Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SURGICEL HEMOSTAT 2x14 1951

Facility

$315.95

Hospital Charge Code	270642925
Hospital Revenue Code	272
Min. Negotiated Rate	$47.39
Max. Negotiated Rate	$47.39
Rate for Payer: Qualcare PPO/HMO/WC	$47.39

SURGICEL HEMOSTAT 2x14 1951

Facility

$315.95

Hospital Charge Code	270642925
Hospital Revenue Code	272
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$157.97
Rate for Payer: Aetna Commercial	$120.06
Rate for Payer: Aetna Medicare Advantage	$94.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.57
Rate for Payer: Cigna Commercial	$157.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.78
Rate for Payer: Oxford Commercial	$63.19
Rate for Payer: Qualcare PPO/HMO/WC	$47.39
Rate for Payer: UnitedHealthcare Commercial	$63.19
Rate for Payer: UnitedHealthcare Community & State	$7.61
Rate for Payer: Wellpoint Medicaid Managed Care	$8.37

SURGICEL HEMOSTAT 2 X 3

Facility

$6.00

Hospital Charge Code	60634737
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SURGICEL HEMOSTAT 2 X 3

Facility

$6.00

Hospital Charge Code	60634737
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SURGICEL NU-KNIT HEMOSTAT

Facility

$7,840.30

Hospital Charge Code	270661748
Hospital Revenue Code	272
Min. Negotiated Rate	$188.95
Max. Negotiated Rate	$3,920.15
Rate for Payer: Aetna Commercial	$2,979.31
Rate for Payer: Aetna Medicare Advantage	$2,352.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,999.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,999.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,999.28
Rate for Payer: Cigna Commercial	$3,920.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,352.09
Rate for Payer: Oxford Commercial	$1,568.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.05
Rate for Payer: UnitedHealthcare Commercial	$1,568.06
Rate for Payer: UnitedHealthcare Community & State	$188.95
Rate for Payer: Wellpoint Medicaid Managed Care	$207.77

SURGICEL NU-KNIT HEMOSTAT

Facility

$7,840.30

Hospital Charge Code	270661748
Hospital Revenue Code	272
Min. Negotiated Rate	$1,176.05
Max. Negotiated Rate	$1,176.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.05

SURGICEL SNOW 4X4

Facility

$1,095.71

Hospital Charge Code	270683431
Hospital Revenue Code	272
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$547.86
Rate for Payer: Aetna Commercial	$416.37
Rate for Payer: Aetna Medicare Advantage	$328.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.41
Rate for Payer: Cigna Commercial	$547.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.71
Rate for Payer: Oxford Commercial	$219.14
Rate for Payer: Qualcare PPO/HMO/WC	$164.36
Rate for Payer: UnitedHealthcare Commercial	$219.14
Rate for Payer: UnitedHealthcare Community & State	$26.41
Rate for Payer: Wellpoint Medicaid Managed Care	$29.04

SURGICEL SNOW 4X4

Facility

$1,095.71

Hospital Charge Code	270683431
Hospital Revenue Code	272
Min. Negotiated Rate	$164.36
Max. Negotiated Rate	$164.36
Rate for Payer: Qualcare PPO/HMO/WC	$164.36

SURGICEL SNOW ABSORB. HEMOSTAT

Facility

$938.66

Hospital Charge Code	270669635
Hospital Revenue Code	272
Min. Negotiated Rate	$140.80
Max. Negotiated Rate	$140.80
Rate for Payer: Qualcare PPO/HMO/WC	$140.80

SURGICEL SNOW ABSORB. HEMOSTAT

Facility

$938.66

Hospital Charge Code	270669635
Hospital Revenue Code	272
Min. Negotiated Rate	$22.62
Max. Negotiated Rate	$469.33
Rate for Payer: Aetna Commercial	$356.69
Rate for Payer: Aetna Medicare Advantage	$281.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.36
Rate for Payer: Cigna Commercial	$469.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.60
Rate for Payer: Oxford Commercial	$187.73
Rate for Payer: Qualcare PPO/HMO/WC	$140.80
Rate for Payer: UnitedHealthcare Commercial	$187.73
Rate for Payer: UnitedHealthcare Community & State	$22.62
Rate for Payer: Wellpoint Medicaid Managed Care	$24.87

SURGICLIP PERMIUM L-13.0

Facility

$1,592.07

Hospital Charge Code	270600051
Hospital Revenue Code	272
Min. Negotiated Rate	$38.37
Max. Negotiated Rate	$796.03
Rate for Payer: Aetna Commercial	$604.99
Rate for Payer: Aetna Medicare Advantage	$477.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$405.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$405.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$405.98
Rate for Payer: Cigna Commercial	$796.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.62
Rate for Payer: Oxford Commercial	$318.41
Rate for Payer: Qualcare PPO/HMO/WC	$238.81
Rate for Payer: UnitedHealthcare Commercial	$318.41
Rate for Payer: UnitedHealthcare Community & State	$38.37
Rate for Payer: Wellpoint Medicaid Managed Care	$42.19

SURGICLIP PERMIUM L-13.0

Facility

$1,592.07

Hospital Charge Code	270600051
Hospital Revenue Code	272
Min. Negotiated Rate	$238.81
Max. Negotiated Rate	$238.81
Rate for Payer: Qualcare PPO/HMO/WC	$238.81

