Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634S
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$129.00
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634N
Hospital Revenue Code	278
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$100.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634S
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWIRE CHICE PT 300C ST TIP

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270653634N
Hospital Revenue Code	278
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Commercial	$124.50
Rate for Payer: Aetna Medicare Advantage	$124.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.83
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

GUIDEWIRE CHIKAI 10 MM

Facility

$2,745.00

Service Code	HCPCS C1769
Hospital Charge Code	270696455S
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 CHIKAI 10 MM

Facility

$2,745.00

Service Code	HCPCS C1769
Hospital Charge Code	270696455S
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 CHOICE 182cm 1216001

Facility

$595.25

Hospital Charge Code	270629663
Hospital Revenue Code	278
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$144.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.05
Rate for Payer: Qualcare PPO/HMO/WC	$89.29

GUIDEWIRE CHOICE 182cm 1216001

Facility

$595.25

Hospital Charge Code	270629663
Hospital Revenue Code	278
Min. Negotiated Rate	$89.29
Max. Negotiated Rate	$297.62
Rate for Payer: Aetna Commercial	$178.57
Rate for Payer: Aetna Medicare Advantage	$178.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.79
Rate for Payer: Cigna Commercial	$297.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.05
Rate for Payer: Qualcare PPO/HMO/WC	$89.29

GUIDEWIRE CHOIC PT 300 1215501

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270637306
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWIRE CHOIC PT 300 1215501

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270637306
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$129.00
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWIRE CLEVER CUT V

Facility

$810.00

Service Code	HCPCS C1769
Hospital Charge Code	270684736
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna Commercial	$243.00
Rate for Payer: Aetna Medicare Advantage	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.55
Rate for Payer: Cigna Commercial	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.02
Rate for Payer: Qualcare PPO/HMO/WC	$121.50

GUIDEWIRE CLEVER CUT V

Facility

$810.00

Service Code	HCPCS C1769
Hospital Charge Code	270684736
Hospital Revenue Code	278
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$196.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.02
Rate for Payer: Qualcare PPO/HMO/WC	$121.50

GUIDEWIRE CONTROL 8x300CM STR

Facility

$798.25

Service Code	HCPCS C1769
Hospital Charge Code	270670509
Hospital Revenue Code	278
Min. Negotiated Rate	$119.74
Max. Negotiated Rate	$399.12
Rate for Payer: Aetna Commercial	$239.47
Rate for Payer: Aetna Medicare Advantage	$239.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.55
Rate for Payer: Cigna Commercial	$399.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.18
Rate for Payer: Qualcare PPO/HMO/WC	$119.74

GUIDEWIRE CONTROL 8x300CM STR

Facility

$798.25

Service Code	HCPCS C1769
Hospital Charge Code	270670509
Hospital Revenue Code	278
Min. Negotiated Rate	$119.74
Max. Negotiated Rate	$193.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.18
Rate for Payer: Qualcare PPO/HMO/WC	$119.74

GUIDEWIRE COPE MANDRIL 60cm

Facility

$241.45

Service Code	HCPCS C1769
Hospital Charge Code	270632089
Hospital Revenue Code	278
Min. Negotiated Rate	$36.22
Max. Negotiated Rate	$120.72
Rate for Payer: Aetna Commercial	$72.44
Rate for Payer: Aetna Medicare Advantage	$72.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.57
Rate for Payer: Cigna Commercial	$120.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.43
Rate for Payer: Qualcare PPO/HMO/WC	$36.22

GUIDEWIRE COPE MANDRIL 60cm

Facility

$241.45

Service Code	HCPCS C1769
Hospital Charge Code	270632089
Hospital Revenue Code	278
Min. Negotiated Rate	$36.22
Max. Negotiated Rate	$58.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.43
Rate for Payer: Qualcare PPO/HMO/WC	$36.22

GUIDEWIRE COPE NITINOL 218125

Facility

$251.45

Service Code	HCPCS C1769
Hospital Charge Code	270630862
Hospital Revenue Code	278
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$125.72
Rate for Payer: Aetna Commercial	$75.44
Rate for Payer: Aetna Medicare Advantage	$75.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.12
Rate for Payer: Cigna Commercial	$125.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.85
Rate for Payer: Qualcare PPO/HMO/WC	$37.72

GUIDEWIRE COPE NITINOL 218125

Facility

$251.45

Service Code	HCPCS C1769
Hospital Charge Code	270630862
Hospital Revenue Code	278
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$60.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.85
Rate for Payer: Qualcare PPO/HMO/WC	$37.72

GUIDE WIRE COPILOT

Facility

$250.00

Service Code	HCPCS C1789
Hospital Charge Code	270682243N
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

GUIDE WIRE COPILOT

Facility

$250.00

Service Code	HCPCS C1789
Hospital Charge Code	270682243N
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

GUIDE WIRE COPILOT

Facility

$325.00

Service Code	HCPCS C1769
Hospital Charge Code	270682243S
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$97.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

GUIDE WIRE COPILOT

Facility

$325.00

Service Code	HCPCS C1769
Hospital Charge Code	270682243
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$97.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

GUIDE WIRE COPILOT

Facility

$325.00

Service Code	HCPCS C1769
Hospital Charge Code	270682243S
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

GUIDE WIRE COPILOT

Facility

$325.00

Service Code	HCPCS C1769
Hospital Charge Code	270682243
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

GUIDEWIRE CRD .018 503-558X

Facility

$560.00

Hospital Charge Code	270624763
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$168.00
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

Know your out-of-pocket cost for care.

All Charges