Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUT GORE-TEX CV-7 TTC-07 D/A

Facility

$272.08

Hospital Charge Code	270650826
Hospital Revenue Code	272
Min. Negotiated Rate	$40.81
Max. Negotiated Rate	$40.81
Rate for Payer: Qualcare PPO/HMO/WC	$40.81

SUT GORE-TEX CV-7 TTC-07 D/A

Facility

$272.08

Hospital Charge Code	270650826
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$136.04
Rate for Payer: Aetna Commercial	$103.39
Rate for Payer: Aetna Medicare Advantage	$81.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.38
Rate for Payer: Cigna Commercial	$136.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.62
Rate for Payer: Oxford Commercial	$54.42
Rate for Payer: Qualcare PPO/HMO/WC	$40.81
Rate for Payer: UnitedHealthcare Commercial	$54.42
Rate for Payer: UnitedHealthcare Community & State	$6.56
Rate for Payer: Wellpoint Medicaid Managed Care	$7.21

SUTH ANCHOR BIOCOMP P-LOCK

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687858
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SUTH ANCHOR BIOCOMP P-LOCK

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687858
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

SUTRE LASSO 30DEG STR AR406830

Facility

$1,125.00

Hospital Charge Code	270640196
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

SUTRE LASSO 30DEG STR AR406830

Facility

$1,125.00

Hospital Charge Code	270640196
Hospital Revenue Code	272
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

SUTRELASSO HIP CRESCENT

Facility

$825.00

Hospital Charge Code	270677470
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.50
Rate for Payer: Oxford Commercial	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$165.00
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

SUTRELASSO HIP CRESCENT

Facility

$825.00

Hospital Charge Code	270677470
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTRLASSO FOR HIP

Facility

$825.00

Hospital Charge Code	270681513
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.50
Rate for Payer: Oxford Commercial	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$165.00
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

SUTRLASSO FOR HIP

Facility

$825.00

Hospital Charge Code	270681513
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTRLASSO FOR HIP 45DEG L

Facility

$825.00

Hospital Charge Code	270681512
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTRLASSO FOR HIP 45DEG L

Facility

$825.00

Hospital Charge Code	270681512
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.50
Rate for Payer: Oxford Commercial	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$165.00
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

SUTRLASSO FOR HIP 45DEG R

Facility

$825.00

Hospital Charge Code	270681511
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTRLASSO FOR HIP 45DEG R

Facility

$825.00

Hospital Charge Code	270681511
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.50
Rate for Payer: Oxford Commercial	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$165.00
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

SUTRLASSO HIP 90 STR

Facility

$825.00

Hospital Charge Code	270681514
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.50
Rate for Payer: Oxford Commercial	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$165.00
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

SUTRLASSO HIP 90 STR

Facility

$825.00

Hospital Charge Code	270681514
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SUTR ORTH BLUE WO/NEED 223111

Facility

$1,325.00

Hospital Charge Code	270635836
Hospital Revenue Code	272
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$198.75
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

SUTR ORTH BLUE WO/NEED 223111

Facility

$1,325.00

Hospital Charge Code	270635836
Hospital Revenue Code	272
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.50
Rate for Payer: Oxford Commercial	$265.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Commercial	$265.00
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

SUT SOFSIL 3-0 C-14 BLK SS684G

Facility

$5.35

Hospital Charge Code	270640893
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SUT SOFSIL 3-0 C-14 BLK SS684G

Facility

$5.35

Hospital Charge Code	270640893
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.67
Rate for Payer: Aetna Commercial	$2.03
Rate for Payer: Aetna Medicare Advantage	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.36
Rate for Payer: Cigna Commercial	$2.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.60
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

SUTURE

Facility

$108.41

Hospital Charge Code	270999002
Hospital Revenue Code	272
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$54.20
Rate for Payer: Aetna Commercial	$41.20
Rate for Payer: Aetna Medicare Advantage	$32.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.64
Rate for Payer: Cigna Commercial	$54.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.52
Rate for Payer: Oxford Commercial	$21.68
Rate for Payer: Qualcare PPO/HMO/WC	$16.26
Rate for Payer: UnitedHealthcare Commercial	$21.68
Rate for Payer: UnitedHealthcare Community & State	$2.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.87

SUTURE

Facility

$108.41

Hospital Charge Code	270999002
Hospital Revenue Code	272
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$16.26
Rate for Payer: Qualcare PPO/HMO/WC	$16.26

SUTURE 0 POLYSORB GS-21 NEEDLE

Facility

$26.11

Hospital Charge Code	270654988
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Qualcare PPO/HMO/WC	$3.92

SUTURE 0 POLYSORB GS-21 NEEDLE

Facility

$26.11

Hospital Charge Code	270654988
Hospital Revenue Code	272
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.05
Rate for Payer: Aetna Commercial	$9.92
Rate for Payer: Aetna Medicare Advantage	$7.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.66
Rate for Payer: Cigna Commercial	$13.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.83
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.92
Rate for Payer: UnitedHealthcare Commercial	$5.22
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

SUTURE 0 THX26 CV-2 GORE 2U05A

Facility

$107.50

Hospital Charge Code	270641568
Hospital Revenue Code	272
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare Advantage	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.41
Rate for Payer: Cigna Commercial	$53.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.25
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.12
Rate for Payer: UnitedHealthcare Commercial	$21.50
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.85

Know your out-of-pocket cost for care.

All Charges