Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE AD JTIP 3MM 5500601

Facility

$52.85

Hospital Charge Code	270623761
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.93

GUIDEWIRE ADVANT .018 X 180CM

Facility

$1,662.50

Hospital Charge Code	270665131
Hospital Revenue Code	279
Min. Negotiated Rate	$249.38
Max. Negotiated Rate	$249.38
Rate for Payer: Qualcare PPO/HMO/WC	$249.38

GUIDEWIRE ADVANT .018 X 180CM

Facility

$1,662.50

Hospital Charge Code	270665131
Hospital Revenue Code	279
Min. Negotiated Rate	$216.12
Max. Negotiated Rate	$831.25
Rate for Payer: Aetna Commercial	$498.75
Rate for Payer: Aetna Medicare Advantage	$498.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.94
Rate for Payer: Cigna Commercial	$831.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.12
Rate for Payer: Oxford Commercial	$831.25
Rate for Payer: Qualcare PPO/HMO/WC	$249.38
Rate for Payer: UnitedHealthcare Commercial	$831.25

GUIDEWIRE ADVANTAGE .018 X 18

Facility

$1,100.00

Service Code	HCPCS C1769
Hospital Charge Code	270665131N
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$330.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

GUIDEWIRE ADVANTAGE .018 X 18

Facility

$1,380.00

Service Code	HCPCS C1769
Hospital Charge Code	270665131S
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$414.00
Rate for Payer: Aetna Medicare Advantage	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$351.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$351.90
Rate for Payer: Cigna Commercial	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

GUIDEWIRE ADVANTAGE .018 X 18

Facility

$1,380.00

Service Code	HCPCS C1769
Hospital Charge Code	270665131S
Hospital Revenue Code	278
Min. Negotiated Rate	$207.00
Max. Negotiated Rate	$333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.96
Rate for Payer: Qualcare PPO/HMO/WC	$207.00

GUIDEWIRE ADVANTAGE .018 X 18

Facility

$1,100.00

Service Code	HCPCS C1769
Hospital Charge Code	270665131N
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$266.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

GUIDEWIRE ADVANTAGE .018 X 300

Facility

$1,810.00

Service Code	HCPCS C1769
Hospital Charge Code	270665130
Hospital Revenue Code	279
Min. Negotiated Rate	$271.50
Max. Negotiated Rate	$271.50
Rate for Payer: Qualcare PPO/HMO/WC	$271.50

GUIDEWIRE ADVANTAGE .018 X 300

Facility

$1,810.00

Service Code	HCPCS C1769
Hospital Charge Code	270665130
Hospital Revenue Code	279
Min. Negotiated Rate	$235.30
Max. Negotiated Rate	$905.00
Rate for Payer: Aetna Commercial	$543.00
Rate for Payer: Aetna Medicare Advantage	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.55
Rate for Payer: Cigna Commercial	$905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.30
Rate for Payer: Oxford Commercial	$905.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.50
Rate for Payer: UnitedHealthcare Commercial	$905.00

GUIDEWIRE ADVANTAGE .018 X 300

Facility

$1,200.00

Service Code	HCPCS C1769
Hospital Charge Code	270665130N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

GUIDEWIRE ADVANTAGE .018 X 300

Facility

$1,200.00

Service Code	HCPCS C1769
Hospital Charge Code	270665130N
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$360.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

GUIDEWIRE AG .038 150 05500801

Facility

$66.45

Hospital Charge Code	270626419
Hospital Revenue Code	272
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$33.23
Rate for Payer: Aetna Commercial	$19.93
Rate for Payer: Aetna Medicare Advantage	$19.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.94
Rate for Payer: Cigna Commercial	$33.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.64
Rate for Payer: Oxford Commercial	$33.23
Rate for Payer: Qualcare PPO/HMO/WC	$9.97
Rate for Payer: UnitedHealthcare Commercial	$33.23

GUIDEWIRE AG .038 150 05500801

Facility

$66.45

Hospital Charge Code	270626419
Hospital Revenue Code	272
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.97

GUIDEWIRE AIMING ANT POST ORIN

Facility

$4,557.80

Service Code	HCPCS C1769
Hospital Charge Code	270691501
Hospital Revenue Code	278
Min. Negotiated Rate	$683.67
Max. Negotiated Rate	$1,102.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$911.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,102.99
Rate for Payer: Qualcare PPO/HMO/WC	$683.67

GUIDEWIRE AIMING ANT POST ORIN

Facility

$4,557.80

Service Code	HCPCS C1769
Hospital Charge Code	270691501
Hospital Revenue Code	278
Min. Negotiated Rate	$683.67
Max. Negotiated Rate	$2,278.90
Rate for Payer: Aetna Commercial	$1,367.34
Rate for Payer: Aetna Medicare Advantage	$1,367.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,162.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,162.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$911.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,162.24
Rate for Payer: Cigna Commercial	$2,278.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,102.99
Rate for Payer: Qualcare PPO/HMO/WC	$683.67

GUIDEWIRE AIMING DEVICE OFFSE

Facility

$1,924.30

Service Code	HCPCS C1769
Hospital Charge Code	270691502
Hospital Revenue Code	278
Min. Negotiated Rate	$288.64
Max. Negotiated Rate	$962.15
Rate for Payer: Aetna Commercial	$577.29
Rate for Payer: Aetna Medicare Advantage	$577.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$384.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.70
Rate for Payer: Cigna Commercial	$962.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.68
Rate for Payer: Qualcare PPO/HMO/WC	$288.64

GUIDEWIRE AIMING DEVICE OFFSE

Facility

$1,924.30

Service Code	HCPCS C1769
Hospital Charge Code	270691502
Hospital Revenue Code	278
Min. Negotiated Rate	$288.64
Max. Negotiated Rate	$465.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$384.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.68
Rate for Payer: Qualcare PPO/HMO/WC	$288.64

GUIDEWIRE ALL STAR 190cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651776
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE ALL STAR 190cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651776
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDE WIRE ALL STAR 190CM

Facility

$450.00

Hospital Charge Code	2709001139
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GUIDE WIRE ALL STAR 190CM

Facility

$450.00

Hospital Charge Code	2709001139
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$135.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$225.00

GUIDEWIRE ALL STAR 300cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651832
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE ALL STAR 300cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651832
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDE WIRE ALL STAR 300CM

Facility

$375.00

Hospital Charge Code	2709001140
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$112.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$187.50

GUIDE WIRE ALL STAR 300CM

Facility

$375.00

Hospital Charge Code	2709001140
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

Know your out-of-pocket cost for care.

All Charges