Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE VICRYL PLUS 0 CT 1

Facility

$172.05

Hospital Charge Code	270663655
Hospital Revenue Code	272
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$25.81
Rate for Payer: Qualcare PPO/HMO/WC	$25.81

SUTURE VICRYL PLUS 0 CT 1

Facility

$172.05

Hospital Charge Code	270663655
Hospital Revenue Code	272
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$86.03
Rate for Payer: Aetna Commercial	$65.38
Rate for Payer: Aetna Medicare Advantage	$51.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.87
Rate for Payer: Cigna Commercial	$86.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.62
Rate for Payer: Oxford Commercial	$34.41
Rate for Payer: Qualcare PPO/HMO/WC	$25.81
Rate for Payer: UnitedHealthcare Commercial	$34.41
Rate for Payer: UnitedHealthcare Community & State	$4.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

SUTURE VICRYL PLUS 0-CT-1

Facility

$25.00

Hospital Charge Code	270669358
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

SUTURE VICRYL PLUS 0-CT-1

Facility

$25.00

Hospital Charge Code	270669358
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

SUTURE VICRYLPLUS 0 CTX

Facility

$8.84

Hospital Charge Code	270678680
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.42
Rate for Payer: Aetna Commercial	$3.36
Rate for Payer: Aetna Medicare Advantage	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.25
Rate for Payer: Cigna Commercial	$4.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.65
Rate for Payer: Oxford Commercial	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.33
Rate for Payer: UnitedHealthcare Commercial	$1.77
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

SUTURE VICRYLPLUS 0 CTX

Facility

$8.84

Hospital Charge Code	270678680
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

SUTURE VICRYL PLUS 2-0 27IN 26

Facility

$60.05

Hospital Charge Code	270697869
Hospital Revenue Code	272
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$9.01
Rate for Payer: Qualcare PPO/HMO/WC	$9.01

SUTURE VICRYL PLUS 2-0 27IN 26

Facility

$60.05

Hospital Charge Code	270697869
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.02
Rate for Payer: Aetna Commercial	$22.82
Rate for Payer: Aetna Medicare Advantage	$18.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.31
Rate for Payer: Cigna Commercial	$30.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.02
Rate for Payer: Oxford Commercial	$12.01
Rate for Payer: Qualcare PPO/HMO/WC	$9.01
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

SUTURE VICRYL RAPIDE 2-0 CT-1

Facility

$15.81

Hospital Charge Code	270664583
Hospital Revenue Code	272
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.37

SUTURE VICRYL RAPIDE 2-0 CT-1

Facility

$15.81

Hospital Charge Code	270664583
Hospital Revenue Code	272
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.91
Rate for Payer: Aetna Commercial	$6.01
Rate for Payer: Aetna Medicare Advantage	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.03
Rate for Payer: Cigna Commercial	$7.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.74
Rate for Payer: Oxford Commercial	$3.16
Rate for Payer: Qualcare PPO/HMO/WC	$2.37
Rate for Payer: UnitedHealthcare Commercial	$3.16
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

SUTURE VICRYL RAPIDE 2-0 SH

Facility

$14.90

Hospital Charge Code	270677270
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.45
Rate for Payer: Aetna Commercial	$5.66
Rate for Payer: Aetna Medicare Advantage	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.80
Rate for Payer: Cigna Commercial	$7.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.47
Rate for Payer: Oxford Commercial	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.23
Rate for Payer: UnitedHealthcare Commercial	$2.98
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

SUTURE VICRYL RAPIDE 2-0 SH

Facility

$14.90

Hospital Charge Code	270677270
Hospital Revenue Code	272
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.23

