Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE BLK BRAIDED PC-5 4-0

Facility

$62.50

Hospital Charge Code	270638533
Hospital Revenue Code	272
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$31.25
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$31.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.75
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.38
Rate for Payer: UnitedHealthcare Commercial	$12.50
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

SUTURE BLK BRAIDED PC-5 4-0

Facility

$62.50

Hospital Charge Code	270638533
Hospital Revenue Code	272
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.38

SUTURE BLUE W/NEEDLE

Facility

$230.00

Hospital Charge Code	270672215
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare Advantage	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.65
Rate for Payer: Cigna Commercial	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.00
Rate for Payer: Oxford Commercial	$46.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.50
Rate for Payer: UnitedHealthcare Commercial	$46.00
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

SUTURE BLUE W/NEEDLE

Facility

$230.00

Hospital Charge Code	270672215
Hospital Revenue Code	272
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$34.50
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

SUTURE BOLSTERS RETENTION

Facility

$25.13

Hospital Charge Code	270651256
Hospital Revenue Code	272
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.56
Rate for Payer: Aetna Commercial	$9.55
Rate for Payer: Aetna Medicare Advantage	$7.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.41
Rate for Payer: Cigna Commercial	$12.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.54
Rate for Payer: Oxford Commercial	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$3.77
Rate for Payer: UnitedHealthcare Commercial	$5.03
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

SUTURE BOLSTERS RETENTION

Facility

$25.13

Hospital Charge Code	270651256
Hospital Revenue Code	272
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$3.77

SUTURE BOOTIES STERION AID

Facility

$52.20

Hospital Charge Code	270663758
Hospital Revenue Code	270
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$7.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.83

SUTURE BOOTIES STERION AID

Facility

$52.20

Hospital Charge Code	270663758
Hospital Revenue Code	270
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$26.10
Rate for Payer: Aetna Commercial	$19.84
Rate for Payer: Aetna Medicare Advantage	$15.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.31
Rate for Payer: Cigna Commercial	$26.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.66
Rate for Payer: Oxford Commercial	$10.44
Rate for Payer: Qualcare PPO/HMO/WC	$7.83
Rate for Payer: UnitedHealthcare Commercial	$10.44
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

SUTURE BRALON CV22 4-0

Facility

$159.25

Hospital Charge Code	270604724
Hospital Revenue Code	272
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$79.62
Rate for Payer: Aetna Commercial	$60.52
Rate for Payer: Aetna Medicare Advantage	$47.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.61
Rate for Payer: Cigna Commercial	$79.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.77
Rate for Payer: Oxford Commercial	$31.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.89
Rate for Payer: UnitedHealthcare Commercial	$31.85
Rate for Payer: UnitedHealthcare Community & State	$3.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4.22

SUTURE BRALON CV22 4-0

Facility

$159.25

Hospital Charge Code	270604724
Hospital Revenue Code	272
Min. Negotiated Rate	$23.89
Max. Negotiated Rate	$23.89
Rate for Payer: Qualcare PPO/HMO/WC	$23.89

SUTURE BRD BLACK NONABS 4X30IN

Facility

$104.17

Service Code	HCPCS A4649
Hospital Charge Code	270699896
Hospital Revenue Code	272
Min. Negotiated Rate	$15.63
Max. Negotiated Rate	$15.63
Rate for Payer: Qualcare PPO/HMO/WC	$15.63

SUTURE BRD BLACK NONABS 4X30IN

Facility

$104.17

Service Code	HCPCS A4649
Hospital Charge Code	270699896
Hospital Revenue Code	272
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$52.09
Rate for Payer: Aetna Commercial	$39.58
Rate for Payer: Aetna Medicare Advantage	$31.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.56
Rate for Payer: Cigna Commercial	$52.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.25
Rate for Payer: Oxford Commercial	$20.83
Rate for Payer: Qualcare PPO/HMO/WC	$15.63
Rate for Payer: UnitedHealthcare Commercial	$20.83
Rate for Payer: UnitedHealthcare Community & State	$2.51
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

