Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COIL PENUMBRA SOFT 6MMX15CM

Facility

$8,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270695117S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,771.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

COIL PENUMBRA SOFT 6MMX15CM

Facility

$8,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270695117S
Hospital Revenue Code	278
Min. Negotiated Rate	$194.00
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$3,059.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,771.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50
Rate for Payer: UnitedHealthcare Community & State	$194.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.32

COIL PENUMBRA SOFT 8MMX20CM

Facility

$8,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270695118S
Hospital Revenue Code	278
Min. Negotiated Rate	$194.00
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$3,059.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,771.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50
Rate for Payer: UnitedHealthcare Community & State	$194.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.32

COIL PENUMBRA SOFT 8MMX20CM

Facility

$8,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270695118S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,771.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

COIL PENUMBRA XT SOFT 3MMX6CM

Facility

$8,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270689738S
Hospital Revenue Code	278
Min. Negotiated Rate	$194.00
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$3,059.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,771.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50
Rate for Payer: UnitedHealthcare Community & State	$194.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.32

COIL PENUMBRA XT SOFT 3MMX6CM

Facility

$8,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270689738S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,771.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

COIL RUBY LP 3MMX15CM

Facility

$4,950.00

Service Code	HCPCS C1889
Hospital Charge Code	270696381
Hospital Revenue Code	278
Min. Negotiated Rate	$119.30
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,881.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50
Rate for Payer: UnitedHealthcare Community & State	$119.30
Rate for Payer: Wellpoint Medicaid Managed Care	$131.18

COIL RUBY LP 3MMX15CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270696381C
Hospital Revenue Code	278
Min. Negotiated Rate	$119.30
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,881.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50
Rate for Payer: UnitedHealthcare Community & State	$119.30
Rate for Payer: Wellpoint Medicaid Managed Care	$131.18

COIL RUBY LP 3MMX15CM

Facility

$4,950.00

Service Code	HCPCS C1889
Hospital Charge Code	270696381
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL RUBY LP 3MMX15CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270696381C
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL RUBY LP 3MMX4CM

Facility

$3,950.00

Service Code	HCPCS C1889
Hospital Charge Code	270696377
Hospital Revenue Code	278
Min. Negotiated Rate	$592.50
Max. Negotiated Rate	$955.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$869.00
Rate for Payer: Qualcare PPO/HMO/WC	$592.50

COIL RUBY LP 3MMX4CM

Facility

$3,950.00

Service Code	HCPCS C1889
Hospital Charge Code	270696377
Hospital Revenue Code	278
Min. Negotiated Rate	$95.19
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,501.00
Rate for Payer: Aetna Medicare Advantage	$1,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,007.25
Rate for Payer: Cigna Commercial	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$869.00
Rate for Payer: Qualcare PPO/HMO/WC	$592.50
Rate for Payer: UnitedHealthcare Community & State	$95.19
Rate for Payer: Wellpoint Medicaid Managed Care	$104.67

COIL RUBY LP 4MMX15CM

Facility

$4,450.00

Service Code	HCPCS C1884
Hospital Charge Code	270696383C
Hospital Revenue Code	278
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$2,225.00
Rate for Payer: Aetna Commercial	$1,691.00
Rate for Payer: Aetna Medicare Advantage	$1,335.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,134.75
Rate for Payer: Cigna Commercial	$2,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$979.00
Rate for Payer: Qualcare PPO/HMO/WC	$667.50
Rate for Payer: UnitedHealthcare Community & State	$107.25
Rate for Payer: Wellpoint Medicaid Managed Care	$117.92

COIL RUBY LP 4MMX15CM

Facility

$4,450.00

Service Code	HCPCS C1884
Hospital Charge Code	270696383C
Hospital Revenue Code	278
Min. Negotiated Rate	$667.50
Max. Negotiated Rate	$1,076.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$979.00
Rate for Payer: Qualcare PPO/HMO/WC	$667.50

