Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$45.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
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	$100.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

GUIDEWIRE 3.2x400MM

Facility

$578.45

Service Code	HCPCS C1769
Hospital Charge Code	270660158
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

GUIDEWIRE 3.2x400MM

Facility

$578.45

Service Code	HCPCS C1769
Hospital Charge Code	270660158
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 3.2x400MM

Facility

$1,270.00

Service Code	HCPCS C1769
Hospital Charge Code	270633464
Hospital Revenue Code	278
Min. Negotiated Rate	$190.50
Max. Negotiated Rate	$307.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.34
Rate for Payer: Qualcare PPO/HMO/WC	$190.50

GUIDEWIRE 3.2x400MM

Facility

$1,270.00

Service Code	HCPCS C1769
Hospital Charge Code	270633464
Hospital Revenue Code	278
Min. Negotiated Rate	$190.50
Max. Negotiated Rate	$635.00
Rate for Payer: Cigna Commercial	$635.00
Rate for Payer: Aetna Commercial	$381.00
Rate for Payer: Aetna Medicare Advantage	$381.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$323.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$323.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$323.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.34
Rate for Payer: Qualcare PPO/HMO/WC	$190.50

GUIDE WIRE 3.2X400MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693266
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 3.2X400MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693266
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 .38 3MMJ 150CM

Facility

$35.00

Hospital Charge Code	270646432
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

GUIDEWIRE .38 3MMJ 150CM

Facility

$35.00

Hospital Charge Code	270646432
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$10.50
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$17.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$17.50

GUIDEWIRE 3MM J .035/150CM

Facility

$32.50

Hospital Charge Code	2709000373
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

GUIDEWIRE 3MM J .035/150CM

Facility

$32.50

Hospital Charge Code	2709000373
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$9.75
Rate for Payer: Aetna Medicare Advantage	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.22
Rate for Payer: Oxford Commercial	$16.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Commercial	$16.25

GUIDE WIRE 3x800 1806-0080S

Facility

$935.00

Hospital Charge Code	270638646
Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$140.25
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

GUIDE WIRE 3x800 1806-0080S

Facility

$935.00

Hospital Charge Code	270638646
Hospital Revenue Code	272
Min. Negotiated Rate	$121.55
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$280.50
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.55
Rate for Payer: Oxford Commercial	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Commercial	$467.50

GUIDEWIRE .86MM LASER LINE

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270689954
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GUIDEWIRE .86MM LASER LINE

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270689954
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GUIDEWIRE .86MM W/LASER LINE

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270662158
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GUIDEWIRE .86MM W/LASER LINE

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270662158
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GUIDEWIRE .8MM

Facility

$4,240.00

Service Code	HCPCS C1713
Hospital Charge Code	270700824
Hospital Revenue Code	278
Min. Negotiated Rate	$636.00
Max. Negotiated Rate	$2,120.00
Rate for Payer: Aetna Commercial	$1,272.00
Rate for Payer: Aetna Medicare Advantage	$1,272.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,081.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,081.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,081.20
Rate for Payer: Cigna Commercial	$2,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.08
Rate for Payer: Qualcare PPO/HMO/WC	$636.00

GUIDEWIRE .8MM

Facility

$4,240.00

Service Code	HCPCS C1713
Hospital Charge Code	270700824
Hospital Revenue Code	278
Min. Negotiated Rate	$636.00
Max. Negotiated Rate	$1,026.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$848.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,026.08
Rate for Payer: Qualcare PPO/HMO/WC	$636.00

GUIDEWIRE.8MM 100MMLEN TRO TIP

Facility

$280.80

Service Code	HCPCS C1713
Hospital Charge Code	270691909
Hospital Revenue Code	278
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Commercial	$84.24
Rate for Payer: Aetna Medicare Advantage	$84.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.60
Rate for Payer: Cigna Commercial	$140.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$42.12

GUIDEWIRE.8MM 100MMLEN TRO TIP

Facility

$280.80

Service Code	HCPCS C1713
Hospital Charge Code	270691909
Hospital Revenue Code	278
Min. Negotiated Rate	$42.12
Max. Negotiated Rate	$67.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$42.12

GUIDEWIRE ACCESS KIT 5F 10CM

Facility

$250.00

Service Code	HCPCS C1769
Hospital Charge Code	270697737S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

GUIDEWIRE ACCESS KIT 5F 10CM

Facility

$250.00

Service Code	HCPCS C1769
Hospital Charge Code	270697737S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

GUIDEWIRE AD JTIP 3MM 5500601

Facility

$52.85

Hospital Charge Code	270623761
Hospital Revenue Code	272
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$26.43
Rate for Payer: Aetna Commercial	$15.86
Rate for Payer: Aetna Medicare Advantage	$15.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.48
Rate for Payer: Cigna Commercial	$26.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.87
Rate for Payer: Oxford Commercial	$26.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.93
Rate for Payer: UnitedHealthcare Commercial	$26.43

Know your out-of-pocket cost for care.

All Charges