Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE 3-0 VICRYL PLUS

Facility

$59.57

Service Code	HCPCS A4649
Hospital Charge Code	270664981S
Hospital Revenue Code	272
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$8.94
Rate for Payer: Qualcare PPO/HMO/WC	$8.94

SUTURE 4-0 PROLENE BLUE MONO

Facility

$35.14

Service Code	HCPCS A4649
Hospital Charge Code	270693787
Hospital Revenue Code	272
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$5.27

SUTURE 4-0 PROLENE BLUE MONO

Facility

$35.14

Service Code	HCPCS A4649
Hospital Charge Code	270693787
Hospital Revenue Code	272
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$17.57
Rate for Payer: Aetna Commercial	$13.35
Rate for Payer: Aetna Medicare Advantage	$10.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.96
Rate for Payer: Cigna Commercial	$17.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.14
Rate for Payer: Oxford Commercial	$7.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.27
Rate for Payer: UnitedHealthcare Commercial	$7.03
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

SUTURE 4-0 SILK SH POP OFF MUL

Facility

$64.80

Hospital Charge Code	270685435
Hospital Revenue Code	272
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$9.72
Rate for Payer: Qualcare PPO/HMO/WC	$9.72

SUTURE 4-0 SILK SH POP OFF MUL

Facility

$64.80

Hospital Charge Code	270685435
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$32.40
Rate for Payer: Aetna Commercial	$24.62
Rate for Payer: Aetna Medicare Advantage	$19.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.52
Rate for Payer: Cigna Commercial	$32.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.85
Rate for Payer: Oxford Commercial	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$9.72
Rate for Payer: UnitedHealthcare Commercial	$12.96
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.84

SUTURE 4-0 VICRYL RB-1 18 IN

Facility

$70.40

Hospital Charge Code	270690132
Hospital Revenue Code	272
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna Commercial	$26.75
Rate for Payer: Aetna Medicare Advantage	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.95
Rate for Payer: Cigna Commercial	$35.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$14.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.56
Rate for Payer: UnitedHealthcare Commercial	$14.08
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

SUTURE 4-0 VICRYL RB-1 18 IN

Facility

$70.40

Hospital Charge Code	270690132
Hospital Revenue Code	272
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$10.56

SUTURE 5-0 18IN VICRYL PC-3

Facility

$22.65

Hospital Charge Code	270671350
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.32
Rate for Payer: Aetna Commercial	$8.61
Rate for Payer: Aetna Medicare Advantage	$6.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.78
Rate for Payer: Cigna Commercial	$11.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.89
Rate for Payer: Oxford Commercial	$4.53
Rate for Payer: Qualcare PPO/HMO/WC	$3.40
Rate for Payer: UnitedHealthcare Commercial	$4.53
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

SUTURE 5-0 18IN VICRYL PC-3

Facility

$22.65

Hospital Charge Code	270671350
Hospital Revenue Code	272
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.40

SUTURE 5-0 MONOCRYL PLUS PS-2

Facility

$27.36

Service Code	HCPCS A4649
Hospital Charge Code	270671353
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.68
Rate for Payer: Aetna Commercial	$10.40
Rate for Payer: Aetna Medicare Advantage	$8.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.98
Rate for Payer: Cigna Commercial	$13.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.11
Rate for Payer: Oxford Commercial	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$4.10
Rate for Payer: UnitedHealthcare Commercial	$5.47
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

SUTURE 5-0 MONOCRYL PLUS PS-2

Facility

$27.36

Service Code	HCPCS A4649
Hospital Charge Code	270671353
Hospital Revenue Code	272
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.10
Rate for Payer: Qualcare PPO/HMO/WC	$4.10

SUTURE 5-0 PLAIN GUT 12 S-14

Facility

$98.89

Hospital Charge Code	270674245
Hospital Revenue Code	272
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$49.45
Rate for Payer: Aetna Commercial	$37.58
Rate for Payer: Aetna Medicare Advantage	$29.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.22
Rate for Payer: Cigna Commercial	$49.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.71
Rate for Payer: Oxford Commercial	$19.78
Rate for Payer: Qualcare PPO/HMO/WC	$14.83
Rate for Payer: UnitedHealthcare Commercial	$19.78
Rate for Payer: UnitedHealthcare Community & State	$3.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

