: Aetna Medicare Advantage	$38.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.86
Rate for Payer: Cigna Commercial	$64.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.33
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.41

WIRE NITIROL 1.0mm 234-030-027

Facility

$128.85

Hospital Charge Code	270626965
Hospital Revenue Code	278
Min. Negotiated Rate	$19.33
Max. Negotiated Rate	$31.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.33

WIRE NITREX GUIDEWIRED STIFF

Facility

$233.33

Hospital Charge Code	270653899
Hospital Revenue Code	272
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.00

WIRE NITREX GUIDEWIRED STIFF

Facility

$233.33

Hospital Charge Code	270653899S
Hospital Revenue Code	272
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.00

WIRE NITREX GUIDEWIRED STIFF

Facility

$233.33

Hospital Charge Code	270653899
Hospital Revenue Code	272
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$116.67
Rate for Payer: Aetna Commercial	$88.67
Rate for Payer: Aetna Medicare Advantage	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.50
Rate for Payer: Cigna Commercial	$116.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.00
Rate for Payer: Oxford Commercial	$46.67
Rate for Payer: Qualcare PPO/HMO/WC	$35.00
Rate for Payer: UnitedHealthcare Commercial	$46.67
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.18

WIRE NITREX GUIDEWIRED STIFF

Facility

$233.33

Hospital Charge Code	270653899N
Hospital Revenue Code	272
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.00

WIRE NITREX GUIDEWIRED STIFF

Facility

$233.33

Hospital Charge Code	270653899R
Hospital Revenue Code	272
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.00

WIRE NITREX GUIDEWIRED STIFF

Facility

$233.33

Hospital Charge Code	270653899S
Hospital Revenue Code	272
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$116.67
Rate for Payer: Aetna Commercial	$88.67
Rate for Payer: Aetna Medicare Advantage	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.50
Rate for Payer: Cigna Commercial	$116.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.00
Rate for Payer: Oxford Commercial	$46.67
Rate for Payer: Qualcare PPO/HMO/WC	$35.00
Rate for Payer: UnitedHealthcare Commercial	$46.67
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.18

WIRE NITREX GUIDEWIRED STIFF

Facility

$233.33

Hospital Charge Code	270653899N
Hospital Revenue Code	272
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$116.67
Rate for Payer: Aetna Commercial	$88.67
Rate for Payer: Aetna Medicare Advantage	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.50
Rate for Payer: Cigna Commercial	$116.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.00
Rate for Payer: Oxford Commercial	$46.67
Rate for Payer: Qualcare PPO/HMO/WC	$35.00
Rate for Payer: UnitedHealthcare Commercial	$46.67
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.18

WIRE NITREX GUIDEWIRED STIFF

Facility

$233.33

Hospital Charge Code	270653899R
Hospital Revenue Code	272
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$116.67
Rate for Payer: Aetna Commercial	$88.67
Rate for Payer: Aetna Medicare Advantage	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.50
Rate for Payer: Cigna Commercial	$116.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.00
Rate for Payer: Oxford Commercial	$46.67
Rate for Payer: Qualcare PPO/HMO/WC	$35.00
Rate for Payer: UnitedHealthcare Commercial	$46.67
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.18

WIRE OLIVE

Facility

$920.00

Hospital Charge Code	270661007
Hospital Revenue Code	279
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.00

WIRE OLIVE

Facility

$920.00

Hospital Charge Code	270661007
Hospital Revenue Code	279
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$460.00
Rate for Payer: Aetna Commercial	$349.60
Rate for Payer: Aetna Medicare Advantage	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.60
Rate for Payer: Cigna Commercial	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.00
Rate for Payer: Oxford Commercial	$184.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.00
Rate for Payer: UnitedHealthcare Commercial	$184.00
Rate for Payer: UnitedHealthcare Community & State	$22.17
Rate for Payer: Wellpoint Medicaid Managed Care	$24.38

WIRE OLIVE, 1.1MM

Facility

$150.00

Hospital Charge Code	270657194
Hospital Revenue Code	272
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

WIRE OLIVE, 1.1MM

Facility

$150.00

Hospital Charge Code	270657194
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

WIRE OLIVE 1.25 MM

Facility

$742.50

Service Code	HCPCS C1713
Hospital Charge Code	270692341
Hospital Revenue Code	278
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$371.25
Rate for Payer: Aetna Commercial	$282.15
Rate for Payer: Aetna Medicare Advantage	$222.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.34
Rate for Payer: Cigna Commercial	$371.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$111.38
Rate for Payer: UnitedHealthcare Community & State	$17.89
Rate for Payer: Wellpoint Medicaid Managed Care	$19.68

WIRE OLIVE 1.25 MM

Facility

$742.50

Service Code	HCPCS C1713
Hospital Charge Code	270692341
Hospital Revenue Code	278
Min. Negotiated Rate	$111.38
Max. Negotiated Rate	$179.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$111.38

WIRE OLIVE 1.25MM

Facility

$742.50

Service Code	HCPCS C1713
Hospital Charge Code	270695537
Hospital Revenue Code	278
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$371.25
Rate for Payer: Aetna Commercial	$282.15
Rate for Payer: Aetna Medicare Advantage	$222.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.34
Rate for Payer: Cigna Commercial	$371.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$111.38
Rate for Payer: UnitedHealthcare Community & State	$17.89
Rate for Payer: Wellpoint Medicaid Managed Care	$19.68

WIRE OLIVE 1.25MM

Facility

$742.50

Service Code	HCPCS C1713
Hospital Charge Code	270695537
Hospital Revenue Code	278
Min. Negotiated Rate	$111.38
Max. Negotiated Rate	$179.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$111.38

WIRE OLIVE SALVATION 2MM

Facility

$875.00

Hospital Charge Code	270684457
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

Know your out-of-pocket cost for care.

All Charges