Heights University Hospital

All Charges

Charge

Type

Setting

Price

SURGICLIP PERMIUM S-9.0

Facility

$1,800.21

Hospital Charge Code	270600140
Hospital Revenue Code	272
Min. Negotiated Rate	$270.03
Max. Negotiated Rate	$270.03
Rate for Payer: Qualcare PPO/HMO/WC	$270.03

SURGICLIP PREMIUM M-11.5

Facility

$963.98

Hospital Charge Code	270600049
Hospital Revenue Code	272
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$144.60
Rate for Payer: Qualcare PPO/HMO/WC	$144.60

SURGICLIP PREMIUM M-11.5

Facility

$963.98

Hospital Charge Code	270600049
Hospital Revenue Code	272
Min. Negotiated Rate	$125.32
Max. Negotiated Rate	$481.99
Rate for Payer: Aetna Commercial	$289.19
Rate for Payer: Aetna Medicare Advantage	$289.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.81
Rate for Payer: Cigna Commercial	$481.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.32
Rate for Payer: Oxford Commercial	$481.99
Rate for Payer: Qualcare PPO/HMO/WC	$144.60
Rate for Payer: UnitedHealthcare Commercial	$481.99

SURGICLIP TITAN *******

Facility

$168.00

Hospital Charge Code	1600972
Hospital Revenue Code	272
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$50.40
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.84
Rate for Payer: Oxford Commercial	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$84.00

SURGICLIP TITAN *******

Facility

$168.00

Hospital Charge Code	1600972
Hospital Revenue Code	272
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

SURGICLOSE 4X6CM

Facility

$7,780.00

Service Code	HCPCS C1765
Hospital Charge Code	270705487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.00
Max. Negotiated Rate	$3,890.00
Rate for Payer: Aetna Commercial	$2,334.00
Rate for Payer: Aetna Medicare Advantage	$2,334.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,983.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,983.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,983.90
Rate for Payer: Cigna Commercial	$3,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.00

SURGICLOSE 4X6CM

Facility

$7,780.00

Service Code	HCPCS C1765
Hospital Charge Code	270705487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.00
Max. Negotiated Rate	$1,882.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,556.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,882.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,167.00

SURGICLOSE7X20CM

Facility

$35,830.00

Service Code	HCPCS C1765
Hospital Charge Code	270706060
Hospital Revenue Code	278
Min. Negotiated Rate	$5,374.50
Max. Negotiated Rate	$8,670.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,670.86
Rate for Payer: Qualcare PPO/HMO/WC	$5,374.50

SURGICLOSE7X20CM

Facility

$35,830.00

Service Code	HCPCS C1765
Hospital Charge Code	270706060
Hospital Revenue Code	278
Min. Negotiated Rate	$5,374.50
Max. Negotiated Rate	$17,915.00
Rate for Payer: Aetna Commercial	$10,749.00
Rate for Payer: Aetna Medicare Advantage	$10,749.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,136.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,136.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,166.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,136.65
Rate for Payer: Cigna Commercial	$17,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,670.86
Rate for Payer: Qualcare PPO/HMO/WC	$5,374.50

SURGICLOSE MESHED 2:1 6X8CM

Facility

$14,550.00

Service Code	HCPCS C1781
Hospital Charge Code	270705088
Hospital Revenue Code	278
Min. Negotiated Rate	$2,182.50
Max. Negotiated Rate	$7,275.00
Rate for Payer: Aetna Commercial	$4,365.00
Rate for Payer: Aetna Medicare Advantage	$4,365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,710.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,710.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,710.25
Rate for Payer: Cigna Commercial	$7,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,521.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,182.50

SURGICLOSE MESHED 2:1 6X8CM

Facility

$14,550.00

Service Code	HCPCS C1781
Hospital Charge Code	270705088
Hospital Revenue Code	278
Min. Negotiated Rate	$2,182.50
Max. Negotiated Rate	$3,521.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,521.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,182.50

