Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE ASAHI GRNDSLM 300

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512S
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

GUIDEWIRE ASAHI GRNDSLM 300

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512S
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 ASAHI MIRACLEBRO 300

Facility

$3,375.00

Hospital Charge Code	270636224C
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

GUIDEWIRE ASAHI MIRACLEBRO 300

Facility

$3,375.00

Hospital Charge Code	270636224C
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,012.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

GUIDEWIRE ASAHI PROWATER 300CM

Facility

$2,250.00

Hospital Charge Code	270636742C
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

GUIDEWIRE ASAHI PROWATER 300CM

Facility

$2,250.00

Hospital Charge Code	270636742C
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 PTCA MICRACLIB

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270651834
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 PTCA MICRACLIB

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270651834
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 ASHAI ASTATO 30

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

GUIDEWIRE ASHAI ASTATO 30

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

GUIDEWIRE ASHAI TREASURE 12

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270643115C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GUIDEWIRE ASHAI TREASURE 12

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270643115C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GUIDEWIRE ASHI GSL 300 1494001

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512
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

GUIDEWIRE ASHI GSL 300 1494001

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512
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 ATW FL0PPY MEJ 195cm

Facility

$1,975.00

Hospital Charge Code	270637334
Hospital Revenue Code	279
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

GUIDEWIRE ATW FL0PPY MEJ 195cm

Facility

$358.75

Hospital Charge Code	290637334C
Hospital Revenue Code	278
Min. Negotiated Rate	$53.81
Max. Negotiated Rate	$86.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.82
Rate for Payer: Qualcare PPO/HMO/WC	$53.81

GUIDEWIRE ATW FL0PPY MEJ 195cm

Facility

$1,975.00

Hospital Charge Code	270637334
Hospital Revenue Code	279
Min. Negotiated Rate	$256.75
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$592.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.75
Rate for Payer: Oxford Commercial	$987.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$987.50

GUIDEWIRE ATW FL0PPY MEJ 195cm

Facility

$358.75

Hospital Charge Code	290637334C
Hospital Revenue Code	278
Min. Negotiated Rate	$53.81
Max. Negotiated Rate	$179.38
Rate for Payer: Aetna Commercial	$107.62
Rate for Payer: Aetna Medicare Advantage	$107.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.48
Rate for Payer: Cigna Commercial	$179.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.82
Rate for Payer: Qualcare PPO/HMO/WC	$53.81

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$414.80

Service Code	HCPCS C1769
Hospital Charge Code	270637325N
Hospital Revenue Code	278
Min. Negotiated Rate	$62.22
Max. Negotiated Rate	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.38
Rate for Payer: Qualcare PPO/HMO/WC	$62.22

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$414.80

Service Code	HCPCS C1769
Hospital Charge Code	270637325N
Hospital Revenue Code	278
Min. Negotiated Rate	$62.22
Max. Negotiated Rate	$207.40
Rate for Payer: Aetna Commercial	$124.44
Rate for Payer: Aetna Medicare Advantage	$124.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.77
Rate for Payer: Cigna Commercial	$207.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.38
Rate for Payer: Qualcare PPO/HMO/WC	$62.22

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$1,802.50

Service Code	HCPCS C1769
Hospital Charge Code	270637325
Hospital Revenue Code	278
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$1,802.50

Service Code	HCPCS C1769
Hospital Charge Code	270637325
Hospital Revenue Code	278
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$901.25
Rate for Payer: Aetna Commercial	$540.75
Rate for Payer: Aetna Medicare Advantage	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.64
Rate for Payer: Cigna Commercial	$901.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

GUIDE WIRE BALL MDL WT 190CM

Facility

$375.00

Hospital Charge Code	2709001141
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 BALL MDL WT 190CM

Facility

$375.00

Hospital Charge Code	2709001141
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE BALL NOSE3.0MMX100CM

Facility

$528.70

Service Code	HCPCS C1713
Hospital Charge Code	270673675
Hospital Revenue Code	278
Min. Negotiated Rate	$79.31
Max. Negotiated Rate	$127.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.95
Rate for Payer: Qualcare PPO/HMO/WC	$79.31

Know your out-of-pocket cost for care.

All Charges