COIL RUBY LP 4MMX6CM

Facility

$3,950.00

Service Code	HCPCS C1889
Hospital Charge Code	270696382
Hospital Revenue Code	278
Min. Negotiated Rate	$592.50
Max. Negotiated Rate	$955.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$869.00
Rate for Payer: Qualcare PPO/HMO/WC	$592.50

COIL RUBY LP 4MMX6CM

Facility

$3,950.00

Service Code	HCPCS C1889
Hospital Charge Code	270696382
Hospital Revenue Code	278
Min. Negotiated Rate	$95.19
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,501.00
Rate for Payer: Aetna Medicare Advantage	$1,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,007.25
Rate for Payer: Cigna Commercial	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$869.00
Rate for Payer: Qualcare PPO/HMO/WC	$592.50
Rate for Payer: UnitedHealthcare Community & State	$95.19
Rate for Payer: Wellpoint Medicaid Managed Care	$104.67

COIL RUBY SOFT 6MM x 30CM

Facility

$6,495.00

Service Code	HCPCS C1889
Hospital Charge Code	270677201
Hospital Revenue Code	278
Min. Negotiated Rate	$974.25
Max. Negotiated Rate	$1,571.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,428.90
Rate for Payer: Qualcare PPO/HMO/WC	$974.25

COIL RUBY SOFT 6MM x 30CM

Facility

$6,495.00

Service Code	HCPCS C1889
Hospital Charge Code	270677201
Hospital Revenue Code	278
Min. Negotiated Rate	$156.53
Max. Negotiated Rate	$3,247.50
Rate for Payer: Aetna Commercial	$2,468.10
Rate for Payer: Aetna Medicare Advantage	$1,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.22
Rate for Payer: Cigna Commercial	$3,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,571.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,428.90
Rate for Payer: Qualcare PPO/HMO/WC	$974.25
Rate for Payer: UnitedHealthcare Community & State	$156.53
Rate for Payer: Wellpoint Medicaid Managed Care	$172.12

COIL RUBY STAND 3 X 12

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270690724
Hospital Revenue Code	278
Min. Negotiated Rate	$119.30
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,881.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50
Rate for Payer: UnitedHealthcare Community & State	$119.30
Rate for Payer: Wellpoint Medicaid Managed Care	$131.18

COIL RUBY STAND 3 X 12

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270690724
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL RUBY STAND 3 X 20 MM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270690725
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

COIL RUBY STAND 3 X 20 MM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270690725
Hospital Revenue Code	278
Min. Negotiated Rate	$119.30
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,881.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50
Rate for Payer: UnitedHealthcare Community & State	$119.30
Rate for Payer: Wellpoint Medicaid Managed Care	$131.18

COIL SMART 2.5MM X 4CM EXTRA

Facility

$8,675.00

Hospital Charge Code	270689739
Hospital Revenue Code	278
Min. Negotiated Rate	$209.07
Max. Negotiated Rate	$4,337.50
Rate for Payer: Aetna Commercial	$3,296.50
Rate for Payer: Aetna Medicare Advantage	$2,602.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,212.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,212.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,212.12
Rate for Payer: Cigna Commercial	$4,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,099.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,908.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,301.25
Rate for Payer: UnitedHealthcare Community & State	$209.07
Rate for Payer: Wellpoint Medicaid Managed Care	$229.89

COIL SMART 2.5MM X 4CM EXTRA

Facility

$8,675.00

Hospital Charge Code	270689739
Hospital Revenue Code	278
Min. Negotiated Rate	$1,301.25
Max. Negotiated Rate	$2,099.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,735.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,099.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,908.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,301.25

COIL SMART 2MM X 4 CM WAVE EXT

Facility

$5,775.00

Hospital Charge Code	270689740
Hospital Revenue Code	278
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$1,397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

Know your out-of-pocket cost for care.

All Charges