Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COIL OCCLUSION DEVICE 8-10MM 6

Facility

$8,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270684527N
Hospital Revenue Code	278
Min. Negotiated Rate	$215.69
Max. Negotiated Rate	$4,475.00
Rate for Payer: Aetna Commercial	$3,401.00
Rate for Payer: Aetna Medicare Advantage	$2,685.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,282.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,282.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,282.25
Rate for Payer: Cigna Commercial	$4,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,165.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,969.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,342.50
Rate for Payer: UnitedHealthcare Community & State	$215.69
Rate for Payer: Wellpoint Medicaid Managed Care	$237.18

COIL OCCLUSION DEVICE 8-10MM 6

Facility

$8,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270684527N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,342.50
Max. Negotiated Rate	$2,165.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,165.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,969.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,342.50

COIL OPTIMA 1MM X 1CM

Facility

$13,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697238S
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 OPTIMA 1MM X 1CM

Facility

$13,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697238S
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 OPTIMA 1MMX2CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697243S
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

COIL OPTIMA 1MMX2CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697243S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

COIL OPTIMA 2MM 3 CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697244S
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

COIL OPTIMA 2MM 3 CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697244S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

COIL OPTIMA 2MM X 2CM

Facility

$13,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697239S
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 OPTIMA 2MM X 2CM

Facility

$13,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697239S
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 OPTIMA 3.5MM X 6CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697247S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

COIL OPTIMA 3.5MM X 6CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697247S
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

COIL OPTIMA 3MM X 6 CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697245S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

COIL OPTIMA 3MM X 6 CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697245S
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

COIL OPTIMA 3MM X 8CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697246S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

COIL OPTIMA 3MM X 8CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697246S
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

COIL OPTIMA 4MMX4CM

Facility

$13,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697746S
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 OPTIMA 4MMX4CM

Facility

$13,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697746S
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 OPTIMA 5MMX9CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697248S
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

COIL OPTIMA 5MMX9CM

Facility

$9,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697248S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

COIL OPTIMA 7MM X 15CM

Facility

$13,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697240S
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 OPTIMA 7MM X 15CM

Facility

$13,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697240S
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 OPTIMA COMP10SS 1.5MMX2CM

Facility

$9,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270697733S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

COIL OPTIMA COMP10SS 1.5MMX2CM

Facility

$9,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270697733S
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

COIL OPTIMA COMP10SS 1.5MMX3CM

Facility

$9,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270697732S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

Know your out-of-pocket cost for care.

All Charges