Heights University Hospital

All Charges

Charge

Type

Setting

Price

SURGICEL 4X8

Facility

$248.00

Hospital Charge Code	270060855
Hospital Revenue Code	272
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

SURGICEL 4X8

Facility

$248.00

Hospital Charge Code	270060855
Hospital Revenue Code	272
Min. Negotiated Rate	$32.24
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$74.40
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.24
Rate for Payer: Oxford Commercial	$124.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.20
Rate for Payer: UnitedHealthcare Commercial	$124.00

SURGICEL ABSORB HEMOSTAT

Facility

$153.65

Hospital Charge Code	6010185
Hospital Revenue Code	272
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

SURGICEL ABSORB HEMOSTAT

Facility

$153.65

Hospital Charge Code	6010185
Hospital Revenue Code	272
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$76.83
Rate for Payer: Aetna Commercial	$46.09
Rate for Payer: Aetna Medicare Advantage	$46.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.18
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.97
Rate for Payer: Oxford Commercial	$76.83
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$76.83

SURGICEL FIB 2X4 HEMOSTAT 1962

Facility

$906.84

Hospital Charge Code	270632664
Hospital Revenue Code	272
Min. Negotiated Rate	$117.89
Max. Negotiated Rate	$453.42
Rate for Payer: Aetna Commercial	$272.05
Rate for Payer: Aetna Medicare Advantage	$272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.24
Rate for Payer: Cigna Commercial	$453.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.89
Rate for Payer: Oxford Commercial	$453.42
Rate for Payer: Qualcare PPO/HMO/WC	$136.03
Rate for Payer: UnitedHealthcare Commercial	$453.42

SURGICEL FIB 2X4 HEMOSTAT 1962

Facility

$906.84

Hospital Charge Code	270632664
Hospital Revenue Code	272
Min. Negotiated Rate	$136.03
Max. Negotiated Rate	$136.03
Rate for Payer: Qualcare PPO/HMO/WC	$136.03

SURGICEL HEMOSTAT 2 X 0.5

Facility

$6.00

Hospital Charge Code	60634736
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SURGICEL HEMOSTAT 2 X 0.5

Facility

$6.00

Hospital Charge Code	60634736
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

SURGICEL HEMOSTAT 2x14 1951

Facility

$315.95

Hospital Charge Code	270642925
Hospital Revenue Code	272
Min. Negotiated Rate	$47.39
Max. Negotiated Rate	$47.39
Rate for Payer: Qualcare PPO/HMO/WC	$47.39

SURGICEL HEMOSTAT 2x14 1951

Facility

$315.95

Hospital Charge Code	270642925
Hospital Revenue Code	272
Min. Negotiated Rate	$41.07
Max. Negotiated Rate	$157.97
Rate for Payer: Aetna Commercial	$94.78
Rate for Payer: Aetna Medicare Advantage	$94.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.57
Rate for Payer: Cigna Commercial	$157.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.07
Rate for Payer: Oxford Commercial	$157.97
Rate for Payer: Qualcare PPO/HMO/WC	$47.39
Rate for Payer: UnitedHealthcare Commercial	$157.97

SURGICEL HEMOSTAT 2 X 3

Facility

$6.00

Hospital Charge Code	60634737
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$1.80
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$3.00

SURGICEL HEMOSTAT 2 X 3

Facility

$6.00

Hospital Charge Code	60634737
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

SURGICEL NU-KNIT HEMOSTAT

Facility

$7,840.30

Hospital Charge Code	270661748
Hospital Revenue Code	272
Min. Negotiated Rate	$1,019.24
Max. Negotiated Rate	$3,920.15
Rate for Payer: Aetna Commercial	$2,352.09
Rate for Payer: Aetna Medicare Advantage	$2,352.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,999.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,999.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,999.28
Rate for Payer: Cigna Commercial	$3,920.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,019.24
Rate for Payer: Oxford Commercial	$3,920.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.05
Rate for Payer: UnitedHealthcare Commercial	$3,920.15

SURGICEL NU-KNIT HEMOSTAT

Facility

$7,840.30

Hospital Charge Code	270661748
Hospital Revenue Code	272
Min. Negotiated Rate	$1,176.05
Max. Negotiated Rate	$1,176.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.05

SURGICEL SNOW 4X4

Facility

$1,095.71

Hospital Charge Code	270683431
Hospital Revenue Code	272
Min. Negotiated Rate	$142.44
Max. Negotiated Rate	$547.86
Rate for Payer: Aetna Commercial	$328.71
Rate for Payer: Aetna Medicare Advantage	$328.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.41
Rate for Payer: Cigna Commercial	$547.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.44
Rate for Payer: Oxford Commercial	$547.86
Rate for Payer: Qualcare PPO/HMO/WC	$164.36
Rate for Payer: UnitedHealthcare Commercial	$547.86