SUTURE CAPIO ETHIBOND 1/2 TAPE

Facility

$216.75

Hospital Charge Code	270683969
Hospital Revenue Code	272
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$108.38
Rate for Payer: Aetna Commercial	$82.36
Rate for Payer: Aetna Medicare Advantage	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.27
Rate for Payer: Cigna Commercial	$108.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.03
Rate for Payer: Oxford Commercial	$43.35
Rate for Payer: Qualcare PPO/HMO/WC	$32.51
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$5.74

SUTURE CAPIO ETHIBOND 1/2 TAPE

Facility

$216.75

Hospital Charge Code	270683969
Hospital Revenue Code	272
Min. Negotiated Rate	$32.51
Max. Negotiated Rate	$32.51
Rate for Payer: Qualcare PPO/HMO/WC	$32.51

SUTURE CAPIO PDS SZ 0

Facility

$199.56

Hospital Charge Code	270678356
Hospital Revenue Code	272
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$99.78
Rate for Payer: Aetna Commercial	$75.83
Rate for Payer: Aetna Medicare Advantage	$59.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.89
Rate for Payer: Cigna Commercial	$99.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.87
Rate for Payer: Oxford Commercial	$39.91
Rate for Payer: Qualcare PPO/HMO/WC	$29.93
Rate for Payer: UnitedHealthcare Commercial	$39.91
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

SUTURE CAPIO PDS SZ 0

Facility

$199.56

Hospital Charge Code	270678356
Hospital Revenue Code	272
Min. Negotiated Rate	$29.93
Max. Negotiated Rate	$29.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.93

SUTURE CAPIO PROLENE 1/2 CIRCL

Facility

$200.00

Hospital Charge Code	270616241
Hospital Revenue Code	272
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

SUTURE CAPIO PROLENE 1/2 CIRCL

Facility

$200.00

Hospital Charge Code	270616241
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

SUTURE CAPIO PROLENE SZ 0 48

Facility

$199.56

Hospital Charge Code	270621604
Hospital Revenue Code	272
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$99.78
Rate for Payer: Aetna Commercial	$75.83
Rate for Payer: Aetna Medicare Advantage	$59.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.89
Rate for Payer: Cigna Commercial	$99.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.87
Rate for Payer: Oxford Commercial	$39.91
Rate for Payer: Qualcare PPO/HMO/WC	$29.93
Rate for Payer: UnitedHealthcare Commercial	$39.91
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

SUTURE CAPIO PROLENE SZ 0 48

Facility

$199.56

Hospital Charge Code	270621604
Hospital Revenue Code	272
Min. Negotiated Rate	$29.93
Max. Negotiated Rate	$29.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.93

SUTURE CAPIO PROLENT TC 36 IN

Facility

$216.75

Hospital Charge Code	270683968
Hospital Revenue Code	272
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$108.38
Rate for Payer: Aetna Commercial	$82.36
Rate for Payer: Aetna Medicare Advantage	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.27
Rate for Payer: Cigna Commercial	$108.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.03
Rate for Payer: Oxford Commercial	$43.35
Rate for Payer: Qualcare PPO/HMO/WC	$32.51
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$5.74

SUTURE CAPIO PROLENT TC 36 IN

Facility

$216.75

Hospital Charge Code	270683968
Hospital Revenue Code	272
Min. Negotiated Rate	$32.51
Max. Negotiated Rate	$32.51
Rate for Payer: Qualcare PPO/HMO/WC	$32.51

SUTURE CAPROSY 3-0 P14 SC5780G

Facility

$16.25

Hospital Charge Code	270632706
Hospital Revenue Code	272
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.44

SUTURE CAPROSY 3-0 P14 SC5780G

Facility

$16.25

Hospital Charge Code	270632706
Hospital Revenue Code	272
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.12
Rate for Payer: Aetna Commercial	$6.17
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.14
Rate for Payer: Cigna Commercial	$8.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.88
Rate for Payer: Oxford Commercial	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.44
Rate for Payer: UnitedHealthcare Commercial	$3.25
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

SUTURE CAPROSYN 0 HGS21 CC942

Facility

$7.50

Hospital Charge Code	270633220
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

Know your out-of-pocket cost for care.

All Charges