Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE PROLENE 6-0 RB-2

Facility

$28.25

Hospital Charge Code	270671417
Hospital Revenue Code	272
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.12
Rate for Payer: Aetna Commercial	$10.73
Rate for Payer: Aetna Medicare Advantage	$8.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.20
Rate for Payer: Cigna Commercial	$14.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.47
Rate for Payer: Oxford Commercial	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.24
Rate for Payer: UnitedHealthcare Commercial	$5.65
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

SUTURE PROLENE 6-0 RB-2

Facility

$28.25

Hospital Charge Code	270671417
Hospital Revenue Code	272
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$4.24
Rate for Payer: Qualcare PPO/HMO/WC	$4.24

SUTURE PROLENE 7-0 BLUE BV

Facility

$168.64

Hospital Charge Code	270688584
Hospital Revenue Code	272
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$25.30
Rate for Payer: Qualcare PPO/HMO/WC	$25.30

SUTURE PROLENE 7-0 BLUE BV

Facility

$168.64

Hospital Charge Code	270688584
Hospital Revenue Code	272
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$84.32
Rate for Payer: Aetna Commercial	$64.08
Rate for Payer: Aetna Medicare Advantage	$50.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.00
Rate for Payer: Cigna Commercial	$84.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.59
Rate for Payer: Oxford Commercial	$33.73
Rate for Payer: Qualcare PPO/HMO/WC	$25.30
Rate for Payer: UnitedHealthcare Commercial	$33.73
Rate for Payer: UnitedHealthcare Community & State	$4.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.47

SUTURE PROLENE 7-0 BV-1

Facility

$63.33

Hospital Charge Code	270672360
Hospital Revenue Code	272
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.50

SUTURE PROLENE 7-0 BV-1

Facility

$63.33

Hospital Charge Code	270672360
Hospital Revenue Code	272
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$31.66
Rate for Payer: Aetna Commercial	$24.07
Rate for Payer: Aetna Medicare Advantage	$19.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.15
Rate for Payer: Cigna Commercial	$31.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.00
Rate for Payer: Oxford Commercial	$12.67
Rate for Payer: Qualcare PPO/HMO/WC	$9.50
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Community & State	$1.53
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

SUTURE PROLENE BLUE 1 X 18 IN

Facility

$81.08

Hospital Charge Code	270688290
Hospital Revenue Code	272
Min. Negotiated Rate	$12.16
Max. Negotiated Rate	$12.16
Rate for Payer: Qualcare PPO/HMO/WC	$12.16

SUTURE PROLENE BLUE 1 X 18 IN

Facility

$81.08

Hospital Charge Code	270688290
Hospital Revenue Code	272
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.54
Rate for Payer: Aetna Commercial	$30.81
Rate for Payer: Aetna Medicare Advantage	$24.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.68
Rate for Payer: Cigna Commercial	$40.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.32
Rate for Payer: Oxford Commercial	$16.22
Rate for Payer: Qualcare PPO/HMO/WC	$12.16
Rate for Payer: UnitedHealthcare Commercial	$16.22
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

SUTURE PROLENE BLUE 30IN SH 0

Facility

$21.37

Service Code	HCPCS A4649
Hospital Charge Code	270699922
Hospital Revenue Code	272
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.69
Rate for Payer: Aetna Commercial	$8.12
Rate for Payer: Aetna Medicare Advantage	$6.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.45
Rate for Payer: Cigna Commercial	$10.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.41
Rate for Payer: Oxford Commercial	$4.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Commercial	$4.27
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SUTURE PROLENE BLUE 30IN SH 0

Facility

$21.37

Service Code	HCPCS A4649
Hospital Charge Code	270699922
Hospital Revenue Code	272
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

SUTURE PROLENE BLU MON 30-18

Facility

$21.45

Hospital Charge Code	270673326
Hospital Revenue Code	272
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.72
Rate for Payer: Aetna Commercial	$8.15
Rate for Payer: Aetna Medicare Advantage	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.47
Rate for Payer: Cigna Commercial	$10.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.43
Rate for Payer: Oxford Commercial	$4.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.22
Rate for Payer: UnitedHealthcare Commercial	$4.29
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SUTURE PROLENE BLU MON 30-18

