Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COILS SOFT RUBY 4MM X 6CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686478
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 4MM X 6CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686478
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 6MM X 20CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686479
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 6MM X 20CM

Facility

$3,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270686479
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 8MM x 35CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677202N
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 RUBY 8MM x 35CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677202
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 RUBY 8MM x 35CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677202N
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 8MM x 35CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677202
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 8MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677203
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 RUBY 8MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677203N
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 8MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677203
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 8MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677203N
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 STD RUBY 12MM x 40CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673586
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 STD RUBY 12MM x 40CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673586N
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 STD RUBY 12MM x 40CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673586N
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 STD RUBY 12MM x 40CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673586
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 STD RUBY 14MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673585N
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 STD RUBY 14MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673585N
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 STD RUBY 14MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673585
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 STD RUBY 14MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673585
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 STD RUBY 16MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673587N
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 STD RUBY 16MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673587N
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 STD RUBY 16MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673587
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 STD RUBY 16MM x 60CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270673587
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 STD RUBY 6MM X 30CM

Facility

$6,495.00

Service Code	HCPCS C1884
Hospital Charge Code	270677679N
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

Know your out-of-pocket cost for care.

All Charges