SUTURE 5-0 PLAIN GUT 12 S-14

Facility

$98.89

Hospital Charge Code	270674245
Hospital Revenue Code	272
Min. Negotiated Rate	$14.83
Max. Negotiated Rate	$14.83
Rate for Payer: Qualcare PPO/HMO/WC	$14.83

SUTURE 5-0 RB-1 VICRYL

Facility

$9.96

Hospital Charge Code	270690404
Hospital Revenue Code	272
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.98
Rate for Payer: Aetna Commercial	$3.78
Rate for Payer: Aetna Medicare Advantage	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.54
Rate for Payer: Cigna Commercial	$4.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.59
Rate for Payer: Oxford Commercial	$1.99
Rate for Payer: Qualcare PPO/HMO/WC	$1.49
Rate for Payer: UnitedHealthcare Commercial	$1.99
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

SUTURE 5-0 RB-1 VICRYL

Facility

$9.96

Hospital Charge Code	270690404
Hospital Revenue Code	272
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.49

SUTURE 5-0 VICRYL RB-1

Facility

$8.24

Hospital Charge Code	270690131
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Oxford Commercial	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$1.65
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

SUTURE 5-0 VICRYL RB-1

Facility

$8.24

Hospital Charge Code	270690131
Hospital Revenue Code	272
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

SUTURE 5-0 VICRYL UNDYES PC-3

Facility

$33.50

Hospital Charge Code	270684898
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$16.75
Rate for Payer: Aetna Commercial	$12.73
Rate for Payer: Aetna Medicare Advantage	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.54
Rate for Payer: Cigna Commercial	$16.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.71
Rate for Payer: Oxford Commercial	$6.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.03
Rate for Payer: UnitedHealthcare Commercial	$6.70
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

SUTURE 5-0 VICRYL UNDYES PC-3

Facility

$31.85

Hospital Charge Code	270684897
Hospital Revenue Code	272
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$4.78
Rate for Payer: Qualcare PPO/HMO/WC	$4.78

SUTURE 5-0 VICRYL UNDYES PC-3

Facility

$31.85

Hospital Charge Code	270684897
Hospital Revenue Code	272
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$15.93
Rate for Payer: Aetna Commercial	$12.10
Rate for Payer: Aetna Medicare Advantage	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.12
Rate for Payer: Cigna Commercial	$15.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.28
Rate for Payer: Oxford Commercial	$6.37
Rate for Payer: Qualcare PPO/HMO/WC	$4.78
Rate for Payer: UnitedHealthcare Commercial	$6.37
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

SUTURE 5-0 VICRYL UNDYES PC-3

Facility

$33.50

Hospital Charge Code	270684898
Hospital Revenue Code	272
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$5.03

SUTURE 5 SILK 60 IN

Facility

$17.85

Hospital Charge Code	270702978
Hospital Revenue Code	278
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$8.93
Rate for Payer: Aetna Commercial	$6.78
Rate for Payer: Aetna Medicare Advantage	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.55
Rate for Payer: Cigna Commercial	$8.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

SUTURE 5 SILK 60 IN

Facility

$17.85

Hospital Charge Code	270702978
Hospital Revenue Code	278
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

SUTURE 6-0 PROLENE BL BV-1 36

Facility

$462.48

Hospital Charge Code	270679571
Hospital Revenue Code	272
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$231.24
Rate for Payer: Aetna Commercial	$175.74
Rate for Payer: Aetna Medicare Advantage	$138.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.93
Rate for Payer: Cigna Commercial	$231.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.24
Rate for Payer: Oxford Commercial	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$69.37
Rate for Payer: UnitedHealthcare Commercial	$92.50
Rate for Payer: UnitedHealthcare Community & State	$14.61
Rate for Payer: Wellpoint Medicaid Managed Care	$13.13

SUTURE 6-0 PROLENE BL BV-1 36

Facility

$462.48

Hospital Charge Code	270679571
Hospital Revenue Code	272
Min. Negotiated Rate	$69.37
Max. Negotiated Rate	$69.37
Rate for Payer: Qualcare PPO/HMO/WC	$69.37

Know your out-of-pocket cost for care.

All Charges