Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE ARISTOT 18 STD 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694241S
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

GUIDEWIRE ARISTOT 18 SUP 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694242S
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,042.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

GUIDEWIRE ARISTOT 18 SUP 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694242S
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

GUIDEWIRE ARISTOT 24 SFT 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694243S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ARISTOT 24 SFT 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694243S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ARISTOT 24 STD 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694245S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ARISTOT 24 STD 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694245S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ARISTOT 24 SUP 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694244S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,192.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ARISTOT 24 SUP 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694244S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ASAHI CHIKAI 200CM

Facility

$2,745.00

Service Code	HCPCS C1769
Hospital Charge Code	270694474S
Hospital Revenue Code	278
Min. Negotiated Rate	$411.75
Max. Negotiated Rate	$664.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.29
Rate for Payer: Qualcare PPO/HMO/WC	$411.75

GUIDEWIRE ASAHI CHIKAI 200CM

Facility

$2,745.00

Service Code	HCPCS C1769
Hospital Charge Code	270694474S
Hospital Revenue Code	278
Min. Negotiated Rate	$411.75
Max. Negotiated Rate	$1,372.50
Rate for Payer: Aetna Commercial	$823.50
Rate for Payer: Aetna Medicare Advantage	$823.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.98
Rate for Payer: Cigna Commercial	$1,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.29
Rate for Payer: Qualcare PPO/HMO/WC	$411.75

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270636225N
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270636225N
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Hospital Charge Code	270648404C
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Hospital Charge Code	270648404C
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270636225C
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$202.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270636225C
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASAHI GRANDSLAM 180

Facility

$375.00

Hospital Charge Code	270644718
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE ASAHI GRANDSLAM 180

Facility

$375.00

Hospital Charge Code	270644718
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

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719C
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719S
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719S
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719C
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE ASAHI GRANDSLAM 300

Facility

$2,250.00

Hospital Charge Code	270638512C
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

GUIDEWIRE ASAHI GRANDSLAM 300

Facility

$2,250.00

Hospital Charge Code	270638512C
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$675.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

Know your out-of-pocket cost for care.

All Charges