Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COIL 400 CPLX XSFT 6MMX15CM

Facility

$11,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695167S
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

COIL 400 CPLX XSFT 7MMX15CM

Facility

$11,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695168S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

COIL 400 CPLX XSFT 7MMX15CM

Facility

$11,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695168S
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

COIL 400 CURVE SFT 2MMX4CM

Facility

$9,135.00

Service Code	HCPCS C1889
Hospital Charge Code	270695170S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,370.25
Max. Negotiated Rate	$2,210.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,827.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,210.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,009.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,370.25

COIL 400 CURVE SFT 2MMX4CM

Facility

$9,135.00

Service Code	HCPCS C1889
Hospital Charge Code	270695170S
Hospital Revenue Code	278
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$4,567.50
Rate for Payer: Aetna Commercial	$3,471.30
Rate for Payer: Aetna Medicare Advantage	$2,740.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,329.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,329.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,329.43
Rate for Payer: Cigna Commercial	$4,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,210.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,009.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,370.25
Rate for Payer: UnitedHealthcare Community & State	$220.15
Rate for Payer: Wellpoint Medicaid Managed Care	$242.08

COIL CK EMBOLIZATION 251719

Facility

$540.00

Service Code	HCPCS C1884
Hospital Charge Code	270626429
Hospital Revenue Code	278
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$14.31

COIL CK EMBOLIZATION 251719

Facility

$540.00

Service Code	HCPCS C1884
Hospital Charge Code	270626429
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

COIL CK EMBOLIZATION 274349

Facility

$540.00

Service Code	HCPCS C1884
Hospital Charge Code	270627557
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

COIL CK EMBOLIZATION 274349

Facility

$540.00

Service Code	HCPCS C1884
Hospital Charge Code	270627557
Hospital Revenue Code	278
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$14.31

COIL DET TARGET TETRA1.5MMX3CM

Facility

$10,516.00

Service Code	HCPCS C1889
Hospital Charge Code	270699483S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,577.40
Max. Negotiated Rate	$2,544.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,103.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,544.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,313.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,577.40

COIL DET TARGET TETRA1.5MMX3CM

Facility

$10,516.00

Service Code	HCPCS C1889
Hospital Charge Code	270699483S
Hospital Revenue Code	278
Min. Negotiated Rate	$253.44
Max. Negotiated Rate	$5,258.00
Rate for Payer: Aetna Commercial	$3,996.08
Rate for Payer: Aetna Medicare Advantage	$3,154.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,681.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,681.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,103.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,681.58
Rate for Payer: Cigna Commercial	$5,258.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,544.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,313.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,577.40
Rate for Payer: UnitedHealthcare Community & State	$253.44
Rate for Payer: Wellpoint Medicaid Managed Care	$278.67

COILDETTARGETTETRA 2.5MMX4.5CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699012S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,917.75
Max. Negotiated Rate	$3,093.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,812.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75

COILDETTARGETTETRA 2.5MMX4.5CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699012S
Hospital Revenue Code	278
Min. Negotiated Rate	$308.12
Max. Negotiated Rate	$6,392.50
Rate for Payer: Aetna Commercial	$4,858.30
Rate for Payer: Aetna Medicare Advantage	$3,835.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,260.18
Rate for Payer: Cigna Commercial	$6,392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,812.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75
Rate for Payer: UnitedHealthcare Community & State	$308.12
Rate for Payer: Wellpoint Medicaid Managed Care	$338.80

COIL DETTARGET TETRA 2MMX3.5CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699010S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,917.75
Max. Negotiated Rate	$3,093.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,812.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75

COIL DETTARGET TETRA 2MMX3.5CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699010S
Hospital Revenue Code	278
Min. Negotiated Rate	$308.12
Max. Negotiated Rate	$6,392.50
Rate for Payer: Aetna Commercial	$4,858.30
Rate for Payer: Aetna Medicare Advantage	$3,835.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,260.18
Rate for Payer: Cigna Commercial	$6,392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,812.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75
Rate for Payer: UnitedHealthcare Community & State	$308.12
Rate for Payer: Wellpoint Medicaid Managed Care	$338.80

COILDETTARGET TETRA 3.5MMX10CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699014S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,917.75
Max. Negotiated Rate	$3,093.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,812.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75

COILDETTARGET TETRA 3.5MMX10CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699014S
Hospital Revenue Code	278
Min. Negotiated Rate	$308.12
Max. Negotiated Rate	$6,392.50
Rate for Payer: Aetna Commercial	$4,858.30
Rate for Payer: Aetna Medicare Advantage	$3,835.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,260.18
Rate for Payer: Cigna Commercial	$6,392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,812.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75
Rate for Payer: UnitedHealthcare Community & State	$308.12
Rate for Payer: Wellpoint Medicaid Managed Care	$338.80

COIL EMBO 10/5 12.5 CM

Facility

$480.00

Hospital Charge Code	270626428
Hospital Revenue Code	278
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

COIL EMBO 10/5 12.5 CM

Facility

$480.00

Hospital Charge Code	270626428
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL EMBO 18S-6/2 7CM

Facility

$480.00

Hospital Charge Code	270669488
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL EMBO 18S-6/2 7CM

Facility

$480.00

Hospital Charge Code	270669488
Hospital Revenue Code	278
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

COIL EMBO 35-10/4 12.5CM

Facility

$480.00

Hospital Charge Code	270669492
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL EMBO 35-10/4 12.5CM

Facility

$480.00

Hospital Charge Code	270669492
Hospital Revenue Code	278
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

COIL EMBO 35-8/4 8CM

Facility

$480.00

Hospital Charge Code	270669491
Hospital Revenue Code	278
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

COIL EMBO 35-8/4 8CM

Facility

$480.00

Hospital Charge Code	270669491
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

Know your out-of-pocket cost for care.

All Charges