Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE NITINOL 1.4 MMX457

Facility

$500.00

Service Code	HCPCS C1769
Hospital Charge Code	270692234
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

GUIDE WIRE NON COLORED 2x230MM

Facility

$168.40

Service Code	HCPCS C1769
Hospital Charge Code	270645547
Hospital Revenue Code	278
Min. Negotiated Rate	$25.26
Max. Negotiated Rate	$40.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.75
Rate for Payer: Qualcare PPO/HMO/WC	$25.26

GUIDE WIRE NON COLORED 2x230MM

Facility

$168.40

Service Code	HCPCS C1769
Hospital Charge Code	270645547
Hospital Revenue Code	278
Min. Negotiated Rate	$25.26
Max. Negotiated Rate	$84.20
Rate for Payer: Aetna Commercial	$50.52
Rate for Payer: Aetna Medicare Advantage	$50.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.94
Rate for Payer: Cigna Commercial	$84.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.75
Rate for Payer: Qualcare PPO/HMO/WC	$25.26

GUIDEWIRE NONTHREAD 1.25X150MM

Facility

$125.85

Service Code	HCPCS C1713
Hospital Charge Code	270689660
Hospital Revenue Code	278
Min. Negotiated Rate	$18.88
Max. Negotiated Rate	$62.92
Rate for Payer: Aetna Commercial	$37.76
Rate for Payer: Aetna Medicare Advantage	$37.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.09
Rate for Payer: Cigna Commercial	$62.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.46
Rate for Payer: Qualcare PPO/HMO/WC	$18.88

GUIDEWIRE NONTHREAD 1.25X150MM

Facility

$125.85

Service Code	HCPCS C1713
Hospital Charge Code	270689660
Hospital Revenue Code	278
Min. Negotiated Rate	$18.88
Max. Negotiated Rate	$30.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.46
Rate for Payer: Qualcare PPO/HMO/WC	$18.88

GUIDEWIRE NOVAGOLD .018 260cm

Facility

$977.45

Service Code	HCPCS C1769
Hospital Charge Code	270675453
Hospital Revenue Code	278
Min. Negotiated Rate	$146.62
Max. Negotiated Rate	$236.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.54
Rate for Payer: Qualcare PPO/HMO/WC	$146.62

GUIDEWIRE NOVAGOLD .018 260cm

Facility

$977.45

Service Code	HCPCS C1769
Hospital Charge Code	270675453
Hospital Revenue Code	278
Min. Negotiated Rate	$146.62
Max. Negotiated Rate	$488.73
Rate for Payer: Aetna Commercial	$293.24
Rate for Payer: Aetna Medicare Advantage	$293.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.25
Rate for Payer: Cigna Commercial	$488.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.54
Rate for Payer: Qualcare PPO/HMO/WC	$146.62

GUIDEWIRE NOVA GOLD 0.18x450cm

Facility

$977.45

Service Code	HCPCS C1769
Hospital Charge Code	270683529
Hospital Revenue Code	278
Min. Negotiated Rate	$146.62
Max. Negotiated Rate	$488.73
Rate for Payer: Aetna Commercial	$293.24
Rate for Payer: Aetna Medicare Advantage	$293.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.25
Rate for Payer: Cigna Commercial	$488.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.54
Rate for Payer: Qualcare PPO/HMO/WC	$146.62

GUIDEWIRE NOVA GOLD 0.18x450cm

Facility

$977.45

Service Code	HCPCS C1769
Hospital Charge Code	270683529
Hospital Revenue Code	278
Min. Negotiated Rate	$146.62
Max. Negotiated Rate	$236.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.54
Rate for Payer: Qualcare PPO/HMO/WC	$146.62

GUIDEWIRE PANTA2 3.2X600MM

Facility

$1,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270699968
Hospital Revenue Code	278
Min. Negotiated Rate	$285.75
Max. Negotiated Rate	$461.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$381.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.01
Rate for Payer: Qualcare PPO/HMO/WC	$285.75

GUIDEWIRE PANTA2 3.2X600MM

Facility

$1,905.00

Service Code	HCPCS C1713
Hospital Charge Code	270699968
Hospital Revenue Code	278
Min. Negotiated Rate	$285.75
Max. Negotiated Rate	$952.50
Rate for Payer: Aetna Commercial	$571.50
Rate for Payer: Aetna Medicare Advantage	$571.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$381.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$485.77
Rate for Payer: Cigna Commercial	$952.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$461.01
Rate for Payer: Qualcare PPO/HMO/WC	$285.75

GUIDEWIRE PRIMEWIRE J DS 185CM

Facility

$3,375.00

Service Code	HCPCS C1769
Hospital Charge Code	270646539
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 PRIMEWIRE J DS 185CM

Facility

$3,125.00

Hospital Charge Code	270643087C
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$937.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

GUIDEWIRE PRIMEWIRE J DS 185CM

Facility

$3,375.00

Hospital Charge Code	270643087
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 PRIMEWIRE J DS 185CM

Facility

$3,375.00

Service Code	HCPCS C1769
Hospital Charge Code	270646539
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 PRIMEWIRE J DS 185CM

Facility

$3,375.00

Hospital Charge Code	270643087
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 PRIMEWIRE J DS 185CM

Facility

$3,125.00

Hospital Charge Code	270643087C
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

GUIDEWIRE PROWATER 180 1277601

Facility

$1,700.00

Hospital Charge Code	270363741
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

GUIDEWIRE PROWATER 180 1277601

Facility

$1,700.00

Hospital Charge Code	270363741
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.00
Rate for Payer: Oxford Commercial	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$850.00

GUIDEWIRE PROWATER 300 1493501

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE PROWATER 300 1493501

Facility

$425.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$127.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

GUIDEWIRE PROWATER 300 1493501

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE PROWATER 300 1493501

Facility

$425.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

GUIDEWIRE PTFE .023

Facility

$68.70

Hospital Charge Code	270647880
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$16.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.63
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

GUIDEWIRE PTFE .023

Facility

$68.70

Hospital Charge Code	270647880
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$34.35
Rate for Payer: Aetna Commercial	$20.61
Rate for Payer: Aetna Medicare Advantage	$20.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.52
Rate for Payer: Cigna Commercial	$34.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.63
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

Know your out-of-pocket cost for care.

All Charges