Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$264.35
Rate for Payer: Aetna Commercial	$158.61
Rate for Payer: Aetna Medicare Advantage	$158.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.82
Rate for Payer: Cigna Commercial	$264.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.95
Rate for Payer: Qualcare PPO/HMO/WC	$79.31

GUIDEWIRE BALL NOSE 3.0MMX80CM

Facility

$747.50

Service Code	HCPCS C1713
Hospital Charge Code	270695828
Hospital Revenue Code	278
Min. Negotiated Rate	$112.12
Max. Negotiated Rate	$373.75
Rate for Payer: Aetna Commercial	$224.25
Rate for Payer: Aetna Medicare Advantage	$224.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$190.61
Rate for Payer: Cigna Commercial	$373.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.90
Rate for Payer: Qualcare PPO/HMO/WC	$112.12

GUIDEWIRE BALL NOSE 3.0MMX80CM

Facility

$747.50

Service Code	HCPCS C1713
Hospital Charge Code	270695828
Hospital Revenue Code	278
Min. Negotiated Rate	$112.12
Max. Negotiated Rate	$180.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.90
Rate for Payer: Qualcare PPO/HMO/WC	$112.12

GUIDE WIRE BALL TIP 03x1000mm

Facility

$1,084.45

Service Code	HCPCS C1769
Hospital Charge Code	270645790
Hospital Revenue Code	278
Min. Negotiated Rate	$162.67
Max. Negotiated Rate	$262.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.44
Rate for Payer: Qualcare PPO/HMO/WC	$162.67

GUIDE WIRE BALL TIP 03x1000mm

Facility

$1,084.45

Service Code	HCPCS C1769
Hospital Charge Code	270645790
Hospital Revenue Code	278
Min. Negotiated Rate	$162.67
Max. Negotiated Rate	$542.23
Rate for Payer: Aetna Commercial	$325.33
Rate for Payer: Aetna Medicare Advantage	$325.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.53
Rate for Payer: Cigna Commercial	$542.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.44
Rate for Payer: Qualcare PPO/HMO/WC	$162.67

GUIDE WIRE BALL TIPPED

Facility

$2,297.75

Hospital Charge Code	270661241
Hospital Revenue Code	278
Min. Negotiated Rate	$344.66
Max. Negotiated Rate	$1,148.88
Rate for Payer: Aetna Commercial	$689.33
Rate for Payer: Aetna Medicare Advantage	$689.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.93
Rate for Payer: Cigna Commercial	$1,148.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: Qualcare PPO/HMO/WC	$344.66

GUIDE WIRE BALL TIPPED

Facility

$2,297.75

Hospital Charge Code	270661241
Hospital Revenue Code	278
Min. Negotiated Rate	$344.66
Max. Negotiated Rate	$556.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: Qualcare PPO/HMO/WC	$344.66

GUIDEWIRE BAL MDL WT 190cm

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270651830N
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 BAL MDL WT 190cm

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270651830N
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 BAL MDL WT 190cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651830S
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 BAL MDL WT 190cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651830S
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 BAL MDL WT 190cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651830
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 BAL MDL WT 190cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651830
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 BAL MDL WT 300CM

Facility

$450.00

Hospital Charge Code	2709001142
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 BAL MDL WT 300CM

Facility

$450.00

Hospital Charge Code	270651802
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GUIDE WIRE BAL MDL WT 300CM

Facility

$450.00

Hospital Charge Code	270651802
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
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) NJ Health	$90.00
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	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GUIDE WIRE BAL MDL WT 300CM

Facility

$450.00

Hospital Charge Code	2709001142
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

GUIDE WIRE BEAD 2.2Mx98c 27534

Facility

$460.00

Hospital Charge Code	270638576
Hospital Revenue Code	272
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$138.00
Rate for Payer: Aetna Medicare Advantage	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.30
Rate for Payer: Cigna Commercial	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.80
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Commercial	$230.00

GUIDE WIRE BEAD 2.2Mx98c 27534

Facility

$460.00

Hospital Charge Code	270638576
Hospital Revenue Code	272
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

GUIDEWIRE BEAD TIP 2.6mmx80cm

Facility

$600.00

Service Code	HCPCS C1769
Hospital Charge Code	270646652
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$180.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

GUIDEWIRE BEAD TIP 2.6mmx80cm

Facility

$600.00

Service Code	HCPCS C1769
Hospital Charge Code	270646652
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

GUIDEWIRE BEAD TIP 27934

Facility

$460.00

Hospital Charge Code	270637525
Hospital Revenue Code	272
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$138.00
Rate for Payer: Aetna Medicare Advantage	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.30
Rate for Payer: Cigna Commercial	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.80
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Commercial	$230.00

GUIDEWIRE BEAD TIP 27934

Facility

$460.00

Hospital Charge Code	270637525
Hospital Revenue Code	272
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

GUIDEWIRE BEADTIP 3.0MM

Facility

$955.00

Service Code	HCPCS C1769
Hospital Charge Code	270677453
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

GUIDEWIRE BEADTIP 3.0MM

Facility

$955.00

Service Code	HCPCS C1769
Hospital Charge Code	270677453
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$286.50
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

Know your out-of-pocket cost for care.

All Charges