Facility

$21.45

Hospital Charge Code	270673326
Hospital Revenue Code	272
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.22

SUTURE PROLENE BV-1 24

Facility

$98.69

Hospital Charge Code	270680741
Hospital Revenue Code	272
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$14.80
Rate for Payer: Qualcare PPO/HMO/WC	$14.80

SUTURE PROLENE BV-1 24

Facility

$98.69

Hospital Charge Code	270680741
Hospital Revenue Code	272
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$49.34
Rate for Payer: Aetna Commercial	$37.50
Rate for Payer: Aetna Medicare Advantage	$29.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.17
Rate for Payer: Cigna Commercial	$49.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.61
Rate for Payer: Oxford Commercial	$19.74
Rate for Payer: Qualcare PPO/HMO/WC	$14.80
Rate for Payer: UnitedHealthcare Commercial	$19.74
Rate for Payer: UnitedHealthcare Community & State	$2.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

SUTURE PROLENE PC-5 4-1 MONO

Facility

$25.35

Hospital Charge Code	270651499
Hospital Revenue Code	272
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.80

SUTURE PROLENE PC-5 4-1 MONO

Facility

$25.35

Hospital Charge Code	270651499
Hospital Revenue Code	272
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.68
Rate for Payer: Aetna Commercial	$9.63
Rate for Payer: Aetna Medicare Advantage	$7.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.46
Rate for Payer: Cigna Commercial	$12.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.61
Rate for Payer: Oxford Commercial	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.80
Rate for Payer: UnitedHealthcare Commercial	$5.07
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

SUTURE PROLENE PS-4 4-0 CLEAR

Facility

$23.81

Hospital Charge Code	270622558
Hospital Revenue Code	272
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$3.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.57

SUTURE PROLENE PS-4 4-0 CLEAR

Facility

$23.81

Hospital Charge Code	270622558
Hospital Revenue Code	272
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$11.90
Rate for Payer: Aetna Commercial	$9.05
Rate for Payer: Aetna Medicare Advantage	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.07
Rate for Payer: Cigna Commercial	$11.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.14
Rate for Payer: Oxford Commercial	$4.76
Rate for Payer: Qualcare PPO/HMO/WC	$3.57
Rate for Payer: UnitedHealthcare Commercial	$4.76
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

SUTURE PROLENE RB-1 6-0

Facility

$821.00

Hospital Charge Code	270676569
Hospital Revenue Code	272
Min. Negotiated Rate	$123.15
Max. Negotiated Rate	$123.15
Rate for Payer: Qualcare PPO/HMO/WC	$123.15

SUTURE PROLENE RB-1 6-0

Facility

$821.00

Hospital Charge Code	270676569
Hospital Revenue Code	272
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$410.50
Rate for Payer: Aetna Commercial	$311.98
Rate for Payer: Aetna Medicare Advantage	$246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.35
Rate for Payer: Cigna Commercial	$410.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.30
Rate for Payer: Oxford Commercial	$164.20
Rate for Payer: Qualcare PPO/HMO/WC	$123.15
Rate for Payer: UnitedHealthcare Commercial	$164.20
Rate for Payer: UnitedHealthcare Community & State	$19.79
Rate for Payer: Wellpoint Medicaid Managed Care	$21.76

SUTURE PROLENE SURGIPRO 5/0

Facility

$8.59

Hospital Charge Code	270659856
Hospital Revenue Code	272
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

SUTURE PROLENE SURGIPRO 5/0

Facility

$8.59

Hospital Charge Code	270659856
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna Medicare Advantage	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$1.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$1.72
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

SUTURE PROLENE SZ 0 CTX 75 CM

Facility

$11.25

Hospital Charge Code	270682525
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

SUTURE PROLENE SZ 0 CTX 75 CM

Facility

$11.25

Hospital Charge Code	270682525
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

SUTURE PROLENE SZ 0 UR 6 30

Facility

$173.45

Hospital Charge Code	270680623
Hospital Revenue Code	272
Min. Negotiated Rate	$26.02
Max. Negotiated Rate	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$26.02

Know your out-of-pocket cost for care.

All Charges