Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Service Code	HCPCS C1769
Hospital Charge Code	270650770
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$48.00
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Hospital Charge Code	270657419
Hospital Revenue Code	270
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$48.00
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$80.00

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Service Code	HCPCS C1769
Hospital Charge Code	270650770
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

GUIDEWIRE AMPLATZ SS .035/260

Facility

$116.25

Hospital Charge Code	270633268
Hospital Revenue Code	272
Min. Negotiated Rate	$15.11
Max. Negotiated Rate	$58.12
Rate for Payer: Aetna Commercial	$34.88
Rate for Payer: Aetna Medicare Advantage	$34.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.64
Rate for Payer: Cigna Commercial	$58.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.11
Rate for Payer: Oxford Commercial	$58.12
Rate for Payer: Qualcare PPO/HMO/WC	$17.44
Rate for Payer: UnitedHealthcare Commercial	$58.12

GUIDEWIRE AMPLATZ SS .035/260

Facility

$116.25

Hospital Charge Code	270633268
Hospital Revenue Code	272
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$17.44
Rate for Payer: Qualcare PPO/HMO/WC	$17.44

GUIDE WIRE AMPLATZ SUPER STIFF

Facility

$212.04

Hospital Charge Code	270CH0136
Hospital Revenue Code	272
Min. Negotiated Rate	$31.81
Max. Negotiated Rate	$31.81
Rate for Payer: Qualcare PPO/HMO/WC	$31.81

GUIDE WIRE AMPLATZ SUPER STIFF

Facility

$212.04

Hospital Charge Code	2703111088
Hospital Revenue Code	272
Min. Negotiated Rate	$27.57
Max. Negotiated Rate	$106.02
Rate for Payer: Aetna Commercial	$63.61
Rate for Payer: Aetna Medicare Advantage	$63.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.07
Rate for Payer: Cigna Commercial	$106.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.57
Rate for Payer: Oxford Commercial	$106.02
Rate for Payer: Qualcare PPO/HMO/WC	$31.81
Rate for Payer: UnitedHealthcare Commercial	$106.02

GUIDE WIRE AMPLATZ SUPER STIFF

Facility

$212.04

Hospital Charge Code	270CH0136
Hospital Revenue Code	272
Min. Negotiated Rate	$27.57
Max. Negotiated Rate	$106.02
Rate for Payer: Aetna Commercial	$63.61
Rate for Payer: Aetna Medicare Advantage	$63.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.07
Rate for Payer: Cigna Commercial	$106.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.57
Rate for Payer: Oxford Commercial	$106.02
Rate for Payer: Qualcare PPO/HMO/WC	$31.81
Rate for Payer: UnitedHealthcare Commercial	$106.02

GUIDE WIRE AMPLATZ SUPER STIFF

Facility

$212.04

Hospital Charge Code	2703111088
Hospital Revenue Code	272
Min. Negotiated Rate	$31.81
Max. Negotiated Rate	$31.81
Rate for Payer: Qualcare PPO/HMO/WC	$31.81

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395S
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

GUIDE WIRE AMPLATZ TORQUE

Facility

$67.50

Service Code	HCPCS C1769
Hospital Charge Code	270655395N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna Commercial	$20.25
Rate for Payer: Aetna Medicare Advantage	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.21
Rate for Payer: Cigna Commercial	$33.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.12

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395S
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

GUIDE WIRE AMPLATZ TORQUE

Facility

$67.50

Service Code	HCPCS C1769
Hospital Charge Code	270655395N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.12

GUIDE WIRE AMPLATZ TORQUE .035

Facility

$142.29

Hospital Charge Code	2706000538
Hospital Revenue Code	272
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$71.14
Rate for Payer: Aetna Commercial	$42.69
Rate for Payer: Aetna Medicare Advantage	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.28
Rate for Payer: Cigna Commercial	$71.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.50
Rate for Payer: Oxford Commercial	$71.14
Rate for Payer: Qualcare PPO/HMO/WC	$21.34
Rate for Payer: UnitedHealthcare Commercial	$71.14

GUIDE WIRE AMPLATZ TORQUE .035

Facility

$142.29

Hospital Charge Code	2706000538
Hospital Revenue Code	272
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$21.34
Rate for Payer: Qualcare PPO/HMO/WC	$21.34

GUIDE WIRE AMPLATZ TORQUE .035

Facility

$142.29

Hospital Charge Code	270CH0072
Hospital Revenue Code	272
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$21.34
Rate for Payer: Qualcare PPO/HMO/WC	$21.34

GUIDE WIRE AMPLATZ TORQUE .035

Facility

$142.29

Hospital Charge Code	270CH0072
Hospital Revenue Code	272
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$71.14
Rate for Payer: Aetna Commercial	$42.69
Rate for Payer: Aetna Medicare Advantage	$42.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.28
Rate for Payer: Cigna Commercial	$71.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.50
Rate for Payer: Oxford Commercial	$71.14
Rate for Payer: Qualcare PPO/HMO/WC	$21.34
Rate for Payer: UnitedHealthcare Commercial	$71.14

GUIDEWIRE AMPLZ 035 260c 46526

Facility

$221.95

Hospital Charge Code	270623264C
Hospital Revenue Code	278
Min. Negotiated Rate	$33.29
Max. Negotiated Rate	$53.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.71
Rate for Payer: Qualcare PPO/HMO/WC	$33.29

GUIDEWIRE AMPLZ 035 260c 46526

Facility

$221.95

Hospital Charge Code	270623264C
Hospital Revenue Code	278
Min. Negotiated Rate	$33.29
Max. Negotiated Rate	$110.97
Rate for Payer: Aetna Commercial	$66.58
Rate for Payer: Aetna Medicare Advantage	$66.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.60
Rate for Payer: Cigna Commercial	$110.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.71
Rate for Payer: Qualcare PPO/HMO/WC	$33.29

GUIDEWIRE AMPLZ 038 260c 46520

Facility

$220.85

Hospital Charge Code	270624318
Hospital Revenue Code	278
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$110.42
Rate for Payer: Aetna Commercial	$66.25
Rate for Payer: Aetna Medicare Advantage	$66.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.32
Rate for Payer: Cigna Commercial	$110.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

GUIDEWIRE AMPLZ 038 260c 46520

Facility

$220.85

Hospital Charge Code	270624318
Hospital Revenue Code	278
Min. Negotiated Rate	$33.13
Max. Negotiated Rate	$53.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.13

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$135.85

Service Code	HCPCS C1769
Hospital Charge Code	270656080
Hospital Revenue Code	278
Min. Negotiated Rate	$20.38
Max. Negotiated Rate	$67.92
Rate for Payer: Aetna Commercial	$40.76
Rate for Payer: Aetna Medicare Advantage	$40.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.64
Rate for Payer: Cigna Commercial	$67.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.88
Rate for Payer: Qualcare PPO/HMO/WC	$20.38

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270601254
Hospital Revenue Code	278
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$64.50
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

Know your out-of-pocket cost for care.

All Charges