Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRIVER INS F.A.S.T. 2.0mFPD2.0

Facility

$134.00

Hospital Charge Code	270635667
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$50.92
Rate for Payer: Aetna Medicare Advantage	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.17
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Oxford Commercial	$26.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Commercial	$26.80
Rate for Payer: UnitedHealthcare Community & State	$3.23
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

DRIVER INS F.A.S.T. 2.0mFPD2.0

Facility

$134.00

Hospital Charge Code	270635667
Hospital Revenue Code	272
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

DRIVER MDTP

Facility

$360.00

Hospital Charge Code	270661761
Hospital Revenue Code	272
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: Aetna Medicare Advantage	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.80
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.00
Rate for Payer: Oxford Commercial	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$72.00
Rate for Payer: UnitedHealthcare Community & State	$8.68
Rate for Payer: Wellpoint Medicaid Managed Care	$9.54

DRIVER MDTP

Facility

$360.00

Hospital Charge Code	270661761
Hospital Revenue Code	272
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

DRIVER MSP T6

Facility

$1,395.00

Hospital Charge Code	270696760
Hospital Revenue Code	272
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$209.25
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

DRIVER MSP T6

Facility

$1,395.00

Hospital Charge Code	270696760
Hospital Revenue Code	272
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.50
Rate for Payer: Oxford Commercial	$279.00
Rate for Payer: Qualcare PPO/HMO/WC	$209.25
Rate for Payer: UnitedHealthcare Commercial	$279.00
Rate for Payer: UnitedHealthcare Community & State	$33.62
Rate for Payer: Wellpoint Medicaid Managed Care	$36.97

DRIVER QUICK CONNECT 20MM

Facility

$2,500.00

Hospital Charge Code	270684773
Hospital Revenue Code	272
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

DRIVER QUICK CONNECT 20MM

Facility

$2,500.00

Hospital Charge Code	270684773
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

DRIVER SHAFT T7 HEXALOBE

Facility

$1,425.00

Hospital Charge Code	270690957
Hospital Revenue Code	272
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$541.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.50
Rate for Payer: Oxford Commercial	$285.00
Rate for Payer: Qualcare PPO/HMO/WC	$213.75
Rate for Payer: UnitedHealthcare Commercial	$285.00
Rate for Payer: UnitedHealthcare Community & State	$34.34
Rate for Payer: Wellpoint Medicaid Managed Care	$37.76

DRIVER SHAFT T7 HEXALOBE

Facility

$1,425.00

Hospital Charge Code	270690957
Hospital Revenue Code	272
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$213.75
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

DRIVER SHAFT T8 HEXALOBE CANN

Facility

$975.00

Hospital Charge Code	270690958
Hospital Revenue Code	272
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

DRIVER SHAFT T8 HEXALOBE CANN

Facility

$975.00

Hospital Charge Code	270690958
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

DRIVER SHAFT T8 HEXLOBE CANN

Facility

$790.00

Hospital Charge Code	270690956
Hospital Revenue Code	272
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

DRIVER SHAFT T8 HEXLOBE CANN

Facility

$790.00

Hospital Charge Code	270690956
Hospital Revenue Code	272
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$300.20
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.00
Rate for Payer: Oxford Commercial	$158.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Commercial	$158.00
Rate for Payer: UnitedHealthcare Community & State	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$20.93

DRIVER STEP HEX 2/3.5 mm

Facility

$645.00

Hospital Charge Code	270680474
Hospital Revenue Code	272
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

DRIVER STEP HEX 2/3.5 mm

Facility

$645.00

Hospital Charge Code	270680474
Hospital Revenue Code	272
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$322.50
Rate for Payer: Aetna Commercial	$245.10
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.50
Rate for Payer: Oxford Commercial	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Commercial	$129.00
Rate for Payer: UnitedHealthcare Community & State	$15.54
Rate for Payer: Wellpoint Medicaid Managed Care	$17.09

DRIVER TIP 2.5mm X 6in HT2502

Facility

$300.00

Hospital Charge Code	270638669
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

DRIVER TIP 2.5mm X 6in HT2502

Facility

$300.00

Hospital Charge Code	270638669
Hospital Revenue Code	272
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

DRIVER TORQUE T6 MSP STERILE

Facility

$1,080.00

Hospital Charge Code	270688569
Hospital Revenue Code	272
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

DRIVER TORQUE T6 MSP STERILE

Facility

$1,080.00

Hospital Charge Code	270688569
Hospital Revenue Code	272
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.00
Rate for Payer: Oxford Commercial	$216.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Commercial	$216.00
Rate for Payer: UnitedHealthcare Community & State	$26.03
Rate for Payer: Wellpoint Medicaid Managed Care	$28.62

DRIVER UNIVERSAL QC T-20

Facility

$360.00

Hospital Charge Code	270679707
Hospital Revenue Code	272
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: Aetna Medicare Advantage	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.80
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.00
Rate for Payer: Oxford Commercial	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$72.00
Rate for Payer: UnitedHealthcare Community & State	$8.68
Rate for Payer: Wellpoint Medicaid Managed Care	$9.54

DRIVER UNIVERSAL QC T-20

Facility

$360.00

Hospital Charge Code	270679707
Hospital Revenue Code	272
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

DRIVER UNIVERSAL QUICK CONNECT

Facility

$603.00

Hospital Charge Code	270661790
Hospital Revenue Code	272
Min. Negotiated Rate	$90.45
Max. Negotiated Rate	$90.45
Rate for Payer: Qualcare PPO/HMO/WC	$90.45

DRIVER UNIVERSAL QUICK CONNECT

Facility

$603.00

Hospital Charge Code	270661790
Hospital Revenue Code	272
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$301.50
Rate for Payer: Aetna Commercial	$229.14
Rate for Payer: Aetna Medicare Advantage	$180.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.76
Rate for Payer: Cigna Commercial	$301.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.90
Rate for Payer: Oxford Commercial	$120.60
Rate for Payer: Qualcare PPO/HMO/WC	$90.45
Rate for Payer: UnitedHealthcare Commercial	$120.60
Rate for Payer: UnitedHealthcare Community & State	$14.53
Rate for Payer: Wellpoint Medicaid Managed Care	$15.98

DRIVE SHAFT SEAL RIA

Facility

$89.25

Hospital Charge Code	270671815
Hospital Revenue Code	272
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$13.39
Rate for Payer: Qualcare PPO/HMO/WC	$13.39

Know your out-of-pocket cost for care.

All Charges