Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE POLYSORB V20 2-0 GL61MG

Facility

$1,055.25

Hospital Charge Code	270610528
Hospital Revenue Code	272
Min. Negotiated Rate	$158.29
Max. Negotiated Rate	$158.29
Rate for Payer: Qualcare PPO/HMO/WC	$158.29

SUTURE POLYSORB V20 2-0 GL61MG

Facility

$1,055.25

Hospital Charge Code	270610528
Hospital Revenue Code	272
Min. Negotiated Rate	$25.43
Max. Negotiated Rate	$527.62
Rate for Payer: Aetna Commercial	$401.00
Rate for Payer: Aetna Medicare Advantage	$316.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.09
Rate for Payer: Cigna Commercial	$527.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$316.57
Rate for Payer: Oxford Commercial	$211.05
Rate for Payer: Qualcare PPO/HMO/WC	$158.29
Rate for Payer: UnitedHealthcare Commercial	$211.05
Rate for Payer: UnitedHealthcare Community & State	$25.43
Rate for Payer: Wellpoint Medicaid Managed Care	$27.96

SUTURE POLYSORB V-20 2-0 U/D

Facility

$5.67

Hospital Charge Code	270651670
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SUTURE POLYSORB V-20 2-0 U/D

Facility

$5.67

Hospital Charge Code	270651670
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SUTURE POLYSORB V-20 3-0

Facility

$6.13

Hospital Charge Code	270651148
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 V-20 3-0

Facility

$6.13

Hospital Charge Code	270651148
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.06
Rate for Payer: Aetna Commercial	$2.33
Rate for Payer: Aetna Medicare Advantage	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.56
Rate for Payer: Cigna Commercial	$3.06
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 V-20 3-0 18

Facility

$26.11

Hospital Charge Code	270651276
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 POLYSORB V-20 3-0 18

Facility

$26.11

Hospital Charge Code	270651276
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$3.92
Rate for Payer: Qualcare PPO/HMO/WC	$3.92

SUTURE POLYSORB V-20 4-0

Facility

$6.49

Hospital Charge Code	270651279S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.65
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.97
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUTURE POLYSORB V-20 4-0

Facility

$6.49

Hospital Charge Code	270651279
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.65
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.97
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUTURE POLYSORB V-20 4-0

Facility

$6.49

Hospital Charge Code	270651279
Hospital Revenue Code	272
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.97

SUTURE POLYSORB V-20 4-0

Facility

$1.26

Hospital Charge Code	270651279N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna Commercial	$0.48
Rate for Payer: Aetna Medicare Advantage	$0.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.32
Rate for Payer: Cigna Commercial	$0.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.38
Rate for Payer: Oxford Commercial	$0.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.19
Rate for Payer: UnitedHealthcare Commercial	$0.25
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

SUTURE POLYSORB V-20 4-0

Facility

$1.26

Hospital Charge Code	270651279N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.19

SUTURE POLYSORB V-20 4-0

Facility

$6.49

Hospital Charge Code	270651279S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.97

SUTURE POLYSSORB 2-0 GS-21

Facility

$25.23

Hospital Charge Code	270669983
Hospital Revenue Code	272
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.62
Rate for Payer: Aetna Commercial	$9.59
Rate for Payer: Aetna Medicare Advantage	$7.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.43
Rate for Payer: Cigna Commercial	$12.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.57
Rate for Payer: Oxford Commercial	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$5.05
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

SUTURE POLYSSORB 2-0 GS-21

Facility

$25.23

Hospital Charge Code	270669983
Hospital Revenue Code	272
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

SUTURE POLYSURB GS-12 1

Facility

$8.06

Hospital Charge Code	270617432
Hospital Revenue Code	272
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

SUTURE POLYSURB GS-12 1

Facility

$8.06

Hospital Charge Code	270617432
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.03
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.06
Rate for Payer: Cigna Commercial	$4.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.42
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

SUTURE PROL BL 1X18 8714H

Facility

$35.51

Hospital Charge Code	270698082
Hospital Revenue Code	272
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$5.33
Rate for Payer: Qualcare PPO/HMO/WC	$5.33

SUTURE PROL BL 1X18 8714H

Facility

$35.51

Hospital Charge Code	270698082
Hospital Revenue Code	272
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.75
Rate for Payer: Aetna Commercial	$13.49
Rate for Payer: Aetna Medicare Advantage	$10.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.06
Rate for Payer: Cigna Commercial	$17.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.65
Rate for Payer: Oxford Commercial	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.33
Rate for Payer: UnitedHealthcare Commercial	$7.10
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

SUTURE PROLENE 0 CT-1 GS-21

Facility

$18.65

Hospital Charge Code	270659090
Hospital Revenue Code	272
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.80

SUTURE PROLENE 0 CT-1 GS-21

Facility

$18.65

Hospital Charge Code	270659090
Hospital Revenue Code	272
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.32
Rate for Payer: Aetna Commercial	$7.09
Rate for Payer: Aetna Medicare Advantage	$5.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.76
Rate for Payer: Cigna Commercial	$9.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.80
Rate for Payer: UnitedHealthcare Commercial	$3.73
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

SUTURE PROLENE 0 CT 2

Facility

$12.04

Hospital Charge Code	270655793
Hospital Revenue Code	272
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.02
Rate for Payer: Aetna Commercial	$4.58
Rate for Payer: Aetna Medicare Advantage	$3.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.07
Rate for Payer: Cigna Commercial	$6.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.61
Rate for Payer: Oxford Commercial	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$2.41
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

SUTURE PROLENE 0 CT 2

Facility

$12.04

Hospital Charge Code	270655793
Hospital Revenue Code	272
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

SUTURE PROLENE 0 MO-6

Facility

$15.54

Hospital Charge Code	270671401
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.77
Rate for Payer: Aetna Commercial	$5.91
Rate for Payer: Aetna Medicare Advantage	$4.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.96
Rate for Payer: Cigna Commercial	$7.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.66
Rate for Payer: Oxford Commercial	$3.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.33
Rate for Payer: UnitedHealthcare Commercial	$3.11
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

Know your out-of-pocket cost for care.

All Charges