Heights University Hospital

All Charges

Charge

Type

Setting

Price

SUTURE POLYSORB 0 5x30 GS21

Facility

$26.37

Hospital Charge Code	270651128
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$13.19
Rate for Payer: Aetna Commercial	$7.91
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	$3.43
Rate for Payer: Oxford Commercial	$13.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.96
Rate for Payer: UnitedHealthcare Commercial	$13.19

SUTURE POLYSORB 0 5x30 GS21

Facility

$26.37

Hospital Charge Code	270651128
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 0 60 REEL

Facility

$7.31

Hospital Charge Code	270651159
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	$1.10
Rate for Payer: UnitedHealthcare Commercial	$3.65

SUTURE POLYSORB 0 60 REEL

Facility

$7.31

Hospital Charge Code	270651159
Hospital Revenue Code	272
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: Qualcare PPO/HMO/WC	$1.10

SUTURE POLYSORB 0 60 VIO REEL

Facility

$7.24

Hospital Charge Code	270604521
Hospital Revenue Code	272
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$3.62

SUTURE POLYSORB 0 60 VIO REEL

Facility

$7.24

Hospital Charge Code	270604521
Hospital Revenue Code	272
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

SUTURE POLYSORB 0 6x18 U/D

Facility

$17.19

Hospital Charge Code	270651109
Hospital Revenue Code	272
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$8.60
Rate for Payer: Aetna Commercial	$5.16
Rate for Payer: Aetna Medicare Advantage	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.38
Rate for Payer: Cigna Commercial	$8.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.58
Rate for Payer: UnitedHealthcare Commercial	$8.60

SUTURE POLYSORB 0 6x18 U/D

Facility

$17.19

Hospital Charge Code	270651109
Hospital Revenue Code	272
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.58

SUTURE POLYSORB 0 GS-21 U/D 36

Facility

$6.63

Hospital Charge Code	270651263
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

SUTURE POLYSORB 0 GS-21 U/D 36

Facility

$6.63

Hospital Charge Code	270651263
Hospital Revenue Code	272
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$1.99
Rate for Payer: Aetna Medicare Advantage	$1.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.69
Rate for Payer: Cigna Commercial	$3.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.86
Rate for Payer: Oxford Commercial	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$3.31

SUTURE POLYSORB 0 R-205 UD TIE

Facility

$6.07

Hospital Charge Code	270656141
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 0 R-205 UD TIE

Facility

$6.07

Hospital Charge Code	270656141
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$1.82
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	$0.79
Rate for Payer: Oxford Commercial	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.91
Rate for Payer: UnitedHealthcare Commercial	$3.04

SUTURE POLYSORB 1 18 PRECUT

Facility

$28.33

Hospital Charge Code	270651108
Hospital Revenue Code	272
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$14.16
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: Aetna Medicare Advantage	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.22
Rate for Payer: Cigna Commercial	$14.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.68
Rate for Payer: Oxford Commercial	$14.16
Rate for Payer: Qualcare PPO/HMO/WC	$4.25
Rate for Payer: UnitedHealthcare Commercial	$14.16

SUTURE POLYSORB 1 18 PRECUT

Facility

$28.33

Hospital Charge Code	270651108
Hospital Revenue Code	272
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.25

SUTURE POLYSORB 1 30 CT1

Facility

$6.43

Hospital Charge Code	270604534
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$3.21
Rate for Payer: Aetna Commercial	$1.93
Rate for Payer: Aetna Medicare Advantage	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.64
Rate for Payer: Cigna Commercial	$3.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.84
Rate for Payer: Oxford Commercial	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$3.21

SUTURE POLYSORB 1 30 CT1

Facility

$6.43

Hospital Charge Code	270604534
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

SUTURE POLYSORB 1 30IN VIOLET

Facility

$8.62

Hospital Charge Code	270604533
Hospital Revenue Code	272
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

SUTURE POLYSORB 1 30IN VIOLET

Facility

$8.62

Hospital Charge Code	270604533
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$4.31
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna Medicare Advantage	$2.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.20
Rate for Payer: Cigna Commercial	$4.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$4.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$4.31

SUTURE POLYSORB 1 36 U/D GS21

Facility

$23.16

Hospital Charge Code	270651266
Hospital Revenue Code	272
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$3.47
Rate for Payer: Qualcare PPO/HMO/WC	$3.47

SUTURE POLYSORB 1 36 U/D GS21

Facility

$23.16

Hospital Charge Code	270651266
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$11.58
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: Aetna Medicare Advantage	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.91
Rate for Payer: Cigna Commercial	$11.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.01
Rate for Payer: Oxford Commercial	$11.58
Rate for Payer: Qualcare PPO/HMO/WC	$3.47
Rate for Payer: UnitedHealthcare Commercial	$11.58

SUTURE POLYSORB 1 36 U/D GS24

Facility

$23.04

Hospital Charge Code	270651493
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$11.52
Rate for Payer: Aetna Commercial	$6.91
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	$3.00
Rate for Payer: Oxford Commercial	$11.52
Rate for Payer: Qualcare PPO/HMO/WC	$3.46
Rate for Payer: UnitedHealthcare Commercial	$11.52

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	$0.93
Max. Negotiated Rate	$3.57
Rate for Payer: Aetna Commercial	$2.14
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	$0.93
Rate for Payer: Oxford Commercial	$3.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.07
Rate for Payer: UnitedHealthcare Commercial	$3.57

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 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

Know your out-of-pocket cost for care.

All Charges