Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE 2 4X70 BUTIP 2255008

Facility

$460.00

Hospital Charge Code	270638046
Hospital Revenue Code	272
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

GUIDEWIRE 2.8

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270690801
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$156.00
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

GUIDEWIRE 2.8

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270690801
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

GUIDE WIRE 2.8MM X 300MM

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270680279
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

GUIDE WIRE 2.8MM X 300MM

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270680279
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

GUIDEWIRE 2.8X220MM

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270695400
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

GUIDEWIRE 2.8X220MM

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270695400
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$907.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

GUIDEWIRE 2.8x450 THRD 900726

Facility

$275.00

Hospital Charge Code	270632483
Hospital Revenue Code	272
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$82.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.75
Rate for Payer: Oxford Commercial	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$137.50

GUIDEWIRE 2.8x450 THRD 900726

Facility

$275.00

Hospital Charge Code	270632483
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

GUIDEWIRE 2X200mm

Facility

$700.00

Service Code	HCPCS C1769
Hospital Charge Code	270681218
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

GUIDEWIRE 2X200mm

Facility

$700.00

Service Code	HCPCS C1769
Hospital Charge Code	270681218
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$210.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

GUIDE WIRE 3.0X100 47225500801

Facility

$700.00

Hospital Charge Code	270634681
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$210.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

GUIDE WIRE 3.0X100 47225500801

Facility

$700.00

Hospital Charge Code	270634681
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

GUIDE WIRE 3.2

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270687656
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

GUIDE WIRE 3.2

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270687656
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$375.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

GUIDE WIRE 3.2MM

Facility

$578.45

Hospital Charge Code	270659946
Hospital Revenue Code	278
Min. Negotiated Rate	$86.77
Max. Negotiated Rate	$289.23
Rate for Payer: Aetna Commercial	$173.53
Rate for Payer: Aetna Medicare Advantage	$173.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.50
Rate for Payer: Cigna Commercial	$289.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.77

GUIDE WIRE 3.2MM

Facility

$578.45

Hospital Charge Code	270659946
Hospital Revenue Code	278
Min. Negotiated Rate	$86.77
Max. Negotiated Rate	$139.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.77

GUIDEWIRE 3.2MM

Facility

$1,031.25

Service Code	HCPCS C1769
Hospital Charge Code	270696027
Hospital Revenue Code	278
Min. Negotiated Rate	$154.69
Max. Negotiated Rate	$249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.56
Rate for Payer: Qualcare PPO/HMO/WC	$154.69

GUIDEWIRE 3.2MM

Facility

$1,031.25

Service Code	HCPCS C1769
Hospital Charge Code	270696027
Hospital Revenue Code	278
Min. Negotiated Rate	$154.69
Max. Negotiated Rate	$515.62
Rate for Payer: Aetna Commercial	$309.38
Rate for Payer: Aetna Medicare Advantage	$309.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.97
Rate for Payer: Cigna Commercial	$515.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.56
Rate for Payer: Qualcare PPO/HMO/WC	$154.69

GUIDE WIRE 3.2mm X290MM

Facility

$413.75

Service Code	HCPCS C1769
Hospital Charge Code	270675117
Hospital Revenue Code	278
Min. Negotiated Rate	$62.06
Max. Negotiated Rate	$206.88
Rate for Payer: Aetna Commercial	$124.12
Rate for Payer: Aetna Medicare Advantage	$124.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.51
Rate for Payer: Cigna Commercial	$206.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.06

GUIDE WIRE 3.2mm X290MM

Facility

$413.75

Service Code	HCPCS C1769
Hospital Charge Code	270675117
Hospital Revenue Code	278
Min. Negotiated Rate	$62.06
Max. Negotiated Rate	$100.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.06

GUIDEWIRE 3.2 THREADED 409595

Facility

$400.00

Hospital Charge Code	270637571
Hospital Revenue Code	272
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$120.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$200.00

GUIDEWIRE 3.2 THREADED 409595

Facility

$400.00

Hospital Charge Code	270637571
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

GUIDE WIRE 3.2X230MM SINGLE

Facility

$190.00

Service Code	HCPCS C1769
Hospital Charge Code	270662003
Hospital Revenue Code	278
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

GUIDE WIRE 3.2X230MM SINGLE

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	270673600
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

Know your out-of-pocket cost for care.

All Charges