Heights University Hospital

All Charges

Charge

Type

Setting

Price

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	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

GUIDEWIRE HYBRID .008 DBL ANG

Facility

$3,400.00

Service Code	HCPCS C1769
Hospital Charge Code	270697726S
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 .008 DBL ANG

Facility

$3,400.00

Service Code	HCPCS C1769
Hospital Charge Code	270697726S
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

GUIDEWIREHYBRID.012/.014DBLANG

Facility

$2,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270697725S
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

GUIDEWIREHYBRID.012/.014DBLANG

Facility

$2,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270697725S
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$742.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

GUIDEWIRE HYBRID .012/.014 ST

Facility

$2,350.00

Service Code	HCPCS C1769
Hospital Charge Code	270697722S
Hospital Revenue Code	278
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$705.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.70
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

GUIDEWIRE HYBRID .012/.014 ST

Facility

$2,350.00

Service Code	HCPCS C1769
Hospital Charge Code	270697722S
Hospital Revenue Code	278
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$568.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.70
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

GUIDEWIRE HYDRO ST 300CM

Facility

$860.00

Service Code	HCPCS C1769
Hospital Charge Code	270662852
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

GUIDEWIRE HYDRO ST 300CM

Facility

$860.00

Service Code	HCPCS C1769
Hospital Charge Code	270662852S
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

GUIDEWIRE HYDRO ST 300CM

Facility

$997.50

Service Code	HCPCS C1769
Hospital Charge Code	270662852N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.62
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$299.25
Rate for Payer: Aetna Medicare Advantage	$299.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.36
Rate for Payer: Cigna Commercial	$498.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.62

GUIDEWIRE HYDRO ST 300CM

Facility

$860.00

Service Code	HCPCS C1769
Hospital Charge Code	270662852
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$430.00
Rate for Payer: Aetna Commercial	$258.00
Rate for Payer: Aetna Medicare Advantage	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.30
Rate for Payer: Cigna Commercial	$430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

GUIDEWIRE HYDRO ST 300CM

Facility

$997.50

Service Code	HCPCS C1769
Hospital Charge Code	270662852N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.62
Max. Negotiated Rate	$241.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.40
Rate for Payer: Qualcare PPO/HMO/WC	$149.62

GUIDEWIRE HYDRO ST 300CM

Facility

$860.00

Service Code	HCPCS C1769
Hospital Charge Code	270662852S
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$430.00
Rate for Payer: Aetna Commercial	$258.00
Rate for Payer: Aetna Medicare Advantage	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.30
Rate for Payer: Cigna Commercial	$430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

GUIDEWIRE IRONMAN 190 1001309

Facility

$500.00

Hospital Charge Code	270636705
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GUIDEWIRE IRONMAN 190 1001309

Facility

$500.00

Hospital Charge Code	270636705
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GUIDEWIRE IRONMAN 300C 1001311

Facility

$2,175.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706
Hospital Revenue Code	278
Min. Negotiated Rate	$326.25
Max. Negotiated Rate	$526.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.35
Rate for Payer: Qualcare PPO/HMO/WC	$326.25

GUIDEWIRE IRONMAN 300C 1001311

Facility

$500.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706N
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GUIDEWIRE IRONMAN 300C 1001311

Facility

$500.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706N
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$150.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GUIDEWIRE IRONMAN 300C 1001311

Facility

$2,175.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706
Hospital Revenue Code	278
Min. Negotiated Rate	$326.25
Max. Negotiated Rate	$1,087.50
Rate for Payer: Aetna Commercial	$652.50
Rate for Payer: Aetna Medicare Advantage	$652.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$554.62
Rate for Payer: Cigna Commercial	$1,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.35
Rate for Payer: Qualcare PPO/HMO/WC	$326.25

GUIDEWIRE J 3MM .035/150CM

Facility

$30.90

Service Code	HCPCS C1769
Hospital Charge Code	270653785N
Hospital Revenue Code	278
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$15.45
Rate for Payer: Aetna Commercial	$9.27
Rate for Payer: Aetna Medicare Advantage	$9.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.88
Rate for Payer: Cigna Commercial	$15.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.63

GUIDEWIRE J 3MM .035/150CM

Facility

$30.90

Service Code	HCPCS C1769
Hospital Charge Code	270653785N
Hospital Revenue Code	278
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.63

GUIDEWIRE J 3MM .035/150CM

Facility

$366.00

Hospital Charge Code	270653785
Hospital Revenue Code	279
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Qualcare PPO/HMO/WC	$54.90

GUIDEWIRE J 3MM .035/150CM

Facility

$366.00

Hospital Charge Code	270653785
Hospital Revenue Code	279
Min. Negotiated Rate	$47.58
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$109.80
Rate for Payer: Aetna Medicare Advantage	$109.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.33
Rate for Payer: Cigna Commercial	$183.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.58
Rate for Payer: Oxford Commercial	$183.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.90
Rate for Payer: UnitedHealthcare Commercial	$183.00

GUIDEWIRE JAGTOME RX 39 ERCP

Facility

$1,515.00

Service Code	HCPCS C1769
Hospital Charge Code	270687106
Hospital Revenue Code	278
Min. Negotiated Rate	$227.25
Max. Negotiated Rate	$366.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$303.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.63
Rate for Payer: Qualcare PPO/HMO/WC	$227.25

GUIDEWIRE JAGTOME RX 39 ERCP

Facility

$1,515.00

Service Code	HCPCS C1769
Hospital Charge Code	270687106
Hospital Revenue Code	278
Min. Negotiated Rate	$227.25
Max. Negotiated Rate	$757.50
Rate for Payer: Aetna Commercial	$454.50
Rate for Payer: Aetna Medicare Advantage	$454.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$386.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$386.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$386.32
Rate for Payer: Cigna Commercial	$757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.63
Rate for Payer: Qualcare PPO/HMO/WC	$227.25

Know your out-of-pocket cost for care.

All Charges