Heights University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE CAPIO PROLENE 1/2 CIRCL

Facility

$200.00

Hospital Charge Code	270616241
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

SUTURE CAPIO PROLENE SZ 0 48

Facility

$199.56

Hospital Charge Code	270621604
Hospital Revenue Code	272
Min. Negotiated Rate	$29.93
Max. Negotiated Rate	$29.93
Rate for Payer: Qualcare PPO/HMO/WC	$29.93

SUTURE CAPIO PROLENE SZ 0 48

Facility

$199.56

Hospital Charge Code	270621604
Hospital Revenue Code	272
Min. Negotiated Rate	$25.94
Max. Negotiated Rate	$99.78
Rate for Payer: Aetna Commercial	$59.87
Rate for Payer: Aetna Medicare Advantage	$59.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.89
Rate for Payer: Cigna Commercial	$99.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Oxford Commercial	$99.78
Rate for Payer: Qualcare PPO/HMO/WC	$29.93
Rate for Payer: UnitedHealthcare Commercial	$99.78

SUTURE CAPIO PROLENT TC 36 IN

Facility

$216.75

Hospital Charge Code	270683968
Hospital Revenue Code	272
Min. Negotiated Rate	$32.51
Max. Negotiated Rate	$32.51
Rate for Payer: Qualcare PPO/HMO/WC	$32.51

SUTURE CAPIO PROLENT TC 36 IN

Facility

$216.75

Hospital Charge Code	270683968
Hospital Revenue Code	272
Min. Negotiated Rate	$28.18
Max. Negotiated Rate	$108.38
Rate for Payer: Aetna Commercial	$65.03
Rate for Payer: Aetna Medicare Advantage	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.27
Rate for Payer: Cigna Commercial	$108.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.18
Rate for Payer: Oxford Commercial	$108.38
Rate for Payer: Qualcare PPO/HMO/WC	$32.51
Rate for Payer: UnitedHealthcare Commercial	$108.38

SUTURE CAPROSY 3-0 P14 SC5780G

Facility

$16.25

Hospital Charge Code	270632706
Hospital Revenue Code	272
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.44

SUTURE CAPROSY 3-0 P14 SC5780G

Facility

$16.25

Hospital Charge Code	270632706
Hospital Revenue Code	272
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$8.12
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.14
Rate for Payer: Cigna Commercial	$8.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.11
Rate for Payer: Oxford Commercial	$8.12
Rate for Payer: Qualcare PPO/HMO/WC	$2.44
Rate for Payer: UnitedHealthcare Commercial	$8.12

SUTURE CAPROSYN 0 HGS21 CC942

Facility

$7.50

Hospital Charge Code	270633220
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

SUTURE CAPROSYN 0 HGS21 CC942

Facility

$7.50

Hospital Charge Code	270633220
Hospital Revenue Code	272
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.25
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$3.75

SUTURE CAPROSYN 1 36 KV34

Facility

$10.30

Hospital Charge Code	270675606
Hospital Revenue Code	272
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$5.15
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna Medicare Advantage	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.63
Rate for Payer: Cigna Commercial	$5.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$5.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$5.15

SUTURE CAPROSYN 1 36 KV34

Facility

$10.30

Hospital Charge Code	270675606
Hospital Revenue Code	272
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

SUTURE CAPROSYN 3/0 36 GS21

Facility

$7.29

Hospital Charge Code	270605820
Hospital Revenue Code	272
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

SUTURE CAPROSYN 3/0 36 GS21

Facility

$7.29

Hospital Charge Code	270605820
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.95
Rate for Payer: Oxford Commercial	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.65

SUTURE CAPROSYN 4-0 UNDYED 30

Facility

$36.10

Hospital Charge Code	270671790
Hospital Revenue Code	272
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$18.05
Rate for Payer: Aetna Commercial	$10.83
Rate for Payer: Aetna Medicare Advantage	$10.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.21
Rate for Payer: Cigna Commercial	$18.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.69
Rate for Payer: Oxford Commercial	$18.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.42
Rate for Payer: UnitedHealthcare Commercial	$18.05

SUTURE CAPROSYN 4-0 UNDYED 30

Facility

$36.10

Hospital Charge Code	270671790
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$5.42

SUTURE CAPROSYN 5/0 18 UD P24

Facility

$14.74

Hospital Charge Code	270651283
Hospital Revenue Code	272
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna Commercial	$4.42
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$7.37

SUTURE CAPROSYN 5/0 18 UD P24

Facility

$14.74

Hospital Charge Code	270651283
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

SUTURE CAPROSYN GS-21 0

Facility

$7.60

Hospital Charge Code	270632451
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$3.80
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.94
Rate for Payer: Cigna Commercial	$3.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.99
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.14
Rate for Payer: UnitedHealthcare Commercial	$3.80

SUTURE CAPROSYN GS-21 0

Facility

$7.60

Hospital Charge Code	270632451
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.14

SUTURE CAPROSYN GS-21 36

Facility

$7.85

Hospital Charge Code	270655017
Hospital Revenue Code	272
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.18

SUTURE CAPROSYN GS-21 36

Facility

$7.85

Hospital Charge Code	270655017
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$2.35
Rate for Payer: Aetna Medicare Advantage	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.00
Rate for Payer: Cigna Commercial	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.02
Rate for Payer: Oxford Commercial	$3.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.18
Rate for Payer: UnitedHealthcare Commercial	$3.92

SUTURE CAPROSYN P-12 3-0

Facility

$15.68

Hospital Charge Code	270633106
Hospital Revenue Code	272
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$7.84
Rate for Payer: Aetna Commercial	$4.70
Rate for Payer: Aetna Medicare Advantage	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.00
Rate for Payer: Cigna Commercial	$7.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.04
Rate for Payer: Oxford Commercial	$7.84
Rate for Payer: Qualcare PPO/HMO/WC	$2.35
Rate for Payer: UnitedHealthcare Commercial	$7.84

SUTURE CAPROSYN P-12 3-0

Facility

$15.68

Hospital Charge Code	270633106
Hospital Revenue Code	272
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.35

SUTURE CAPROSYN P-12 4-0

Facility

$16.15

Hospital Charge Code	270633429
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$8.07
Rate for Payer: Aetna Commercial	$4.84
Rate for Payer: Aetna Medicare Advantage	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.12
Rate for Payer: Cigna Commercial	$8.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.42
Rate for Payer: UnitedHealthcare Commercial	$8.07

SUTURE CAPROSYN P-12 4-0

Facility

$16.15

Hospital Charge Code	270633429
Hospital Revenue Code	272
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$2.42

Know your out-of-pocket cost for care.

All Charges