SURGICLIP PERMIUM M-11.5

Facility

$285.91

Hospital Charge Code	270651807
Hospital Revenue Code	272
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$142.96
Rate for Payer: Aetna Commercial	$108.65
Rate for Payer: Aetna Medicare Advantage	$85.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.91
Rate for Payer: Cigna Commercial	$142.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.77
Rate for Payer: Oxford Commercial	$57.18
Rate for Payer: Qualcare PPO/HMO/WC	$42.89
Rate for Payer: UnitedHealthcare Commercial	$57.18
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

SURGICLIP PERMIUM M-11.5

Facility

$285.91

Hospital Charge Code	270651807
Hospital Revenue Code	272
Min. Negotiated Rate	$42.89
Max. Negotiated Rate	$42.89
Rate for Payer: Qualcare PPO/HMO/WC	$42.89

SURGICLIP PERMIUM M-9.75

Facility

$249.29

Hospital Charge Code	270656248
Hospital Revenue Code	272
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$124.64
Rate for Payer: Aetna Commercial	$94.73
Rate for Payer: Aetna Medicare Advantage	$74.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.57
Rate for Payer: Cigna Commercial	$124.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.79
Rate for Payer: Oxford Commercial	$49.86
Rate for Payer: Qualcare PPO/HMO/WC	$37.39
Rate for Payer: UnitedHealthcare Commercial	$49.86
Rate for Payer: UnitedHealthcare Community & State	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$6.61

SURGICLIP PERMIUM M-9.75

Facility

$249.29

Hospital Charge Code	270656248
Hospital Revenue Code	272
Min. Negotiated Rate	$37.39
Max. Negotiated Rate	$37.39
Rate for Payer: Qualcare PPO/HMO/WC	$37.39

SURGICLIP PERMIUM S-9.0

Facility

$1,800.21

Hospital Charge Code	270600140
Hospital Revenue Code	272
Min. Negotiated Rate	$270.03
Max. Negotiated Rate	$270.03
Rate for Payer: Qualcare PPO/HMO/WC	$270.03

SURGICLIP PERMIUM S-9.0

Facility

$1,800.21

Hospital Charge Code	270600140
Hospital Revenue Code	272
Min. Negotiated Rate	$43.39
Max. Negotiated Rate	$900.11
Rate for Payer: Aetna Commercial	$684.08
Rate for Payer: Aetna Medicare Advantage	$540.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.05
Rate for Payer: Cigna Commercial	$900.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.06
Rate for Payer: Oxford Commercial	$360.04
Rate for Payer: Qualcare PPO/HMO/WC	$270.03
Rate for Payer: UnitedHealthcare Commercial	$360.04
Rate for Payer: UnitedHealthcare Community & State	$43.39
Rate for Payer: Wellpoint Medicaid Managed Care	$47.71

SURGICLIP PREMIUM M-11.5

Facility

$963.98

Hospital Charge Code	270600049
Hospital Revenue Code	272
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$144.60
Rate for Payer: Qualcare PPO/HMO/WC	$144.60

SURGICLIP PREMIUM M-11.5

Facility

$963.98

Hospital Charge Code	270600049
Hospital Revenue Code	272
Min. Negotiated Rate	$23.23
Max. Negotiated Rate	$481.99
Rate for Payer: Aetna Commercial	$366.31
Rate for Payer: Aetna Medicare Advantage	$289.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.81
Rate for Payer: Cigna Commercial	$481.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.19
Rate for Payer: Oxford Commercial	$192.80
Rate for Payer: Qualcare PPO/HMO/WC	$144.60
Rate for Payer: UnitedHealthcare Commercial	$192.80
Rate for Payer: UnitedHealthcare Community & State	$23.23
Rate for Payer: Wellpoint Medicaid Managed Care	$25.55

SURGICLIP TITAN *******

Facility

$168.00

Hospital Charge Code	1600972
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$63.84
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.40
Rate for Payer: Oxford Commercial	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$33.60
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.45

SURGICLIP TITAN *******

Facility

$168.00

Hospital Charge Code	1600972
Hospital Revenue Code	272
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

SURGICLOSE 4X6CM

Facility

$7,780.00

Service Code	HCPCS C1765
Hospital Charge Code	270705487
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$3,890.00
Rate for Payer: Aetna Commercial	$2,956.40
Rate for Payer: Aetna Medicare Advantage	$2,334.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,983.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,983.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,983.90
Rate for Payer: Cigna Commercial	$3,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,711.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$187.50
Rate for Payer: Wellpoint Medicaid Managed Care	$206.17

SURGICLOSE 4X6CM

Facility

$7,780.00

Service Code	HCPCS C1765
Hospital Charge Code	270705487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.00
Max. Negotiated Rate	$1,882.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,711.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.00

SURGICLOSE7X20CM

Facility

$35,830.00

Service Code	HCPCS C1765
Hospital Charge Code	270706060
Hospital Revenue Code	278
Min. Negotiated Rate	$5,374.50
Max. Negotiated Rate	$8,670.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,670.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,882.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,374.50

Know your out-of-pocket cost for care.

All Charges