Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SURGICLOSE7X20CM

Facility

$35,830.00

Service Code	HCPCS C1765
Hospital Charge Code	270706060
Hospital Revenue Code	278
Min. Negotiated Rate	$863.50
Max. Negotiated Rate	$17,915.00
Rate for Payer: Aetna Commercial	$13,615.40
Rate for Payer: Aetna Medicare Advantage	$10,749.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,136.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,136.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,166.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,136.65
Rate for Payer: Cigna Commercial	$17,915.00
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
Rate for Payer: UnitedHealthcare Community & State	$863.50
Rate for Payer: Wellpoint Medicaid Managed Care	$949.50

SURGICLOSE MESHED 2:1 6X8CM

Facility

$14,550.00

Service Code	HCPCS C1781
Hospital Charge Code	270705088
Hospital Revenue Code	278
Min. Negotiated Rate	$350.65
Max. Negotiated Rate	$7,275.00
Rate for Payer: Aetna Commercial	$5,529.00
Rate for Payer: Aetna Medicare Advantage	$4,365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,710.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,710.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,710.25
Rate for Payer: Cigna Commercial	$7,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,521.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,201.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,182.50
Rate for Payer: UnitedHealthcare Community & State	$350.65
Rate for Payer: Wellpoint Medicaid Managed Care	$385.57

SURGICLOSE MESHED 2:1 6X8CM

Facility

$14,550.00

Service Code	HCPCS C1781
Hospital Charge Code	270705088
Hospital Revenue Code	278
Min. Negotiated Rate	$2,182.50
Max. Negotiated Rate	$3,521.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,521.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,201.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,182.50

SURGICLOSE MESHED 7X10CM

Facility

$19,735.00

Service Code	HCPCS C1781
Hospital Charge Code	270705089
Hospital Revenue Code	278
Min. Negotiated Rate	$475.61
Max. Negotiated Rate	$9,867.50
Rate for Payer: Aetna Commercial	$7,499.30
Rate for Payer: Aetna Medicare Advantage	$5,920.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,032.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,032.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,947.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,032.43
Rate for Payer: Cigna Commercial	$9,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,775.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,341.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,960.25
Rate for Payer: UnitedHealthcare Community & State	$475.61
Rate for Payer: Wellpoint Medicaid Managed Care	$522.98

SURGICLOSE MESHED 7X10CM

Facility

$19,735.00

Service Code	HCPCS C1781
Hospital Charge Code	270705089
Hospital Revenue Code	278
Min. Negotiated Rate	$2,960.25
Max. Negotiated Rate	$4,775.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,947.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,775.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,341.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,960.25

SURGICLOSE MICRO 38 SQ CM

Facility

$9,100.00

Service Code	HCPCS C1765
Hospital Charge Code	270705486
Hospital Revenue Code	278
Min. Negotiated Rate	$219.31
Max. Negotiated Rate	$4,550.00
Rate for Payer: Aetna Commercial	$3,458.00
Rate for Payer: Aetna Medicare Advantage	$2,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,320.50
Rate for Payer: Cigna Commercial	$4,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,202.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,002.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00
Rate for Payer: UnitedHealthcare Community & State	$219.31
Rate for Payer: Wellpoint Medicaid Managed Care	$241.15

SURGICLOSE MICRO 38 SQ CM

Facility

$9,100.00

Service Code	HCPCS C1765
Hospital Charge Code	270705486
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$2,202.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,202.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,002.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00

SURGICLOSE MICRO 95 SQ CM

Facility

$20,475.00

Service Code	HCPCS C1765
Hospital Charge Code	270705697
Hospital Revenue Code	278
Min. Negotiated Rate	$493.45
Max. Negotiated Rate	$10,237.50
Rate for Payer: Aetna Commercial	$7,780.50
Rate for Payer: Aetna Medicare Advantage	$6,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,221.12
Rate for Payer: Cigna Commercial	$10,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,504.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25
Rate for Payer: UnitedHealthcare Community & State	$493.45
Rate for Payer: Wellpoint Medicaid Managed Care	$542.59

