Heights University Hospital

All Charges

Charge

Type

Setting

Price

GLIDEWIRE MT .025 46-125

Facility

$305.25

Service Code	HCPCS C1769
Hospital Charge Code	270620431
Hospital Revenue Code	278
Min. Negotiated Rate	$45.79
Max. Negotiated Rate	$152.62
Rate for Payer: Aetna Commercial	$91.58
Rate for Payer: Aetna Medicare Advantage	$91.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.84
Rate for Payer: Cigna Commercial	$152.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.87
Rate for Payer: Qualcare PPO/HMO/WC	$45.79

GLIDEWIRE MT .025 46-125

Facility

$305.25

Service Code	HCPCS C1769
Hospital Charge Code	270620431
Hospital Revenue Code	278
Min. Negotiated Rate	$45.79
Max. Negotiated Rate	$73.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.87
Rate for Payer: Qualcare PPO/HMO/WC	$45.79

GLIDEWIRE STD .035 260CM 3CM

Facility

$289.85

Service Code	HCPCS C1769
Hospital Charge Code	270698331S
Hospital Revenue Code	278
Min. Negotiated Rate	$43.48
Max. Negotiated Rate	$144.93
Rate for Payer: Aetna Commercial	$86.95
Rate for Payer: Aetna Medicare Advantage	$86.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.91
Rate for Payer: Cigna Commercial	$144.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.14
Rate for Payer: Qualcare PPO/HMO/WC	$43.48

GLIDEWIRE STD .035 260CM 3CM

Facility

$289.85

Service Code	HCPCS C1769
Hospital Charge Code	270698331S
Hospital Revenue Code	278
Min. Negotiated Rate	$43.48
Max. Negotiated Rate	$70.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.14
Rate for Payer: Qualcare PPO/HMO/WC	$43.48

GLIDEWIRE STIFF ANGKE GUIDE .0

Facility

$258.31

Hospital Charge Code	270CH0073
Hospital Revenue Code	272
Min. Negotiated Rate	$33.58
Max. Negotiated Rate	$129.16
Rate for Payer: Aetna Commercial	$77.49
Rate for Payer: Aetna Medicare Advantage	$77.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.87
Rate for Payer: Cigna Commercial	$129.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.58
Rate for Payer: Oxford Commercial	$129.16
Rate for Payer: Qualcare PPO/HMO/WC	$38.75
Rate for Payer: UnitedHealthcare Commercial	$129.16

GLIDEWIRE STIFF ANGKE GUIDE .0

Facility

$258.31

Hospital Charge Code	270CH0073
Hospital Revenue Code	272
Min. Negotiated Rate	$38.75
Max. Negotiated Rate	$38.75
Rate for Payer: Qualcare PPO/HMO/WC	$38.75

GLIDEWIRE STIFF SHAFT

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270658279S
Hospital Revenue Code	278
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: Qualcare PPO/HMO/WC	$36.34

GLIDEWIRE STIFF SHAFT

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270658279S
Hospital Revenue Code	278
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$121.12
Rate for Payer: Aetna Commercial	$72.67
Rate for Payer: Aetna Medicare Advantage	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.77
Rate for Payer: Cigna Commercial	$121.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: Qualcare PPO/HMO/WC	$36.34

GLIDEWIRE STR .038

Facility

$300.81

Service Code	HCPCS C1769
Hospital Charge Code	270601256
Hospital Revenue Code	278
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$150.41
Rate for Payer: Aetna Commercial	$90.24
Rate for Payer: Aetna Medicare Advantage	$90.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.71
Rate for Payer: Cigna Commercial	$150.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$45.12

GLIDEWIRE STR .038

Facility

$300.81

Service Code	HCPCS C1769
Hospital Charge Code	270601256
Hospital Revenue Code	278
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$72.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$45.12

GLIDEWIRE STRAIGHT .038 X 150

Facility

$679.00

Hospital Charge Code	270331921
Hospital Revenue Code	278
Min. Negotiated Rate	$101.85
Max. Negotiated Rate	$164.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.32
Rate for Payer: Qualcare PPO/HMO/WC	$101.85

GLIDEWIRE STRAIGHT .038 X 150

Facility

$679.00

Hospital Charge Code	270331921
Hospital Revenue Code	278
Min. Negotiated Rate	$101.85
Max. Negotiated Rate	$339.50
Rate for Payer: Aetna Commercial	$203.70
Rate for Payer: Aetna Medicare Advantage	$203.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.15
Rate for Payer: Cigna Commercial	$339.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.32
Rate for Payer: Qualcare PPO/HMO/WC	$101.85

GLIDEWIRE SV 018 180 ANG 46232

Facility

$294.00

Hospital Charge Code	270628049
Hospital Revenue Code	278
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$71.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.15
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

GLIDEWIRE SV 018 180 ANG 46232

Facility

$294.00

Hospital Charge Code	270628049
Hospital Revenue Code	278
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$147.00
Rate for Payer: Aetna Commercial	$88.20
Rate for Payer: Aetna Medicare Advantage	$88.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.97
Rate for Payer: Cigna Commercial	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.15
Rate for Payer: Qualcare PPO/HMO/WC	$44.10

GLIDEWR.035 180 ANGL GR3508

Facility

$205.75

Service Code	HCPCS C1769
Hospital Charge Code	270638087C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$102.88
Rate for Payer: Aetna Commercial	$61.73
Rate for Payer: Aetna Medicare Advantage	$61.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.47
Rate for Payer: Cigna Commercial	$102.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: Qualcare PPO/HMO/WC	$30.86

GLIDEWR.035 180 ANGL GR3508

Facility

$205.75

Service Code	HCPCS C1769
Hospital Charge Code	270638087C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: Qualcare PPO/HMO/WC	$30.86

GLIDWIRE 035 260 STF AN GS3509

Facility

$306.10

Hospital Charge Code	270637622V
Hospital Revenue Code	278
Min. Negotiated Rate	$45.91
Max. Negotiated Rate	$153.05
Rate for Payer: Aetna Commercial	$91.83
Rate for Payer: Aetna Medicare Advantage	$91.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.06
Rate for Payer: Cigna Commercial	$153.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.08
Rate for Payer: Qualcare PPO/HMO/WC	$45.91

GLIDWIRE 035 260 STF AN GS3509

Facility

$306.10

Hospital Charge Code	270637622V
Hospital Revenue Code	278
Min. Negotiated Rate	$45.91
Max. Negotiated Rate	$74.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.08
Rate for Payer: Qualcare PPO/HMO/WC	$45.91

GLIDWIRE .035/450CM ANGELEDTIP

Facility

$186.00

Service Code	HCPCS C1769
Hospital Charge Code	270654318
Hospital Revenue Code	278
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$55.80
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

GLIDWIRE .035/450CM ANGELEDTIP

Facility

$186.00

Service Code	HCPCS C1769
Hospital Charge Code	270654318
Hospital Revenue Code	278
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

GLIDWIRE GD 70DEG 018 5 GM1814

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270637733C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

GLIDWIRE GD 70DEG 018 5 GM1814

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270637733C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

GLIMEPIRIDE 2 MG TAB

Facility

$13.00

Service Code	NDC 39022210
Hospital Charge Code	60629107
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

GLIMEPIRIDE 2 MG TAB

Facility

$13.00

Service Code	NDC 39022210
Hospital Charge Code	60629107
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$6.50

GLIMEPIRIDE 4 MG TAB

Facility

$8.24

Service Code	NDC 51079042620
Hospital Charge Code	60628622
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

Know your out-of-pocket cost for care.

All Charges