Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE PROLENE 0 MO-6

Facility

$15.54

Hospital Charge Code	270671401
Hospital Revenue Code	272
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$2.33

SUTURE PROLENE 10-0 BL MONO 8

Facility

$108.13

Hospital Charge Code	270660017
Hospital Revenue Code	272
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$54.06
Rate for Payer: Aetna Commercial	$41.09
Rate for Payer: Aetna Medicare Advantage	$32.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.57
Rate for Payer: Cigna Commercial	$54.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.44
Rate for Payer: Oxford Commercial	$21.63
Rate for Payer: Qualcare PPO/HMO/WC	$16.22
Rate for Payer: UnitedHealthcare Commercial	$21.63
Rate for Payer: UnitedHealthcare Community & State	$2.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.87

SUTURE PROLENE 10-0 BL MONO 8

Facility

$108.13

Hospital Charge Code	270660017
Hospital Revenue Code	272
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$16.22
Rate for Payer: Qualcare PPO/HMO/WC	$16.22

SUTURE PROLENE 10-0 CTC-6L

Facility

$122.17

Hospital Charge Code	270671358
Hospital Revenue Code	272
Min. Negotiated Rate	$18.33
Max. Negotiated Rate	$18.33
Rate for Payer: Qualcare PPO/HMO/WC	$18.33

SUTURE PROLENE 10-0 CTC-6L

Facility

$122.17

Hospital Charge Code	270671358
Hospital Revenue Code	272
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$61.09
Rate for Payer: Aetna Commercial	$46.42
Rate for Payer: Aetna Medicare Advantage	$36.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.15
Rate for Payer: Cigna Commercial	$61.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.65
Rate for Payer: Oxford Commercial	$24.43
Rate for Payer: Qualcare PPO/HMO/WC	$18.33
Rate for Payer: UnitedHealthcare Commercial	$24.43
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

SUTURE PROLENE 10/0 TC140-8 6

Facility

$87.00

Service Code	HCPCS C1713
Hospital Charge Code	270657196
Hospital Revenue Code	278
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$21.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.14
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

SUTURE PROLENE 10/0 TC140-8 6

Facility

$87.00

Service Code	HCPCS C1713
Hospital Charge Code	270657196
Hospital Revenue Code	278
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.14
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Community & State	$2.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

SUTURE PROLENE 1 GS-25

Facility

$17.73

Hospital Charge Code	270671406
Hospital Revenue Code	272
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.66

SUTURE PROLENE 1 GS-25

Facility

$17.73

Hospital Charge Code	270671406
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.87
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare Advantage	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.52
Rate for Payer: Cigna Commercial	$8.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.32
Rate for Payer: Oxford Commercial	$3.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.66
Rate for Payer: UnitedHealthcare Commercial	$3.55
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

SUTURE PROLENE 2-0 CT-1 GS-21

Facility

$11.87

Hospital Charge Code	270671402
Hospital Revenue Code	272
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.93
Rate for Payer: Aetna Commercial	$4.51
Rate for Payer: Aetna Medicare Advantage	$3.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.03
Rate for Payer: Cigna Commercial	$5.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.56
Rate for Payer: Oxford Commercial	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$1.78
Rate for Payer: UnitedHealthcare Commercial	$2.37
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

SUTURE PROLENE 2-0 CT-1 GS-21

Facility

$11.87

Hospital Charge Code	270671402
Hospital Revenue Code	272
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Qualcare PPO/HMO/WC	$1.78

SUTURE PROLENE 2-0 CT-2

Facility

$70.61

Hospital Charge Code	270671443
Hospital Revenue Code	272
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.30
Rate for Payer: Aetna Commercial	$26.83
Rate for Payer: Aetna Medicare Advantage	$21.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.01
Rate for Payer: Cigna Commercial	$35.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.18
Rate for Payer: Oxford Commercial	$14.12
Rate for Payer: Qualcare PPO/HMO/WC	$10.59
Rate for Payer: UnitedHealthcare Commercial	$14.12
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

SUTURE PROLENE 2-0 CT-2

Facility

$70.61

Hospital Charge Code	270671443
Hospital Revenue Code	272
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$10.59
Rate for Payer: Qualcare PPO/HMO/WC	$10.59

SUTURE PROLENE 2-0 CT-2/GS-22

Facility

$11.78

Hospital Charge Code	270655635
Hospital Revenue Code	272
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.89
Rate for Payer: Aetna Commercial	$4.48
Rate for Payer: Aetna Medicare Advantage	$3.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.00
Rate for Payer: Cigna Commercial	$5.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.53
Rate for Payer: Oxford Commercial	$2.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.77
Rate for Payer: UnitedHealthcare Commercial	$2.36
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

SUTURE PROLENE 2-0 CT-2/GS-22

Facility

$11.78

Hospital Charge Code	270655635
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

SUTURE PROLENE 2-0 FSLX C-17

Facility

$21.01

Hospital Charge Code	270671413
Hospital Revenue Code	272
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

SUTURE PROLENE 2-0 FSLX C-17

Facility

$21.01

Hospital Charge Code	270671413
Hospital Revenue Code	272
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.51
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

SUTURE PROLENE 2-0 KS

Facility

$19.95

Hospital Charge Code	270659087
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.97
Rate for Payer: Aetna Commercial	$7.58
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.09
Rate for Payer: Cigna Commercial	$9.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Oxford Commercial	$3.99
Rate for Payer: Qualcare PPO/HMO/WC	$2.99
Rate for Payer: UnitedHealthcare Commercial	$3.99
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

SUTURE PROLENE 2-0 KS

Facility

$19.95

Hospital Charge Code	270659087
Hospital Revenue Code	272
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Qualcare PPO/HMO/WC	$2.99

SUTURE PROLENE 2-0 MHMH

Facility

$27.40

Hospital Charge Code	270671424
Hospital Revenue Code	272
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.70
Rate for Payer: Aetna Commercial	$10.41
Rate for Payer: Aetna Medicare Advantage	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.99
Rate for Payer: Cigna Commercial	$13.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.22
Rate for Payer: Oxford Commercial	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.11
Rate for Payer: UnitedHealthcare Commercial	$5.48
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

SUTURE PROLENE 2-0 MHMH

Facility

$27.40

Hospital Charge Code	270671424
Hospital Revenue Code	272
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.11

SUTURE PROLENE 2-0 SH

Facility

$20.94

Hospital Charge Code	270671423
Hospital Revenue Code	272
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$3.14
Rate for Payer: Qualcare PPO/HMO/WC	$3.14

SUTURE PROLENE 2-0 SH

Facility

$20.94

Hospital Charge Code	270671423
Hospital Revenue Code	272
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.47
Rate for Payer: Aetna Commercial	$7.96
Rate for Payer: Aetna Medicare Advantage	$6.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.34
Rate for Payer: Cigna Commercial	$10.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.28
Rate for Payer: Oxford Commercial	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.14
Rate for Payer: UnitedHealthcare Commercial	$4.19
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

SUTURE PROLENE 2 TP-1

Facility

$21.24

Hospital Charge Code	270655899
Hospital Revenue Code	272
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.62
Rate for Payer: Aetna Commercial	$8.07
Rate for Payer: Aetna Medicare Advantage	$6.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.42
Rate for Payer: Cigna Commercial	$10.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.37
Rate for Payer: Oxford Commercial	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.19
Rate for Payer: UnitedHealthcare Commercial	$4.25
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

SUTURE PROLENE 2 TP-1

Facility

$21.24

Hospital Charge Code	270655899
Hospital Revenue Code	272
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.19

Know your out-of-pocket cost for care.

All Charges