Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COIL STN RUBY 4MMX15CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683216N
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 STN RUBY 4MMX15CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683216
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 STN RUBY 4MMX20CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683215N
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 STN RUBY 4MMX20CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683215N
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 STN RUBY 4MMX20CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683215
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 STN RUBY 4MMX20CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683215
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 STN RUBY 4MMX35CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683218N
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 STN RUBY 4MMX35CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683218N
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 STN RUBY 4MMX35CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683218
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 STN RUBY 4MMX35CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683218
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 STN RUBY 5MM X 20 CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683213N
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 STN RUBY 5MM X 20 CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683213
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 STN RUBY 5MM X 20 CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683213
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 STN RUBY 5MM X 20 CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270683213N
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 STN RUBY 7MMX 25CM

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270687407
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

COIL STN RUBY 7MMX 25CM

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270687407
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

COIL STN RUBY 7MMX25CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270687386
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 STN RUBY 7MMX25CM

Facility

$4,950.00

Service Code	HCPCS C1884
Hospital Charge Code	270687386
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 STONE CONE 10mm 3FR

Facility

$2,065.00

Hospital Charge Code	270674384
Hospital Revenue Code	272
Min. Negotiated Rate	$49.77
Max. Negotiated Rate	$1,032.50
Rate for Payer: Aetna Commercial	$784.70
Rate for Payer: Aetna Medicare Advantage	$619.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.58
Rate for Payer: Cigna Commercial	$1,032.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$619.50
Rate for Payer: Oxford Commercial	$413.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.75
Rate for Payer: UnitedHealthcare Commercial	$413.00
Rate for Payer: UnitedHealthcare Community & State	$49.77
Rate for Payer: Wellpoint Medicaid Managed Care	$54.72

COIL STONE CONE 10mm 3FR

Facility

$2,065.00

Hospital Charge Code	270674384
Hospital Revenue Code	272
Min. Negotiated Rate	$309.75
Max. Negotiated Rate	$309.75
Rate for Payer: Qualcare PPO/HMO/WC	$309.75

COIL STONE CONE 7mm 3FR

Facility

$2,065.00

Hospital Charge Code	270674383
Hospital Revenue Code	272
Min. Negotiated Rate	$309.75
Max. Negotiated Rate	$309.75
Rate for Payer: Qualcare PPO/HMO/WC	$309.75

COIL STONE CONE 7mm 3FR

Facility

$2,065.00

Hospital Charge Code	270674383
Hospital Revenue Code	272
Min. Negotiated Rate	$49.77
Max. Negotiated Rate	$1,032.50
Rate for Payer: Aetna Commercial	$784.70
Rate for Payer: Aetna Medicare Advantage	$619.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.58
Rate for Payer: Cigna Commercial	$1,032.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$619.50
Rate for Payer: Oxford Commercial	$413.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.75
Rate for Payer: UnitedHealthcare Commercial	$413.00
Rate for Payer: UnitedHealthcare Community & State	$49.77
Rate for Payer: Wellpoint Medicaid Managed Care	$54.72

COIL TARGET TETRA 1.5MMX2CM

Facility

$10,516.00

Service Code	HCPCS C1889
Hospital Charge Code	270699391S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,577.40
Max. Negotiated Rate	$2,544.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,103.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,544.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,313.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,577.40

COIL TARGET TETRA 1.5MMX2CM

Facility

$10,516.00

Service Code	HCPCS C1889
Hospital Charge Code	270699391S
Hospital Revenue Code	278
Min. Negotiated Rate	$253.44
Max. Negotiated Rate	$5,258.00
Rate for Payer: Aetna Commercial	$3,996.08
Rate for Payer: Aetna Medicare Advantage	$3,154.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,681.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,681.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,103.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,681.58
Rate for Payer: Cigna Commercial	$5,258.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,544.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,313.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,577.40
Rate for Payer: UnitedHealthcare Community & State	$253.44
Rate for Payer: Wellpoint Medicaid Managed Care	$278.67

COIL TARGET TETRA 2.0MMX45CM

Facility

$11,113.50

Service Code	HCPCS C1889
Hospital Charge Code	270699562S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,667.03
Max. Negotiated Rate	$2,689.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,222.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,689.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,444.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,667.03

Know your out-of-pocket cost for care.

All Charges