Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE POLYSORB 3/0 3x30 VIO

Facility

$7.24

Hospital Charge Code	270604527
Hospital Revenue Code	272
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

SUTURE POLYSORB 3/0 60 U/D

Facility

$7.29

Hospital Charge Code	270651155
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.19
Rate for Payer: Oxford Commercial	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SUTURE POLYSORB 3/0 60 U/D

Facility

$7.29

Hospital Charge Code	270651155
Hospital Revenue Code	272
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

SUTURE POLYSORB 3/0 60 VIO

Facility

$7.34

Hospital Charge Code	270604523
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 3/0 60 VIO

Facility

$7.34

Hospital Charge Code	270604523
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 3/0 P-12

Facility

$13.87

Hospital Charge Code	2709000783
Hospital Revenue Code	272
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.08

SUTURE POLYSORB 3/0 P-12

Facility

$13.87

Hospital Charge Code	2709000783
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.93
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Aetna Medicare Advantage	$4.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.54
Rate for Payer: Cigna Commercial	$6.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.08
Rate for Payer: UnitedHealthcare Commercial	$2.77
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

SUTURE POLYSORB 3/0 V-20 30 UD

Facility

$5.80

Hospital Charge Code	270656032
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

SUTURE POLYSORB 3/0 V-20 30 UD

Facility

$5.80

Hospital Charge Code	270656032
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.20
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SUTURE POLYSORB 4/0 18IN UNDYE

Facility

$12.94

Hospital Charge Code	2709007229
Hospital Revenue Code	272
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.94

SUTURE POLYSORB 4/0 18IN UNDYE

Facility

$12.94

Hospital Charge Code	2709007229
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.47
Rate for Payer: Aetna Commercial	$4.92
Rate for Payer: Aetna Medicare Advantage	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.30
Rate for Payer: Cigna Commercial	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.88
Rate for Payer: Oxford Commercial	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.94
Rate for Payer: UnitedHealthcare Commercial	$2.59
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

SUTURE POLYSORB 4/0 18 U/D P12

Facility

$14.08

Hospital Charge Code	270651676
Hospital Revenue Code	272
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.11

SUTURE POLYSORB 4/0 18 U/D P12

Facility

$14.08

Hospital Charge Code	270651676
Hospital Revenue Code	272
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.04
Rate for Payer: Aetna Commercial	$5.35
Rate for Payer: Aetna Medicare Advantage	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.59
Rate for Payer: Cigna Commercial	$7.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.22
Rate for Payer: Oxford Commercial	$2.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.11
Rate for Payer: UnitedHealthcare Commercial	$2.82
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

SUTURE POLYSORB 4/0 18 U/D P13

Facility

$15.10

Hospital Charge Code	270600795
Hospital Revenue Code	272
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$2.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.27

SUTURE POLYSORB 4/0 18 U/D P13

Facility

$35.98

Hospital Charge Code	270649102
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

SUTURE POLYSORB 4/0 18 U/D P13

Facility

$35.98

Hospital Charge Code	270649102
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$17.99
Rate for Payer: Aetna Commercial	$13.67
Rate for Payer: Aetna Medicare Advantage	$10.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.17
Rate for Payer: Cigna Commercial	$17.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

SUTURE POLYSORB 4/0 18 U/D P13

Facility

$15.10

Hospital Charge Code	270600795
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.55
Rate for Payer: Aetna Commercial	$5.74
Rate for Payer: Aetna Medicare Advantage	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.85
Rate for Payer: Cigna Commercial	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.53
Rate for Payer: Oxford Commercial	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.27
Rate for Payer: UnitedHealthcare Commercial	$3.02
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

SUTURE POLYSORB 4/0 18 U/D P21

Facility

$13.77

Hospital Charge Code	270651289
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.88
Rate for Payer: Aetna Commercial	$5.23
Rate for Payer: Aetna Medicare Advantage	$4.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.51
Rate for Payer: Cigna Commercial	$6.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.13
Rate for Payer: Oxford Commercial	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Commercial	$2.75
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

SUTURE POLYSORB 4/0 18 U/D P21

Facility

$13.77

Hospital Charge Code	270651289
Hospital Revenue Code	272
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

SUTURE POLYSORB 4/0 18 UNDYED

Facility

$13.40

Hospital Charge Code	270656152
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.70
Rate for Payer: Aetna Commercial	$5.09
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.42
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.02
Rate for Payer: Oxford Commercial	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.01
Rate for Payer: UnitedHealthcare Commercial	$2.68
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

SUTURE POLYSORB 4/0 18 UNDYED

Facility

$13.40

Hospital Charge Code	270656152
Hospital Revenue Code	272
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Qualcare PPO/HMO/WC	$2.01

SUTURE POLYSORB 4/0 30 U/D FS2

Facility

$16.12

Hospital Charge Code	270651171
Hospital Revenue Code	272
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$2.42

SUTURE POLYSORB 4/0 30 U/D FS2

Facility

$16.12

Hospital Charge Code	270651171
Hospital Revenue Code	272
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.06
Rate for Payer: Aetna Commercial	$6.13
Rate for Payer: Aetna Medicare Advantage	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.11
Rate for Payer: Cigna Commercial	$8.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.84
Rate for Payer: Oxford Commercial	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.42
Rate for Payer: UnitedHealthcare Commercial	$3.22
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

SUTURE POLYSORB 4/0 30 U/D SC2

Facility

$6.27

Hospital Charge Code	270604581
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$2.38
Rate for Payer: Aetna Medicare Advantage	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.60
Rate for Payer: Cigna Commercial	$3.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.88
Rate for Payer: Oxford Commercial	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.94
Rate for Payer: UnitedHealthcare Commercial	$1.25
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUTURE POLYSORB 4/0 30 U/D SC2

Facility

$6.27

Hospital Charge Code	270604581
Hospital Revenue Code	272
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.94

Know your out-of-pocket cost for care.

All Charges