Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE POLYSORB 1 GS-21 36 UD

Facility

$7.00

Hospital Charge Code	2703111186
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SUTURE POLYSORB 1 GS-21 36 UD

Facility

$7.00

Hospital Charge Code	2703111186
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SUTURE POLYSORB 2/0 12x18 U/D

Facility

$29.28

Hospital Charge Code	270656145
Hospital Revenue Code	272
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$4.39
Rate for Payer: Qualcare PPO/HMO/WC	$4.39

SUTURE POLYSORB 2/0 12x18 U/D

Facility

$29.28

Hospital Charge Code	270656145
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.64
Rate for Payer: Aetna Commercial	$11.13
Rate for Payer: Aetna Medicare Advantage	$8.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.47
Rate for Payer: Cigna Commercial	$14.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.78
Rate for Payer: Oxford Commercial	$5.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.39
Rate for Payer: UnitedHealthcare Commercial	$5.86
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

SUTURE POLYSORB 2-0 18 U/D

Facility

$29.99

Hospital Charge Code	270651492
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SUTURE POLYSORB 2-0 18 U/D

Facility

$29.99

Hospital Charge Code	270651492
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.99
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$14.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

SUTURE POLYSORB 2/0 30 CT2

Facility

$6.68

Hospital Charge Code	270604546
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.34
Rate for Payer: Aetna Commercial	$2.54
Rate for Payer: Aetna Medicare Advantage	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.70
Rate for Payer: Cigna Commercial	$3.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

SUTURE POLYSORB 2/0 30 CT2

Facility

$6.68

Hospital Charge Code	270604546
Hospital Revenue Code	272
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

SUTURE POLYSORB 2/0 30 GS10

Facility

$7.45

Hospital Charge Code	270651131
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.49
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SUTURE POLYSORB 2/0 30 GS10

Facility

$7.45

Hospital Charge Code	270651131
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

SUTURE POLYSORB 2/0 30IN CT1

Facility

$6.07

Hospital Charge Code	270604545
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$1.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.55
Rate for Payer: Cigna Commercial	$3.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SUTURE POLYSORB 2/0 30IN CT1

Facility

$6.07

Hospital Charge Code	270604545
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.91

SUTURE POLYSORB 2/0 30 U/D FS1

Facility

$6.94

Hospital Charge Code	270606996
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.04

SUTURE POLYSORB 2/0 30 U/D FS1

Facility

$6.94

Hospital Charge Code	270606996
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.47
Rate for Payer: Aetna Commercial	$2.64
Rate for Payer: Aetna Medicare Advantage	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.77
Rate for Payer: Cigna Commercial	$3.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.04
Rate for Payer: UnitedHealthcare Commercial	$1.39
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

SUTURE POLYSORB 2/0 30 UD V20

Facility

$2.24

Hospital Charge Code	270605250
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$0.85
Rate for Payer: Aetna Medicare Advantage	$0.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.57
Rate for Payer: Cigna Commercial	$1.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.67
Rate for Payer: Oxford Commercial	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.34
Rate for Payer: UnitedHealthcare Commercial	$0.45
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

SUTURE POLYSORB 2/0 30 UD V20

Facility

$2.24

Hospital Charge Code	270605250
Hospital Revenue Code	272
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Qualcare PPO/HMO/WC	$0.34

SUTURE POLYSORB 2/0 30 VIOLET

Facility

$7.96

Hospital Charge Code	270604543
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.39
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.19
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

SUTURE POLYSORB 2/0 30 VIOLET

Facility

$7.96

Hospital Charge Code	270604543
Hospital Revenue Code	272
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

SUTURE POLYSORB 2/0 30 VIOLET

Facility

$8.82

Hospital Charge Code	270604548
Hospital Revenue Code	272
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.32

SUTURE POLYSORB 2/0 30 VIOLET

Facility

$8.82

Hospital Charge Code	270604548
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.41
Rate for Payer: Aetna Commercial	$3.35
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	$4.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.65
Rate for Payer: Oxford Commercial	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.32
Rate for Payer: UnitedHealthcare Commercial	$1.76
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

SUTURE POLYSORB 2/0 36 U/D CT

Facility

$6.83

Hospital Charge Code	270651346
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

SUTURE POLYSORB 2/0 36 U/D CT

Facility

$6.83

Hospital Charge Code	270651346
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.42
Rate for Payer: Aetna Commercial	$2.60
Rate for Payer: Aetna Medicare Advantage	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.74
Rate for Payer: Cigna Commercial	$3.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.05
Rate for Payer: Oxford Commercial	$1.37
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$1.37
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

SUTURE POLYSORB 2/0 3x18 VIO

Facility

$7.34

Hospital Charge Code	270670965
Hospital Revenue Code	272
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: Qualcare PPO/HMO/WC	$1.10

SUTURE POLYSORB 2/0 3x18 VIO

Facility

$7.34

Hospital Charge Code	270670965
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.67
Rate for Payer: Aetna Commercial	$2.79
Rate for Payer: Aetna Medicare Advantage	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.87
Rate for Payer: Cigna Commercial	$3.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.20
Rate for Payer: Oxford Commercial	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.10
Rate for Payer: UnitedHealthcare Commercial	$1.47
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SUTURE POLYSORB 2/0 3x27 VIO

Facility

$7.24

Hospital Charge Code	270604526
Hospital Revenue Code	272
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

Know your out-of-pocket cost for care.

All Charges