Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE POLYSORB 1 36 U/D GS24

Facility

$23.04

Hospital Charge Code	270651493
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$11.52
Rate for Payer: Aetna Commercial	$8.76
Rate for Payer: Aetna Medicare Advantage	$6.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.88
Rate for Payer: Cigna Commercial	$11.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Oxford Commercial	$4.61
Rate for Payer: Qualcare PPO/HMO/WC	$3.46
Rate for Payer: UnitedHealthcare Commercial	$4.61
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

SUTURE POLYSORB 1 36 U/D GS24

Facility

$23.04

Hospital Charge Code	270651493
Hospital Revenue Code	272
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$3.46
Rate for Payer: Qualcare PPO/HMO/WC	$3.46

SUTURE POLYSORB 1 36 VIO GS26

Facility

$7.14

Hospital Charge Code	270604532
Hospital Revenue Code	272
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$1.07

SUTURE POLYSORB 1 36 VIO GS26

Facility

$7.14

Hospital Charge Code	270604532
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.57
Rate for Payer: Aetna Commercial	$2.71
Rate for Payer: Aetna Medicare Advantage	$2.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.82
Rate for Payer: Cigna Commercial	$3.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.86
Rate for Payer: Oxford Commercial	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.07
Rate for Payer: UnitedHealthcare Commercial	$1.43
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SUTURE POLYSORB 1 36 VIOLET

Facility

$6.83

Hospital Charge Code	270651134
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

SUTURE POLYSORB 1 36 VIOLET

Facility

$6.83

Hospital Charge Code	270651134
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.42
Rate for Payer: Aetna Commercial	$2.60
Rate for Payer: Aetna Medicare Advantage	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.74
Rate for Payer: Cigna Commercial	$3.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.78
Rate for Payer: Oxford Commercial	$1.37
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$1.37
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SUTURE POLYSORB 1 5x30 VIOLET

Facility

$26.37

Hospital Charge Code	270656027
Hospital Revenue Code	272
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$3.96

SUTURE POLYSORB 1 5x30 VIOLET

Facility

$26.37

Hospital Charge Code	270656027
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$13.19
Rate for Payer: Aetna Commercial	$10.02
Rate for Payer: Aetna Medicare Advantage	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.72
Rate for Payer: Cigna Commercial	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.86
Rate for Payer: Oxford Commercial	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.96
Rate for Payer: UnitedHealthcare Commercial	$5.27
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

SUTURE POLYSORB 1 60 U/D TIES

Facility

$6.07

Hospital Charge Code	270659484
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$1.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.55
Rate for Payer: Cigna Commercial	$3.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.58
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUTURE POLYSORB 1 60 U/D TIES

Facility

$6.07

Hospital Charge Code	270659484
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.91

SUTURE POLYSORB 1 GS-21 36 UD

Facility

$6.95

Hospital Charge Code	270656028
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.04

SUTURE POLYSORB 1 GS-21 36 UD

Facility

$6.95

Hospital Charge Code	270656028
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.48
Rate for Payer: Aetna Commercial	$2.64
Rate for Payer: Aetna Medicare Advantage	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.77
Rate for Payer: Cigna Commercial	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Oxford Commercial	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.04
Rate for Payer: UnitedHealthcare Commercial	$1.39
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SUTURE POLYSORB 2/0 12x18 U/D

Facility

$29.28

Hospital Charge Code	270656145
Hospital Revenue Code	272
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$14.64
Rate for Payer: Aetna Commercial	$11.13
Rate for Payer: Aetna Medicare Advantage	$8.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.47
Rate for Payer: Cigna Commercial	$14.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.61
Rate for Payer: Oxford Commercial	$5.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.39
Rate for Payer: UnitedHealthcare Commercial	$5.86
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

SUTURE POLYSORB 2/0 12x18 U/D

Facility

$29.28

Hospital Charge Code	270656145
Hospital Revenue Code	272
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$4.39
Rate for Payer: Qualcare PPO/HMO/WC	$4.39

SUTURE POLYSORB 2-0 18 U/D

Facility

$29.99

Hospital Charge Code	270651492
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$14.99
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$14.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

SUTURE POLYSORB 2-0 18 U/D

Facility

$29.99

Hospital Charge Code	270651492
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SUTURE POLYSORB 2/0 30 CT2

Facility

$6.68

Hospital Charge Code	270604546
Hospital Revenue Code	272
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

SUTURE POLYSORB 2/0 30 CT2

Facility

$6.68

Hospital Charge Code	270604546
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.34
Rate for Payer: Aetna Commercial	$2.54
Rate for Payer: Aetna Medicare Advantage	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.70
Rate for Payer: Cigna Commercial	$3.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SUTURE POLYSORB 2/0 30 GS10

Facility

$7.45

Hospital Charge Code	270651131
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.94
Rate for Payer: Oxford Commercial	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.49
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

SUTURE POLYSORB 2/0 30 GS10

Facility

$7.45

Hospital Charge Code	270651131
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

SUTURE POLYSORB 2/0 30IN CT1

Facility

$6.07

Hospital Charge Code	270604545
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$2.31
Rate for Payer: Aetna Medicare Advantage	$1.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.55
Rate for Payer: Cigna Commercial	$3.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.58
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SUTURE POLYSORB 2/0 30IN CT1

Facility

$6.07

Hospital Charge Code	270604545
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.91

SUTURE POLYSORB 2/0 30 U/D FS1

Facility

$6.94

Hospital Charge Code	270606996
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.04

SUTURE POLYSORB 2/0 30 U/D FS1

Facility

$6.94

Hospital Charge Code	270606996
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.47
Rate for Payer: Aetna Commercial	$2.64
Rate for Payer: Aetna Medicare Advantage	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.77
Rate for Payer: Cigna Commercial	$3.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.04
Rate for Payer: UnitedHealthcare Commercial	$1.39
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SUTURE POLYSORB 2/0 30 UD V20

Facility

$2.24

Hospital Charge Code	270605250
Hospital Revenue Code	272
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Qualcare PPO/HMO/WC	$0.34

Know your out-of-pocket cost for care.

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