Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE POLYSORB GS11 2

Facility

$32.00

Hospital Charge Code	270604530
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

SUTURE POLYSORB GS11 2

Facility

$32.00

Hospital Charge Code	270604530
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

SUTURE POLYSORB GS-11 2-0

Facility

$6.18

Hospital Charge Code	270617960
Hospital Revenue Code	272
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.93

SUTURE POLYSORB GS-11 2-0

Facility

$6.18

Hospital Charge Code	270617960
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.09
Rate for Payer: Aetna Commercial	$2.35
Rate for Payer: Aetna Medicare Advantage	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.58
Rate for Payer: Cigna Commercial	$3.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.85
Rate for Payer: Oxford Commercial	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.93
Rate for Payer: UnitedHealthcare Commercial	$1.24
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SUTURE POLYSORB GS12 0

Facility

$22.45

Hospital Charge Code	270604539
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$4.49
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

SUTURE POLYSORB GS12 0

Facility

$22.45

Hospital Charge Code	270604539
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

SUTURE POLYSORB GS12 2-0

Facility

$5.80

Hospital Charge Code	270604544
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 GS12 2-0

Facility

$5.80

Hospital Charge Code	270604544
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 GS21 0

Facility

$16.85

Hospital Charge Code	270600568
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

SUTURE POLYSORB GS21 0

Facility

$16.85

Hospital Charge Code	270600568
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

SUTURE POLYSORB GS-21 0 18

Facility

$26.65

Hospital Charge Code	270651261
Hospital Revenue Code	272
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.00

SUTURE POLYSORB GS-21 0 18

Facility

$26.65

Hospital Charge Code	270651261
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.32
Rate for Payer: Aetna Commercial	$10.13
Rate for Payer: Aetna Medicare Advantage	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.80
Rate for Payer: Cigna Commercial	$13.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.00
Rate for Payer: Oxford Commercial	$5.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.00
Rate for Payer: UnitedHealthcare Commercial	$5.33
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

SUTURE POLYSORB GS-21 1 U/D

Facility

$25.80

Hospital Charge Code	270651262
Hospital Revenue Code	272
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$3.87

SUTURE POLYSORB GS-21 1 U/D

Facility

$25.80

Hospital Charge Code	270651262
Hospital Revenue Code	272
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$12.90
Rate for Payer: Aetna Commercial	$9.80
Rate for Payer: Aetna Medicare Advantage	$7.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.58
Rate for Payer: Cigna Commercial	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.74
Rate for Payer: Oxford Commercial	$5.16
Rate for Payer: Qualcare PPO/HMO/WC	$3.87
Rate for Payer: UnitedHealthcare Commercial	$5.16
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

SUTURE POLYSORB GS-21 2

Facility

$5.56

Hospital Charge Code	270625428
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna Commercial	$2.11
Rate for Payer: Aetna Medicare Advantage	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.42
Rate for Payer: Cigna Commercial	$2.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.67
Rate for Payer: Oxford Commercial	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$1.11
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SUTURE POLYSORB GS-21 2

Facility

$5.56

Hospital Charge Code	270625428
Hospital Revenue Code	272
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

SUTURE POLYSORB GS-21 2-1 36

Facility

$18.44

Hospital Charge Code	270651495
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$7.01
Rate for Payer: Aetna Medicare Advantage	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.53
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

SUTURE POLYSORB GS-21 2-1 36

Facility

$18.44

Hospital Charge Code	270651495
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

SUTURE POLYSORB GS-22 3-0

Facility

$7.65

Hospital Charge Code	270617107
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.83
Rate for Payer: Aetna Commercial	$2.91
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$3.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.29
Rate for Payer: Oxford Commercial	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Commercial	$1.53
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SUTURE POLYSORB GS-22 3-0

Facility

$7.65

Hospital Charge Code	270617107
Hospital Revenue Code	272
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

SUTURE POLYSORB GS23 2-0

Facility

$16.85

Hospital Charge Code	270600570
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

SUTURE POLYSORB GS23 2-0

Facility

$16.85

Hospital Charge Code	270600570
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

SUTURE POLYSORB GS23 3-0

Facility

$6.15

Hospital Charge Code	270600569
Hospital Revenue Code	272
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

SUTURE POLYSORB GS23 3-0

Facility

$6.15

Hospital Charge Code	270600569
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna Commercial	$2.34
Rate for Payer: Aetna Medicare Advantage	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.57
Rate for Payer: Cigna Commercial	$3.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.84
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.92
Rate for Payer: UnitedHealthcare Commercial	$1.23
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SUTURE POLYSORB GS-24 0 UNDYED

Facility

$6.90

Hospital Charge Code	270651137
Hospital Revenue Code	272
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$1.03

Know your out-of-pocket cost for care.

All Charges