Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRILL ZIM TWIST 3.2/127MM

Facility

$175.25

Hospital Charge Code	270607660
Hospital Revenue Code	272
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$26.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.29

DRILL ZIM TWIST 3.2/127MM

Facility

$172.85

Hospital Charge Code	270608663
Hospital Revenue Code	272
Min. Negotiated Rate	$25.93
Max. Negotiated Rate	$25.93
Rate for Payer: Qualcare PPO/HMO/WC	$25.93

DRILL ZIM TWIST 3.2/127MM

Facility

$172.85

Hospital Charge Code	270608663
Hospital Revenue Code	272
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$86.42
Rate for Payer: Aetna Commercial	$65.68
Rate for Payer: Aetna Medicare Advantage	$51.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.08
Rate for Payer: Cigna Commercial	$86.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.85
Rate for Payer: Oxford Commercial	$34.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.93
Rate for Payer: UnitedHealthcare Commercial	$34.57
Rate for Payer: UnitedHealthcare Community & State	$4.17
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

DRILL ZIM ZMS 3.5MM 2246-61-35

Facility

$1,166.45

Hospital Charge Code	270610835
Hospital Revenue Code	272
Min. Negotiated Rate	$28.11
Max. Negotiated Rate	$583.23
Rate for Payer: Aetna Commercial	$443.25
Rate for Payer: Aetna Medicare Advantage	$349.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$297.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$297.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$297.44
Rate for Payer: Cigna Commercial	$583.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.94
Rate for Payer: Oxford Commercial	$233.29
Rate for Payer: Qualcare PPO/HMO/WC	$174.97
Rate for Payer: UnitedHealthcare Commercial	$233.29
Rate for Payer: UnitedHealthcare Community & State	$28.11
Rate for Payer: Wellpoint Medicaid Managed Care	$30.91

DRILL ZIM ZMS 3.5MM 2246-61-35

Facility

$1,166.45

Hospital Charge Code	270610835
Hospital Revenue Code	272
Min. Negotiated Rate	$174.97
Max. Negotiated Rate	$174.97
Rate for Payer: Qualcare PPO/HMO/WC	$174.97

DRIVE ADAPTOR QC FOR 5.0mm

Facility

$809.60

Hospital Charge Code	270646032
Hospital Revenue Code	272
Min. Negotiated Rate	$19.51
Max. Negotiated Rate	$404.80
Rate for Payer: Aetna Commercial	$307.65
Rate for Payer: Aetna Medicare Advantage	$242.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.45
Rate for Payer: Cigna Commercial	$404.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.88
Rate for Payer: Oxford Commercial	$161.92
Rate for Payer: Qualcare PPO/HMO/WC	$121.44
Rate for Payer: UnitedHealthcare Commercial	$161.92
Rate for Payer: UnitedHealthcare Community & State	$19.51
Rate for Payer: Wellpoint Medicaid Managed Care	$21.45

DRIVE ADAPTOR QC FOR 5.0mm

Facility

$809.60

Hospital Charge Code	270646032
Hospital Revenue Code	272
Min. Negotiated Rate	$121.44
Max. Negotiated Rate	$121.44
Rate for Payer: Qualcare PPO/HMO/WC	$121.44

DRIVE BMT ULTRA RENTAL 423908

Facility

$3,830.45

Hospital Charge Code	270615812
Hospital Revenue Code	270
Min. Negotiated Rate	$574.57
Max. Negotiated Rate	$574.57
Rate for Payer: Qualcare PPO/HMO/WC	$574.57

DRIVE BMT ULTRA RENTAL 423908

Facility

$3,830.45

Hospital Charge Code	270615812
Hospital Revenue Code	270
Min. Negotiated Rate	$92.31
Max. Negotiated Rate	$1,915.22
Rate for Payer: Aetna Commercial	$1,455.57
Rate for Payer: Aetna Medicare Advantage	$1,149.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$976.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$976.76
Rate for Payer: Cigna Commercial	$1,915.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.13
Rate for Payer: Oxford Commercial	$766.09
Rate for Payer: Qualcare PPO/HMO/WC	$574.57
Rate for Payer: UnitedHealthcare Commercial	$766.09
Rate for Payer: UnitedHealthcare Community & State	$92.31
Rate for Payer: Wellpoint Medicaid Managed Care	$101.51

