Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COIL EMBO 4/2 4CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629011N
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 4/2 4CM

Facility

$550.65

Service Code	HCPCS C1884
Hospital Charge Code	270629011
Hospital Revenue Code	278
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$275.32
Rate for Payer: Aetna Commercial	$209.25
Rate for Payer: Aetna Medicare Advantage	$165.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.42
Rate for Payer: Cigna Commercial	$275.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.14
Rate for Payer: Qualcare PPO/HMO/WC	$82.60
Rate for Payer: UnitedHealthcare Community & State	$13.27
Rate for Payer: Wellpoint Medicaid Managed Care	$14.59

COIL EMBO 4/2 4CM

Facility

$550.65

Service Code	HCPCS C1884
Hospital Charge Code	270629011
Hospital Revenue Code	278
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$133.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.14
Rate for Payer: Qualcare PPO/HMO/WC	$82.60

COIL EMBO 4/2 4CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629011N
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 5/2 5CM

Facility

$550.65

Service Code	HCPCS C1884
Hospital Charge Code	270629012
Hospital Revenue Code	278
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$275.32
Rate for Payer: Aetna Commercial	$209.25
Rate for Payer: Aetna Medicare Advantage	$165.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.42
Rate for Payer: Cigna Commercial	$275.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.14
Rate for Payer: Qualcare PPO/HMO/WC	$82.60
Rate for Payer: UnitedHealthcare Community & State	$13.27
Rate for Payer: Wellpoint Medicaid Managed Care	$14.59

COIL EMBO 5/2 5CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629012N
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 5/2 5CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629012N
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 5/2 5CM

Facility

$550.65

Service Code	HCPCS C1884
Hospital Charge Code	270629012
Hospital Revenue Code	278
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$133.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.14
Rate for Payer: Qualcare PPO/HMO/WC	$82.60

COIL EMBO 5/5 5CM

Facility

$480.00

Hospital Charge Code	270669487
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 5/5 5CM

Facility

$480.00

Hospital Charge Code	270669487
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 6/3 5.8 CM

Facility

$480.00

Hospital Charge Code	270658348
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 6/3 5.8 CM

Facility

$480.00

Hospital Charge Code	270658348
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 7/3 8CM

Facility

$480.00

Hospital Charge Code	270669490
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 7/3 8CM

Facility

$480.00

Hospital Charge Code	270669490
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 7/3 9CM

Facility

$480.00

Hospital Charge Code	270669489
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 7/3 9CM

Facility

$480.00

Hospital Charge Code	270669489
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 EMBOLI INTERLOCK 3MMx12CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669769
Hospital Revenue Code	278
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

COIL EMBOLI INTERLOCK 3MMx12CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669769
Hospital Revenue Code	278
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$622.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

COIL EMBOLI INTERLOCK 3MMX6CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669775
Hospital Revenue Code	278
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

COIL EMBOLI INTERLOCK 3MMX6CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669775S
Hospital Revenue Code	278
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$622.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

COIL EMBOLI INTERLOCK 3MMX6CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669775S
Hospital Revenue Code	278
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

COIL EMBOLI INTERLOCK 3MMX6CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669775
Hospital Revenue Code	278
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$622.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

COIL EMBOLI INTERLOCK 4MMX8CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669772
Hospital Revenue Code	278
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Community & State	$62.00
Rate for Payer: Wellpoint Medicaid Managed Care	$68.17

COIL EMBOLI INTERLOCK 4MMX8CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669772
Hospital Revenue Code	278
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$622.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

COIL EMBOLI INTERLOCK 4MMX8CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669772S
Hospital Revenue Code	278
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$622.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.95
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

Know your out-of-pocket cost for care.

All Charges