SURGICLOSE MICRO 95 SQ CM

Facility

$20,475.00

Service Code	HCPCS C1765
Hospital Charge Code	270705697
Hospital Revenue Code	278
Min. Negotiated Rate	$3,071.25
Max. Negotiated Rate	$4,954.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,504.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25

SURGIFLO HEMOSTATIC 8ML

Facility

$1,200.00

Hospital Charge Code	270701429
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

SURGIFLO HEMOSTATIC 8ML

Facility

$1,200.00

Hospital Charge Code	270701429
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

SURGIFOAM ABSORB GEL POWDER

Facility

$452.26

Hospital Charge Code	270644933C
Hospital Revenue Code	272
Min. Negotiated Rate	$67.84
Max. Negotiated Rate	$67.84
Rate for Payer: Qualcare PPO/HMO/WC	$67.84

SURGIFOAM ABSORB GEL POWDER

Facility

$452.26

Hospital Charge Code	270644933C
Hospital Revenue Code	272
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$226.13
Rate for Payer: Aetna Commercial	$171.86
Rate for Payer: Aetna Medicare Advantage	$135.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.33
Rate for Payer: Cigna Commercial	$226.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.68
Rate for Payer: Oxford Commercial	$90.45
Rate for Payer: Qualcare PPO/HMO/WC	$67.84
Rate for Payer: UnitedHealthcare Commercial	$90.45
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.98

SURGIGRIP 10MM *****

Facility

$30.00

Hospital Charge Code	1603315
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SURGIGRIP 10MM *****

Facility

$30.00

Hospital Charge Code	1603315
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

SURGIGRIP 10MM 173001

Facility

$20.80

Hospital Charge Code	270600075
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.12

SURGIGRIP 10MM 173001

Facility

$20.80

Hospital Charge Code	270600075
Hospital Revenue Code	272
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna Commercial	$7.90
Rate for Payer: Aetna Medicare Advantage	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.30
Rate for Payer: Cigna Commercial	$10.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$4.16
Rate for Payer: Qualcare PPO/HMO/WC	$3.12
Rate for Payer: UnitedHealthcare Commercial	$4.16
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

SURGIGRIP 10MM SLEEVE TEAL BLU

Facility

$25.25

Hospital Charge Code	270658696
Hospital Revenue Code	272
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.62
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$7.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.44
Rate for Payer: Cigna Commercial	$12.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.58
Rate for Payer: Oxford Commercial	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Commercial	$5.05
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

SURGIGRIP 10MM SLEEVE TEAL BLU

Facility

$25.25

Hospital Charge Code	270658696
Hospital Revenue Code	272
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

SURGIGRIP 11MM 174107

Facility

$60.85

Hospital Charge Code	270600078
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.43
Rate for Payer: Aetna Commercial	$23.12
Rate for Payer: Aetna Medicare Advantage	$18.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.52
Rate for Payer: Cigna Commercial	$30.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.25
Rate for Payer: Oxford Commercial	$12.17
Rate for Payer: Qualcare PPO/HMO/WC	$9.13
Rate for Payer: UnitedHealthcare Commercial	$12.17
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

SURGIGRIP 11MM 174107

Facility

$60.85

Hospital Charge Code	270600078
Hospital Revenue Code	272
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$9.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.13

SURGIGRIP 11MM CONDUCT 174205

Facility

$105.65

Hospital Charge Code	270600081
Hospital Revenue Code	272
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

SURGIGRIP 11MM CONDUCT 174205

Facility

$105.65

Hospital Charge Code	270600081
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$52.83
Rate for Payer: Aetna Commercial	$40.15
Rate for Payer: Aetna Medicare Advantage	$31.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.94
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Oxford Commercial	$21.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.85
Rate for Payer: UnitedHealthcare Commercial	$21.13
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

SURGIGRIP 12MM *****

Facility

$32.00

Hospital Charge Code	1606003
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

SURGIGRIP 12MM *****

Facility

$34.00

Hospital Charge Code	1603323
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

Know your out-of-pocket cost for care.

All Charges