Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE HIQUE COMD ES 208175

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270659350S
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

GUIDEWIRE HIQUE COMD ES 208175

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270659350
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

GUIDEWIRE HI-T COMMAND 18 ST 2

Facility

$815.00

Service Code	HCPCS C1769
Hospital Charge Code	270687204
Hospital Revenue Code	278
Min. Negotiated Rate	$122.25
Max. Negotiated Rate	$407.50
Rate for Payer: Aetna Commercial	$244.50
Rate for Payer: Aetna Medicare Advantage	$244.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.82
Rate for Payer: Cigna Commercial	$407.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.23
Rate for Payer: Qualcare PPO/HMO/WC	$122.25

GUIDEWIRE HI-T COMMAND 18 ST 2

Facility

$815.00

Service Code	HCPCS C1769
Hospital Charge Code	270687204
Hospital Revenue Code	278
Min. Negotiated Rate	$122.25
Max. Negotiated Rate	$197.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.23
Rate for Payer: Qualcare PPO/HMO/WC	$122.25

GUIDEWIRE HI-T COMMAND 18 ST 3

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270687203S
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

GUIDEWIRE HI-T COMMAND 18 ST 3

Facility

$815.00

Service Code	HCPCS C1769
Hospital Charge Code	270687203
Hospital Revenue Code	278
Min. Negotiated Rate	$122.25
Max. Negotiated Rate	$407.50
Rate for Payer: Aetna Commercial	$244.50
Rate for Payer: Aetna Medicare Advantage	$244.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.82
Rate for Payer: Cigna Commercial	$407.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.23
Rate for Payer: Qualcare PPO/HMO/WC	$122.25

GUIDEWIRE HI-T COMMAND 18 ST 3

Facility

$815.00

Service Code	HCPCS C1769
Hospital Charge Code	270687203
Hospital Revenue Code	278
Min. Negotiated Rate	$122.25
Max. Negotiated Rate	$197.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.23
Rate for Payer: Qualcare PPO/HMO/WC	$122.25

GUIDEWIRE HI-T COMMAND 18 ST 3

Facility

$650.00

Service Code	HCPCS C1769
Hospital Charge Code	270687203S
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Aetna Commercial	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

GUIDEWIRE HIWIRE .025 STR

Facility

$154.70

Hospital Charge Code	270647875
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .025 STR

Facility

$154.70

Hospital Charge Code	270647875
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$46.41
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .035 180cm.

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270654229
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 HIWIRE .035 180cm.

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270654229
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 HIWIRE .035 ANGL

Facility

$154.70

Service Code	HCPCS C1769
Hospital Charge Code	270647876
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$46.41
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .035 ANGL

Facility

$154.70

Service Code	HCPCS C1769
Hospital Charge Code	270647876
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .038 STR

Facility

$154.70

Hospital Charge Code	270647879
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .038 STR

Facility

$154.70

Hospital Charge Code	270647879
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$46.41
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .35 STR

Facility

$154.70

Hospital Charge Code	270647877
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial	$46.41
Rate for Payer: Aetna Medicare Advantage	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.45
Rate for Payer: Cigna Commercial	$77.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HIWIRE .35 STR

Facility

$154.70

Hospital Charge Code	270647877
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.44
Rate for Payer: Qualcare PPO/HMO/WC	$23.20

GUIDEWIRE HT FLOPPY 0.14 190CM

Facility

$450.00

Hospital Charge Code	270632556C
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

GUIDEWIRE HT FLOPPY 0.14 190CM

Facility

$450.00

Hospital Charge Code	270632556C
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

GUIDEWIRE HT FLOPPY 0.14 300CM

Facility

$450.00

Hospital Charge Code	270632557C
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

GUIDEWIRE HT FLOPPY 0.14 300CM

Facility

$450.00

Hospital Charge Code	270632557C
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

GUIDEWIRE HYBRID .007 DBL ANG

Facility

$3,400.00

Service Code	HCPCS C1769
Hospital Charge Code	270697724S
Hospital Revenue Code	278
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$822.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

GUIDEWIRE HYBRID .007 DBL ANG

Facility

$3,400.00

Service Code	HCPCS C1769
Hospital Charge Code	270697724S
Hospital Revenue Code	278
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,020.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$822.80
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

GUIDEWIRE HYBRID .007 STR

Facility

$3,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270697723S
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$975.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

Know your out-of-pocket cost for care.

All Charges