SURGICEL SNOW 4X4

Facility

$1,095.71

Hospital Charge Code	270683431
Hospital Revenue Code	272
Min. Negotiated Rate	$164.36
Max. Negotiated Rate	$164.36
Rate for Payer: Qualcare PPO/HMO/WC	$164.36

SURGICEL SNOW ABSORB. HEMOSTAT

Facility

$938.66

Hospital Charge Code	270669635
Hospital Revenue Code	272
Min. Negotiated Rate	$122.03
Max. Negotiated Rate	$469.33
Rate for Payer: Aetna Commercial	$281.60
Rate for Payer: Aetna Medicare Advantage	$281.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.36
Rate for Payer: Cigna Commercial	$469.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.03
Rate for Payer: Oxford Commercial	$469.33
Rate for Payer: Qualcare PPO/HMO/WC	$140.80
Rate for Payer: UnitedHealthcare Commercial	$469.33

SURGICEL SNOW ABSORB. HEMOSTAT

Facility

$938.66

Hospital Charge Code	270669635
Hospital Revenue Code	272
Min. Negotiated Rate	$140.80
Max. Negotiated Rate	$140.80
Rate for Payer: Qualcare PPO/HMO/WC	$140.80

SURGICLIP PERMIUM L-13.0

Facility

$1,592.07

Hospital Charge Code	270600051
Hospital Revenue Code	272
Min. Negotiated Rate	$206.97
Max. Negotiated Rate	$796.03
Rate for Payer: Aetna Commercial	$477.62
Rate for Payer: Aetna Medicare Advantage	$477.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$405.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$405.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$405.98
Rate for Payer: Cigna Commercial	$796.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.97
Rate for Payer: Oxford Commercial	$796.03
Rate for Payer: Qualcare PPO/HMO/WC	$238.81
Rate for Payer: UnitedHealthcare Commercial	$796.03

SURGICLIP PERMIUM L-13.0

Facility

$1,592.07

Hospital Charge Code	270600051
Hospital Revenue Code	272
Min. Negotiated Rate	$238.81
Max. Negotiated Rate	$238.81
Rate for Payer: Qualcare PPO/HMO/WC	$238.81

SURGICLIP PERMIUM M-11.5

Facility

$285.91

Hospital Charge Code	270651807
Hospital Revenue Code	272
Min. Negotiated Rate	$37.17
Max. Negotiated Rate	$142.96
Rate for Payer: Aetna Commercial	$85.77
Rate for Payer: Aetna Medicare Advantage	$85.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.91
Rate for Payer: Cigna Commercial	$142.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.17
Rate for Payer: Oxford Commercial	$142.96
Rate for Payer: Qualcare PPO/HMO/WC	$42.89
Rate for Payer: UnitedHealthcare Commercial	$142.96

SURGICLIP PERMIUM M-11.5

Facility

$285.91

Hospital Charge Code	270651807
Hospital Revenue Code	272
Min. Negotiated Rate	$42.89
Max. Negotiated Rate	$42.89
Rate for Payer: Qualcare PPO/HMO/WC	$42.89

SURGICLIP PERMIUM M-9.75

Facility

$249.29

Hospital Charge Code	270656248
Hospital Revenue Code	272
Min. Negotiated Rate	$32.41
Max. Negotiated Rate	$124.64
Rate for Payer: Aetna Commercial	$74.79
Rate for Payer: Aetna Medicare Advantage	$74.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.57
Rate for Payer: Cigna Commercial	$124.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.41
Rate for Payer: Oxford Commercial	$124.64
Rate for Payer: Qualcare PPO/HMO/WC	$37.39
Rate for Payer: UnitedHealthcare Commercial	$124.64

SURGICLIP PERMIUM M-9.75

Facility

$249.29

Hospital Charge Code	270656248
Hospital Revenue Code	272
Min. Negotiated Rate	$37.39
Max. Negotiated Rate	$37.39
Rate for Payer: Qualcare PPO/HMO/WC	$37.39

SURGICLIP PERMIUM S-9.0

Facility

$1,800.21

Hospital Charge Code	270600140
Hospital Revenue Code	272
Min. Negotiated Rate	$234.03
Max. Negotiated Rate	$900.11
Rate for Payer: Aetna Commercial	$540.06
Rate for Payer: Aetna Medicare Advantage	$540.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.05
Rate for Payer: Cigna Commercial	$900.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.03
Rate for Payer: Oxford Commercial	$900.11
Rate for Payer: Qualcare PPO/HMO/WC	$270.03
Rate for Payer: UnitedHealthcare Commercial	$900.11

Know your out-of-pocket cost for care.

All Charges