SURGICLOSE MESHED 7X10CM

Facility

$19,735.00

Service Code	HCPCS C1781
Hospital Charge Code	270705089
Hospital Revenue Code	278
Min. Negotiated Rate	$2,960.25
Max. Negotiated Rate	$4,775.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,947.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,775.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,960.25

SURGICLOSE MESHED 7X10CM

Facility

$19,735.00

Service Code	HCPCS C1781
Hospital Charge Code	270705089
Hospital Revenue Code	278
Min. Negotiated Rate	$2,960.25
Max. Negotiated Rate	$9,867.50
Rate for Payer: Aetna Commercial	$5,920.50
Rate for Payer: Aetna Medicare Advantage	$5,920.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,032.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,032.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,947.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,032.43
Rate for Payer: Cigna Commercial	$9,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,775.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,960.25

SURGICLOSE MICRO 38 SQ CM

Facility

$9,100.00

Service Code	HCPCS C1765
Hospital Charge Code	270705486
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$4,550.00
Rate for Payer: Aetna Commercial	$2,730.00
Rate for Payer: Aetna Medicare Advantage	$2,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,320.50
Rate for Payer: Cigna Commercial	$4,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,202.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00

SURGICLOSE MICRO 38 SQ CM

Facility

$9,100.00

Service Code	HCPCS C1765
Hospital Charge Code	270705486
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$2,202.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,202.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00

SURGICLOSE MICRO 95 SQ CM

Facility

$20,475.00

Service Code	HCPCS C1765
Hospital Charge Code	270705697
Hospital Revenue Code	278
Min. Negotiated Rate	$3,071.25
Max. Negotiated Rate	$10,237.50
Rate for Payer: Aetna Commercial	$6,142.50
Rate for Payer: Aetna Medicare Advantage	$6,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,221.12
Rate for Payer: Cigna Commercial	$10,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25

SURGICLOSE MICRO 95 SQ CM

Facility

$20,475.00

Service Code	HCPCS C1765
Hospital Charge Code	270705697
Hospital Revenue Code	278
Min. Negotiated Rate	$3,071.25
Max. Negotiated Rate	$4,954.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25

SURGIFLO HEMOSTATIC 8ML

Facility

$1,200.00

Hospital Charge Code	270701429
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

SURGIFLO HEMOSTATIC 8ML

Facility

$1,200.00

Hospital Charge Code	270701429
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

SURGIFOAM ABSORB GEL POWDER

Facility

$452.26

Hospital Charge Code	270644933C
Hospital Revenue Code	272
Min. Negotiated Rate	$58.79
Max. Negotiated Rate	$226.13
Rate for Payer: Aetna Commercial	$135.68
Rate for Payer: Aetna Medicare Advantage	$135.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.33
Rate for Payer: Cigna Commercial	$226.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.79
Rate for Payer: Oxford Commercial	$226.13
Rate for Payer: Qualcare PPO/HMO/WC	$67.84
Rate for Payer: UnitedHealthcare Commercial	$226.13

SURGIFOAM ABSORB GEL POWDER

Facility

$452.26

Hospital Charge Code	270644933C
Hospital Revenue Code	272
Min. Negotiated Rate	$67.84
Max. Negotiated Rate	$67.84
Rate for Payer: Qualcare PPO/HMO/WC	$67.84

SURGIGRIP 10MM *****

Facility

$30.00

Hospital Charge Code	1603315
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SURGIGRIP 10MM *****

Facility

$30.00

Hospital Charge Code	1603315
Hospital Revenue Code	272
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$9.00
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	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$15.00

SURGIGRIP 10MM 173001

Facility

$20.80

Hospital Charge Code	270600075
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.12

SURGIGRIP 10MM 173001

Facility

$20.80

Hospital Charge Code	270600075
Hospital Revenue Code	272
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: Aetna Medicare Advantage	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.30
Rate for Payer: Cigna Commercial	$10.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.12
Rate for Payer: UnitedHealthcare Commercial	$10.40

Know your out-of-pocket cost for care.

All Charges