Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE POLYSORB 4/0 30 UD V20

Facility

$6.43

Hospital Charge Code	270605816
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

SUTURE POLYSORB 4/0 30 UD V20

Facility

$6.43

Hospital Charge Code	270605816
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.21
Rate for Payer: Aetna Commercial	$2.44
Rate for Payer: Aetna Medicare Advantage	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.64
Rate for Payer: Cigna Commercial	$3.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.93
Rate for Payer: Oxford Commercial	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$1.29
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUTURE POLYSORB 4/0 30 UNDYED

Facility

$6.43

Hospital Charge Code	270651237
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.21
Rate for Payer: Aetna Commercial	$2.44
Rate for Payer: Aetna Medicare Advantage	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.64
Rate for Payer: Cigna Commercial	$3.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.93
Rate for Payer: Oxford Commercial	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$1.29
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUTURE POLYSORB 4/0 30 UNDYED

Facility

$6.43

Hospital Charge Code	270651237
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

SUTURE POLYSORB 4/0 60 U/D

Facility

$7.24

Hospital Charge Code	270668418
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SUTURE POLYSORB 4/0 60 U/D

Facility

$7.24

Hospital Charge Code	270668418
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 4/0 60 VIO

Facility

$7.24

Hospital Charge Code	270604524
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 4/0 60 VIO

Facility

$7.24

Hospital Charge Code	270604524
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.17
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SUTURE POLYSORB 4/0 PP-13UD 18

Facility

$14.85

Hospital Charge Code	2709000824
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.42
Rate for Payer: Aetna Commercial	$5.64
Rate for Payer: Aetna Medicare Advantage	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.79
Rate for Payer: Cigna Commercial	$7.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.46
Rate for Payer: Oxford Commercial	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.23
Rate for Payer: UnitedHealthcare Commercial	$2.97
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

SUTURE POLYSORB 4/0 PP-13UD 18

Facility

$14.85

Hospital Charge Code	2709000824
Hospital Revenue Code	272
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.23

SUTURE POLYSORB 5/0 18 U/D P12

Facility

$14.59

Hospital Charge Code	270604583
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.29
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.72
Rate for Payer: Cigna Commercial	$7.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Oxford Commercial	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$2.92
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

SUTURE POLYSORB 5/0 18 U/D P12

Facility

$14.59

Hospital Charge Code	270604583
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

SUTURE POLYSORB 5/0 30 VIOLET

Facility

$6.43

Hospital Charge Code	270604585
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.21
Rate for Payer: Aetna Commercial	$2.44
Rate for Payer: Aetna Medicare Advantage	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.64
Rate for Payer: Cigna Commercial	$3.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.93
Rate for Payer: Oxford Commercial	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$1.29
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUTURE POLYSORB 5/0 30 VIOLET

Facility

$6.43

Hospital Charge Code	270604585
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

SUTURE POLYSORB 5-0 UNDYED 18

Facility

$14.32

Hospital Charge Code	270651356
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.16
Rate for Payer: Aetna Commercial	$5.44
Rate for Payer: Aetna Medicare Advantage	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.65
Rate for Payer: Cigna Commercial	$7.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.30
Rate for Payer: Oxford Commercial	$2.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.15
Rate for Payer: UnitedHealthcare Commercial	$2.86
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

SUTURE POLYSORB 5-0 UNDYED 18

Facility

$14.32

Hospital Charge Code	270651356
Hospital Revenue Code	272
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$2.15

SUTURE POLYSORB 6/0 18 UD P13

Facility

$37.32

Hospital Charge Code	270604586
Hospital Revenue Code	272
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.66
Rate for Payer: Aetna Commercial	$14.18
Rate for Payer: Aetna Medicare Advantage	$11.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.52
Rate for Payer: Cigna Commercial	$18.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.20
Rate for Payer: Oxford Commercial	$7.46
Rate for Payer: Qualcare PPO/HMO/WC	$5.60
Rate for Payer: UnitedHealthcare Commercial	$7.46
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

SUTURE POLYSORB 6/0 18 UD P13

Facility

$37.32

Hospital Charge Code	270604586
Hospital Revenue Code	272
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.60

SUTURE POLYSORB 6-0 UNDYED

Facility

$54.59

Hospital Charge Code	270658909
Hospital Revenue Code	272
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.30
Rate for Payer: Aetna Commercial	$20.74
Rate for Payer: Aetna Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.92
Rate for Payer: Cigna Commercial	$27.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.38
Rate for Payer: Oxford Commercial	$10.92
Rate for Payer: Qualcare PPO/HMO/WC	$8.19
Rate for Payer: UnitedHealthcare Commercial	$10.92
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

SUTURE POLYSORB 6-0 UNDYED

Facility

$54.59

Hospital Charge Code	270658909
Hospital Revenue Code	272
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$8.19
Rate for Payer: Qualcare PPO/HMO/WC	$8.19

SUTURE POLYSORB 8-0 8 VL

Facility

$1,151.35

Hospital Charge Code	270658910
Hospital Revenue Code	272
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$575.67
Rate for Payer: Aetna Commercial	$437.51
Rate for Payer: Aetna Medicare Advantage	$345.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.59
Rate for Payer: Cigna Commercial	$575.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.40
Rate for Payer: Oxford Commercial	$230.27
Rate for Payer: Qualcare PPO/HMO/WC	$172.70
Rate for Payer: UnitedHealthcare Commercial	$230.27
Rate for Payer: UnitedHealthcare Community & State	$27.75
Rate for Payer: Wellpoint Medicaid Managed Care	$30.51

SUTURE POLYSORB 8-0 8 VL

Facility

$1,151.35

Hospital Charge Code	270658910
Hospital Revenue Code	272
Min. Negotiated Rate	$172.70
Max. Negotiated Rate	$172.70
Rate for Payer: Qualcare PPO/HMO/WC	$172.70

SUTURE POLYSORB BGS21 0

Facility

$19.25

Hospital Charge Code	270600565
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

SUTURE POLYSORB BGS21 0

Facility

$19.25

Hospital Charge Code	270600565
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

SUTURE POLYSORB BGS-21 3-0 36

Facility

$6.75

Hospital Charge Code	270651136
Hospital Revenue Code	272
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$1.01

Know your out-of-pocket cost for care.

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