Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

COIL SMART 2MM X 6 CM WAVE EXT

Facility

$5,775.00

Hospital Charge Code	270689737
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

COIL SMART 2MM X 6 CM WAVE EXT

Facility

$5,775.00

Hospital Charge Code	270689737
Hospital Revenue Code	278
Min. Negotiated Rate	$139.18
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$2,194.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
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
Rate for Payer: UnitedHealthcare Community & State	$139.18
Rate for Payer: Wellpoint Medicaid Managed Care	$153.04

COIL SMART 3MM X 6 CM EXTRA SO

Facility

$8,675.00

Hospital Charge Code	270689738
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 3MM X 6 CM EXTRA SO

Facility

$8,675.00

Hospital Charge Code	270689738
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 DETRACHMENT HANDLE

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270689741S
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.30
Rate for Payer: Qualcare PPO/HMO/WC	$182.25
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

COIL SMART DETRACHMENT HANDLE

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270689741
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$294.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.30
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

COIL SMART DETRACHMENT HANDLE

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270689741S
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$294.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.30
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

COIL SMART DETRACHMENT HANDLE

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270689741
Hospital Revenue Code	278
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.30
Rate for Payer: Qualcare PPO/HMO/WC	$182.25
Rate for Payer: UnitedHealthcare Community & State	$29.28
Rate for Payer: Wellpoint Medicaid Managed Care	$32.20

COIL SOFT RUBY 20MM X 60CM

Facility

$3,950.00

Hospital Charge Code	270686480O
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 SOFT RUBY 20MM X 60CM

Facility

$3,950.00

Hospital Charge Code	270686480O
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

COILS SOFT 16MMx50CM

Facility

$6,495.00

Hospital Charge Code	270673581
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

COILS SOFT 16MMx50CM

Facility

$6,495.00

Hospital Charge Code	270673581
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

COILS SOFT RUBY 20MM X 60CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686480
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

COILS SOFT RUBY 20MM X 60CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686480
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

COILS SOFT RUBY 2MM X 1CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686475
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

COILS SOFT RUBY 2MM X 1CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686475
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

COILS SOFT RUBY 2MM X 2CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686464
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

COILS SOFT RUBY 2MM X 2CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686464
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

COILS SOFT RUBY 2MM X 4CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686476
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

COILS SOFT RUBY 2MM X 4CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686476
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

COILS SOFT RUBY 3MM X 15CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686477
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

COILS SOFT RUBY 3MM X 15CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686477
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

COILS SOFT RUBY 3MM X 5CM

Facility

$4,950.00

Hospital Charge Code	270677678
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

COILS SOFT RUBY 3MM X 5CM

Facility

$4,950.00

Hospital Charge Code	270677678
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

Know your out-of-pocket cost for care.

All Charges