DRIVER

Facility

$600.00

Hospital Charge Code	270701559
Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

DRIVER

Facility

$600.00

Hospital Charge Code	270701559
Hospital Revenue Code	272
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

DRIVER

Facility

$780.00

Hospital Charge Code	270688225
Hospital Revenue Code	272
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$117.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

DRIVER

Facility

$780.00

Hospital Charge Code	270688225
Hospital Revenue Code	272
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$20.67

DRIVER 2.0

Facility

$240.00

Hospital Charge Code	270661760
Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

DRIVER 2.0

Facility

$240.00

Hospital Charge Code	270661760
Hospital Revenue Code	272
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.00
Rate for Payer: Oxford Commercial	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

DRIVER 2.5MM CANN STD QK REL

Facility

$1,565.00

Service Code	HCPCS A4649
Hospital Charge Code	270696677
Hospital Revenue Code	272
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$782.50
Rate for Payer: Aetna Commercial	$594.70
Rate for Payer: Aetna Medicare Advantage	$469.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.07
Rate for Payer: Cigna Commercial	$782.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$469.50
Rate for Payer: Oxford Commercial	$313.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.75
Rate for Payer: UnitedHealthcare Commercial	$313.00
Rate for Payer: UnitedHealthcare Community & State	$37.72
Rate for Payer: Wellpoint Medicaid Managed Care	$41.47

DRIVER 2.5MM CANN STD QK REL

Facility

$1,565.00

Service Code	HCPCS A4649
Hospital Charge Code	270696677
Hospital Revenue Code	272
Min. Negotiated Rate	$234.75
Max. Negotiated Rate	$234.75
Rate for Payer: Qualcare PPO/HMO/WC	$234.75

DRIVER 2.6x30MM

Facility

$1,026.00

Hospital Charge Code	270672686
Hospital Revenue Code	272
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$153.90
Rate for Payer: Qualcare PPO/HMO/WC	$153.90

DRIVER 2.6x30MM

Facility

$1,026.00

Hospital Charge Code	270672686
Hospital Revenue Code	272
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$513.00
Rate for Payer: Aetna Commercial	$389.88
Rate for Payer: Aetna Medicare Advantage	$307.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.63
Rate for Payer: Cigna Commercial	$513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.80
Rate for Payer: Oxford Commercial	$205.20
Rate for Payer: Qualcare PPO/HMO/WC	$153.90
Rate for Payer: UnitedHealthcare Commercial	$205.20
Rate for Payer: UnitedHealthcare Community & State	$24.73
Rate for Payer: Wellpoint Medicaid Managed Care	$27.19

DRIVER AO CONNECTION POLYAXIAL

Facility

$550.00

Hospital Charge Code	270661789
Hospital Revenue Code	272
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$110.00
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

DRIVER AO CONNECTION POLYAXIAL

Facility

$550.00

Hospital Charge Code	270661789
Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

DRIVER AO CONNECT SQ TIP 2MM

Facility

$670.00

Hospital Charge Code	270661788
Hospital Revenue Code	272
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.00
Rate for Payer: Oxford Commercial	$134.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.50
Rate for Payer: UnitedHealthcare Commercial	$134.00
Rate for Payer: UnitedHealthcare Community & State	$16.15
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

DRIVER AO CONNECT SQ TIP 2MM

Facility

$670.00

Hospital Charge Code	270661788
Hospital Revenue Code	272
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$100.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

DRIVER HEX 2.5 STER MICA SCRW

Facility

$742.50

Service Code	HCPCS C1713
Hospital Charge Code	270702613
Hospital Revenue Code	278
Min. Negotiated Rate	$111.38
Max. Negotiated Rate	$179.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$111.38

DRIVER HEX 2.5 STER MICA SCRW

Facility

$742.50

Service Code	HCPCS C1713
Hospital Charge Code	270702613
Hospital Revenue Code	278
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$371.25
Rate for Payer: Aetna Commercial	$282.15
Rate for Payer: Aetna Medicare Advantage	$222.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.34
Rate for Payer: Cigna Commercial	$371.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$111.38
Rate for Payer: UnitedHealthcare Community & State	$17.89
Rate for Payer: Wellpoint Medicaid Managed Care	$19.68

Know your out-of-pocket cost for care.

All Charges