Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

COIL EMBOLI INTERLOCK 5MMX8CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669770
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 5MMX8CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669770
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 5MMX8CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669770S
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 5MMX8CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669770S
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 6MMX10CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669771S
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 6MMX10CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669771
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 6MMX10CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669771
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 6MMX10CM

Facility

$2,572.50

Service Code	HCPCS C1884
Hospital Charge Code	270669771S
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 6MMX20CM

Facility

$2,695.00

Service Code	HCPCS C1884
Hospital Charge Code	270669773S
Hospital Revenue Code	278
Min. Negotiated Rate	$64.95
Max. Negotiated Rate	$1,347.50
Rate for Payer: Aetna Commercial	$1,024.10
Rate for Payer: Aetna Medicare Advantage	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.23
Rate for Payer: Cigna Commercial	$1,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25
Rate for Payer: UnitedHealthcare Community & State	$64.95
Rate for Payer: Wellpoint Medicaid Managed Care	$71.42

COIL EMBOLI INTERLOCK 6MMX20CM

Facility

$2,695.00

Service Code	HCPCS C1884
Hospital Charge Code	270669773
Hospital Revenue Code	278
Min. Negotiated Rate	$404.25
Max. Negotiated Rate	$652.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25

COIL EMBOLI INTERLOCK 6MMX20CM

Facility

$2,695.00

Service Code	HCPCS C1884
Hospital Charge Code	270669773S
Hospital Revenue Code	278
Min. Negotiated Rate	$404.25
Max. Negotiated Rate	$652.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25

COIL EMBOLI INTERLOCK 6MMX20CM

Facility

$2,695.00

Service Code	HCPCS C1884
Hospital Charge Code	270669773
Hospital Revenue Code	278
Min. Negotiated Rate	$64.95
Max. Negotiated Rate	$1,347.50
Rate for Payer: Aetna Commercial	$1,024.10
Rate for Payer: Aetna Medicare Advantage	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.23
Rate for Payer: Cigna Commercial	$1,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25
Rate for Payer: UnitedHealthcare Community & State	$64.95
Rate for Payer: Wellpoint Medicaid Managed Care	$71.42

COIL EMBOLI INTRLOCK 12MMX20CM

Facility

$2,695.00

Service Code	HCPCS C1884
Hospital Charge Code	270669774
Hospital Revenue Code	278
Min. Negotiated Rate	$404.25
Max. Negotiated Rate	$652.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25

COIL EMBOLI INTRLOCK 12MMX20CM

Facility

$2,695.00

Service Code	HCPCS C1884
Hospital Charge Code	270669774
Hospital Revenue Code	278
Min. Negotiated Rate	$64.95
Max. Negotiated Rate	$1,347.50
Rate for Payer: Aetna Commercial	$1,024.10
Rate for Payer: Aetna Medicare Advantage	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.23
Rate for Payer: Cigna Commercial	$1,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25
Rate for Payer: UnitedHealthcare Community & State	$64.95
Rate for Payer: Wellpoint Medicaid Managed Care	$71.42

COIL, EMBOLIZATION

Facility

$267.00

Hospital Charge Code	2008145
Hospital Revenue Code	278
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$64.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.74
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

COIL, EMBOLIZATION

Facility

$267.00

Hospital Charge Code	2008145
Hospital Revenue Code	278
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna Commercial	$101.46
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.74
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Community & State	$6.43
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

COIL EMBOLIZATIONHYDRO3D2MM3CM

Facility

$10,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270700464S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

COIL EMBOLIZATIONHYDRO3D2MM3CM

Facility

$10,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270700464S
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

COIL EMBOLIZATION HYDRO 3D 3MM

Facility

$14,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270700463S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,156.25
Max. Negotiated Rate	$3,478.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,478.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,162.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,156.25

COIL EMBOLIZATION HYDRO 3D 3MM

Facility

$14,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270700463S
Hospital Revenue Code	278
Min. Negotiated Rate	$346.44
Max. Negotiated Rate	$7,187.50
Rate for Payer: Aetna Commercial	$5,462.50
Rate for Payer: Aetna Medicare Advantage	$4,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,665.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,665.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,665.62
Rate for Payer: Cigna Commercial	$7,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,478.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,162.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,156.25
Rate for Payer: UnitedHealthcare Community & State	$346.44
Rate for Payer: Wellpoint Medicaid Managed Care	$380.94

COIL EMBOL OPTIMA 2MMX3CM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698130S
Hospital Revenue Code	278
Min. Negotiated Rate	$324.75
Max. Negotiated Rate	$6,737.50
Rate for Payer: Aetna Commercial	$5,120.50
Rate for Payer: Aetna Medicare Advantage	$4,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,436.12
Rate for Payer: Cigna Commercial	$6,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25
Rate for Payer: UnitedHealthcare Community & State	$324.75
Rate for Payer: Wellpoint Medicaid Managed Care	$357.09

COIL EMBOL OPTIMA 2MMX3CM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698130S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$3,260.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

COIL EMBOL OPTIMA 5CMX2.5MM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698129S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$3,260.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

COIL EMBOL OPTIMA 5CMX2.5MM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698129S
Hospital Revenue Code	278
Min. Negotiated Rate	$324.75
Max. Negotiated Rate	$6,737.50
Rate for Payer: Aetna Commercial	$5,120.50
Rate for Payer: Aetna Medicare Advantage	$4,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,436.12
Rate for Payer: Cigna Commercial	$6,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25
Rate for Payer: UnitedHealthcare Community & State	$324.75
Rate for Payer: Wellpoint Medicaid Managed Care	$357.09

Know your out-of-pocket cost for care.

All Charges