Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE PROLENE 4-0 FS-2

Facility

$12.98

Hospital Charge Code	270671412
Hospital Revenue Code	272
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

SUTURE PROLENE 4-0 PS-2

Facility

$21.50

Hospital Charge Code	270671411
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$3.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.23

SUTURE PROLENE 4-0 PS-2

Facility

$21.50

Hospital Charge Code	270671411
Hospital Revenue Code	272
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.75
Rate for Payer: Aetna Commercial	$8.17
Rate for Payer: Aetna Medicare Advantage	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.48
Rate for Payer: Cigna Commercial	$10.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.45
Rate for Payer: Oxford Commercial	$4.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.23
Rate for Payer: UnitedHealthcare Commercial	$4.30
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SUTURE PROLENE 4-0 RB-1

Facility

$41.67

Hospital Charge Code	270671408
Hospital Revenue Code	272
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$6.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.25

SUTURE PROLENE 4-0 RB-1

Facility

$41.67

Hospital Charge Code	270671408
Hospital Revenue Code	272
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$20.84
Rate for Payer: Aetna Commercial	$15.83
Rate for Payer: Aetna Medicare Advantage	$12.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.63
Rate for Payer: Cigna Commercial	$20.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.50
Rate for Payer: Oxford Commercial	$8.33
Rate for Payer: Qualcare PPO/HMO/WC	$6.25
Rate for Payer: UnitedHealthcare Commercial	$8.33
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

SUTURE PROLENE 4-0 RB-1

Facility

$14.38

Hospital Charge Code	270673737
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.19
Rate for Payer: Aetna Commercial	$5.46
Rate for Payer: Aetna Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.67
Rate for Payer: Cigna Commercial	$7.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.31
Rate for Payer: Oxford Commercial	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.16
Rate for Payer: UnitedHealthcare Commercial	$2.88
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

SUTURE PROLENE 4-0 RB-1

Facility

$14.38

Hospital Charge Code	270673737
Hospital Revenue Code	272
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.16
Rate for Payer: Qualcare PPO/HMO/WC	$2.16

SUTURE PROLENE 4-0 SH

Facility

$35.52

Hospital Charge Code	270666706
Hospital Revenue Code	272
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.76
Rate for Payer: Aetna Commercial	$13.50
Rate for Payer: Aetna Medicare Advantage	$10.66
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	$17.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
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 4-0 SH

Facility

$21.66

Hospital Charge Code	270671422
Hospital Revenue Code	272
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.25

SUTURE PROLENE 4-0 SH

Facility

$35.52

Hospital Charge Code	270666706
Hospital Revenue Code	272
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$5.33
Rate for Payer: Qualcare PPO/HMO/WC	$5.33

SUTURE PROLENE 4-0 SH

Facility

$21.66

Hospital Charge Code	270671422
Hospital Revenue Code	272
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.83
Rate for Payer: Aetna Commercial	$8.23
Rate for Payer: Aetna Medicare Advantage	$6.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.52
Rate for Payer: Cigna Commercial	$10.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$3.25
Rate for Payer: UnitedHealthcare Commercial	$4.33
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SUTURE PROLENE 4-0 SH-1 1/2C

Facility

$26.99

Hospital Charge Code	270678685
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.49
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SUTURE PROLENE 4-0 SH-1 1/2C

Facility

$26.99

Hospital Charge Code	270678685
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

SUTURE PROLENE 4-0 V-5

Facility

$35.49

Hospital Charge Code	270671426
Hospital Revenue Code	272
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.32

SUTURE PROLENE 4-0 V-5

Facility

$35.49

Hospital Charge Code	270671426
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	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.05
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	$5.32
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 5-0 C-1

Facility

$51.22

Hospital Charge Code	270671418
Hospital Revenue Code	272
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$7.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.68

SUTURE PROLENE 5-0 C-1

Facility

$80.43

Hospital Charge Code	270671419
Hospital Revenue Code	272
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$12.06
Rate for Payer: Qualcare PPO/HMO/WC	$12.06

SUTURE PROLENE 5-0 C-1

Facility

$80.43

Hospital Charge Code	270671419
Hospital Revenue Code	272
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$40.22
Rate for Payer: Aetna Commercial	$30.56
Rate for Payer: Aetna Medicare Advantage	$24.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.51
Rate for Payer: Cigna Commercial	$40.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.13
Rate for Payer: Oxford Commercial	$16.09
Rate for Payer: Qualcare PPO/HMO/WC	$12.06
Rate for Payer: UnitedHealthcare Commercial	$16.09
Rate for Payer: UnitedHealthcare Community & State	$1.94
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

SUTURE PROLENE 5-0 C-1

Facility

$51.22

Hospital Charge Code	270671418
Hospital Revenue Code	272
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.61
Rate for Payer: Aetna Commercial	$19.46
Rate for Payer: Aetna Medicare Advantage	$15.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.06
Rate for Payer: Cigna Commercial	$25.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.37
Rate for Payer: Oxford Commercial	$10.24
Rate for Payer: Qualcare PPO/HMO/WC	$7.68
Rate for Payer: UnitedHealthcare Commercial	$10.24
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

SUTURE PROLENE 5-0 CC-1

Facility

$81.78

Hospital Charge Code	270671420
Hospital Revenue Code	272
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$40.89
Rate for Payer: Aetna Commercial	$31.08
Rate for Payer: Aetna Medicare Advantage	$24.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.85
Rate for Payer: Cigna Commercial	$40.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.53
Rate for Payer: Oxford Commercial	$16.36
Rate for Payer: Qualcare PPO/HMO/WC	$12.27
Rate for Payer: UnitedHealthcare Commercial	$16.36
Rate for Payer: UnitedHealthcare Community & State	$1.97
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

SUTURE PROLENE 5-0 CC-1

Facility

$81.78

Hospital Charge Code	270671420
Hospital Revenue Code	272
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$12.27
Rate for Payer: Qualcare PPO/HMO/WC	$12.27

SUTURE PROLENE 5-0 FS-2

Facility

$13.18

Hospital Charge Code	270671410
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

SUTURE PROLENE 5-0 FS-2

Facility

$13.18

Hospital Charge Code	270671410
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$6.59
Rate for Payer: Aetna Commercial	$5.01
Rate for Payer: Aetna Medicare Advantage	$3.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.36
Rate for Payer: Cigna Commercial	$6.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.95
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

SUTURE PROLENE 5-0 P-3

Facility

$26.51

Hospital Charge Code	270663644
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.26
Rate for Payer: Aetna Commercial	$10.07
Rate for Payer: Aetna Medicare Advantage	$7.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.76
Rate for Payer: Cigna Commercial	$13.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.95
Rate for Payer: Oxford Commercial	$5.30
Rate for Payer: Qualcare PPO/HMO/WC	$3.98
Rate for Payer: UnitedHealthcare Commercial	$5.30
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

SUTURE PROLENE 5-0 P-3

Facility

$26.51

Hospital Charge Code	270663644
Hospital Revenue Code	272
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.98

Know your out-of-pocket cost for care.

All Charges