SUTURE VICRYL RAPIDE 3/0 27

Facility

$23.05

Hospital Charge Code	270657588
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.53
Rate for Payer: Aetna Commercial	$8.76
Rate for Payer: Aetna Medicare Advantage	$6.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.88
Rate for Payer: Cigna Commercial	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.92
Rate for Payer: Oxford Commercial	$4.61
Rate for Payer: Qualcare PPO/HMO/WC	$3.46
Rate for Payer: UnitedHealthcare Commercial	$4.61
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

SUTURE VICRYL RAPIDE 3/0 27

Facility

$23.05

Hospital Charge Code	270657588
Hospital Revenue Code	272
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$3.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.46

SUTURE VICRYL RAPIDE 3-0 SH

Facility

$14.90

Hospital Charge Code	270677269
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.45
Rate for Payer: Aetna Commercial	$5.66
Rate for Payer: Aetna Medicare Advantage	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.80
Rate for Payer: Cigna Commercial	$7.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.47
Rate for Payer: Oxford Commercial	$2.98
Rate for Payer: Qualcare PPO/HMO/WC	$2.23
Rate for Payer: UnitedHealthcare Commercial	$2.98
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

SUTURE VICRYL RAPIDE 3-0 SH

Facility

$14.90

Hospital Charge Code	270677269
Hospital Revenue Code	272
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.23

SUTURE VICRYL RAPIDE 4-0 PS-2

Facility

$30.80

Hospital Charge Code	270661984
Hospital Revenue Code	272
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$4.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.62

SUTURE VICRYL RAPIDE 4-0 PS-2

Facility

$30.80

Hospital Charge Code	270661984
Hospital Revenue Code	272
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.40
Rate for Payer: Aetna Commercial	$11.70
Rate for Payer: Aetna Medicare Advantage	$9.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.85
Rate for Payer: Cigna Commercial	$15.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.24
Rate for Payer: Oxford Commercial	$6.16
Rate for Payer: Qualcare PPO/HMO/WC	$4.62
Rate for Payer: UnitedHealthcare Commercial	$6.16
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

SUTURE VICRYL SZ 0 CT-1 18 IN

Facility

$32.32

Hospital Charge Code	270688291
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.16
Rate for Payer: Aetna Commercial	$12.28
Rate for Payer: Aetna Medicare Advantage	$9.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.24
Rate for Payer: Cigna Commercial	$16.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.70
Rate for Payer: Oxford Commercial	$6.46
Rate for Payer: Qualcare PPO/HMO/WC	$4.85
Rate for Payer: UnitedHealthcare Commercial	$6.46
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

SUTURE VICRYL SZ 0 CT-1 18 IN

Facility

$32.32

Hospital Charge Code	270688291
Hospital Revenue Code	272
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$4.85
Rate for Payer: Qualcare PPO/HMO/WC	$4.85

SUTURE VICRYL SZ 2-0 CT-2

Facility

$58.86

Hospital Charge Code	270688292
Hospital Revenue Code	272
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$8.83
Rate for Payer: Qualcare PPO/HMO/WC	$8.83

SUTURE VICRYL SZ 2-0 CT-2

Facility

$58.86

Hospital Charge Code	270688292
Hospital Revenue Code	272
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$29.43
Rate for Payer: Aetna Commercial	$22.37
Rate for Payer: Aetna Medicare Advantage	$17.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.01
Rate for Payer: Cigna Commercial	$29.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.66
Rate for Payer: Oxford Commercial	$11.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.83
Rate for Payer: UnitedHealthcare Commercial	$11.77
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

SUTURE VICRYL VIOLET CTD 27IN

Facility

$10.99

Service Code	HCPCS A4649
Hospital Charge Code	270672130
Hospital Revenue Code	272
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

SUTURE VICRYL VIOLET CTD 27IN

Facility

$10.99

Service Code	HCPCS A4649
Hospital Charge Code	270672130
Hospital Revenue Code	272
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.80
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

SUTURE V-LOC 180 2-0 GS-21

Facility

$110.00

Hospital Charge Code	270665291
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

Know your out-of-pocket cost for care.

All Charges