Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE VICRYL 8-0 TG140-8 8

Facility

$17.93

Hospital Charge Code	270655747
Hospital Revenue Code	272
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

SUTURE VICRYL 9-0 CS160-8

Facility

$84.78

Hospital Charge Code	270663418
Hospital Revenue Code	272
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$12.72
Rate for Payer: Qualcare PPO/HMO/WC	$12.72

SUTURE VICRYL 9-0 CS160-8

Facility

$84.78

Hospital Charge Code	270663418
Hospital Revenue Code	272
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$42.39
Rate for Payer: Aetna Commercial	$32.22
Rate for Payer: Aetna Medicare Advantage	$25.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.62
Rate for Payer: Cigna Commercial	$42.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.43
Rate for Payer: Oxford Commercial	$16.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.72
Rate for Payer: UnitedHealthcare Commercial	$16.96
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

SUTURE VICRYL CP-2 3/0

Facility

$819.80

Hospital Charge Code	270676531
Hospital Revenue Code	272
Min. Negotiated Rate	$122.97
Max. Negotiated Rate	$122.97
Rate for Payer: Qualcare PPO/HMO/WC	$122.97

SUTURE VICRYL CP-2 3/0

Facility

$819.80

Hospital Charge Code	270676531
Hospital Revenue Code	272
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$409.90
Rate for Payer: Aetna Commercial	$311.52
Rate for Payer: Aetna Medicare Advantage	$245.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.05
Rate for Payer: Cigna Commercial	$409.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.94
Rate for Payer: Oxford Commercial	$163.96
Rate for Payer: Qualcare PPO/HMO/WC	$122.97
Rate for Payer: UnitedHealthcare Commercial	$163.96
Rate for Payer: UnitedHealthcare Community & State	$19.76
Rate for Payer: Wellpoint Medicaid Managed Care	$21.72

SUTURE VICRYL CTD 0 TIES

Facility

$9.55

Hospital Charge Code	270677551
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$3.63
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$1.91
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.91
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

SUTURE VICRYL CTD 0 TIES

Facility

$9.55

Hospital Charge Code	270677551
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

SUTURE VICRYL CTD 1 CT-2

Facility

$8.05

Hospital Charge Code	270677554
Hospital Revenue Code	272
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

SUTURE VICRYL CTD 1 CT-2

Facility

$8.05

Hospital Charge Code	270677554
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.03
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.42
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

SUTURE VICRYL CTD 2-0 TIES

Facility

$9.55

Hospital Charge Code	270677552
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$3.63
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$1.91
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.91
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

SUTURE VICRYL CTD 2-0 TIES

Facility

$9.55

Hospital Charge Code	270677552
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

SUTURE VICRYL CTD 2-0 V-34

Facility

$13.10

Hospital Charge Code	270677581
Hospital Revenue Code	272
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.97

SUTURE VICRYL CTD 2-0 V-34

Facility

$13.10

Hospital Charge Code	270677581
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.55
Rate for Payer: Aetna Commercial	$4.98
Rate for Payer: Aetna Medicare Advantage	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.34
Rate for Payer: Cigna Commercial	$6.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.93
Rate for Payer: Oxford Commercial	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.97
Rate for Payer: UnitedHealthcare Commercial	$2.62
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

SUTURE VICRYL CTD 3-0 SH

Facility

$7.75

Hospital Charge Code	270677691
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

SUTURE VICRYL CTD 3-0 SH

Facility

$7.75

Hospital Charge Code	270677691
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$2.94
Rate for Payer: Aetna Medicare Advantage	$2.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.98
Rate for Payer: Cigna Commercial	$3.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.33
Rate for Payer: Oxford Commercial	$1.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.55
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

SUTURE VICRYL CTD 3-0 SH CR

Facility

$17.30

Hospital Charge Code	270677714
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.60

SUTURE VICRYL CTD 3-0 SH CR

Facility

$17.30

Hospital Charge Code	270677714
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.65
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: Aetna Medicare Advantage	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.41
Rate for Payer: Cigna Commercial	$8.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.19
Rate for Payer: Oxford Commercial	$3.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.60
Rate for Payer: UnitedHealthcare Commercial	$3.46
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

SUTURE VICRYL CTD 3-0 TIES

Facility

$9.55

Hospital Charge Code	270677553
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.78
Rate for Payer: Aetna Commercial	$3.63
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.87
Rate for Payer: Oxford Commercial	$1.91
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.91
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

SUTURE VICRYL CTD 3-0 TIES

Facility

$9.55

Hospital Charge Code	270677553
Hospital Revenue Code	272
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

SUTURE VICRYL O UR-6 DBL ARM

Facility

$69.10

Hospital Charge Code	270677493
Hospital Revenue Code	272
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$10.37
Rate for Payer: Qualcare PPO/HMO/WC	$10.37

SUTURE VICRYL O UR-6 DBL ARM

Facility

$69.10

Hospital Charge Code	270677493
Hospital Revenue Code	272
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$34.55
Rate for Payer: Aetna Commercial	$26.26
Rate for Payer: Aetna Medicare Advantage	$20.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.62
Rate for Payer: Cigna Commercial	$34.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.73
Rate for Payer: Oxford Commercial	$13.82
Rate for Payer: Qualcare PPO/HMO/WC	$10.37
Rate for Payer: UnitedHealthcare Commercial	$13.82
Rate for Payer: UnitedHealthcare Community & State	$1.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

SUTURE VICRYL P-3 5/0

Facility

$15.00

Hospital Charge Code	2706491110
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

SUTURE VICRYL P-3 5/0

Facility

$15.00

Hospital Charge Code	2706491110
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

SUTURE VICRYL P-3 5/0

Facility

$15.00

Hospital Charge Code	270649110
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

SUTURE VICRYL P-3 5/0

Facility

$15.00

Hospital Charge Code	270649110
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

Know your out-of-pocket cost for care.

All Charges