Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE SOLO FLEX NI .038 15

Facility

$212.00

Service Code	HCPCS C1769
Hospital Charge Code	270682483
Hospital Revenue Code	278
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$51.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

GUIDEWIRE SPADE-PT 1.6X150MM

Facility

$124.10

Service Code	HCPCS C1769
Hospital Charge Code	270667996
Hospital Revenue Code	278
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$62.05
Rate for Payer: Aetna Commercial	$37.23
Rate for Payer: Aetna Medicare Advantage	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.65
Rate for Payer: Cigna Commercial	$62.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.03
Rate for Payer: Qualcare PPO/HMO/WC	$18.61

GUIDEWIRE SPADE-PT 1.6X150MM

Facility

$124.10

Service Code	HCPCS C1769
Hospital Charge Code	270667996
Hospital Revenue Code	278
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$30.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.03
Rate for Payer: Qualcare PPO/HMO/WC	$18.61

GUIDEWIRE SPARTACORE .014X300

Facility

$375.00

Hospital Charge Code	270676707
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE SPARTACORE .014X300

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270676707S
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE SPARTACORE .014X300

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270676707S
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$187.50

GUIDEWIRE SPARTACORE .014X300

Facility

$375.00

Hospital Charge Code	270676707
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.75
Rate for Payer: Oxford Commercial	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$187.50

GUIDEWIRE SPHINRX JAGTOME 20MM

Facility

$1,515.00

Service Code	HCPCS C1769
Hospital Charge Code	270684463
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

GUIDEWIRE SPHINRX JAGTOME 20MM

Facility

$1,515.00

Service Code	HCPCS C1769
Hospital Charge Code	270684463
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 STIFF SHAFT STRAIGHT

Facility

$117.00

Hospital Charge Code	270651204
Hospital Revenue Code	278
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$35.10
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

GUIDEWIRE STIFF SHAFT STRAIGHT

Facility

$117.00

Hospital Charge Code	270651204
Hospital Revenue Code	278
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$28.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

GUIDEWIRE STIFF SHAFT STRAIGHT

Facility

$117.00

Hospital Charge Code	270651200
Hospital Revenue Code	278
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$35.10
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

GUIDEWIRE STIFF SHAFT STRAIGHT

Facility

$117.00

Hospital Charge Code	270651200
Hospital Revenue Code	278
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$28.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

GUIDEWIRE STIFF SHAFT/STR TIP

Facility

$2,187.25

Hospital Charge Code	270675205
Hospital Revenue Code	272
Min. Negotiated Rate	$328.09
Max. Negotiated Rate	$328.09
Rate for Payer: Qualcare PPO/HMO/WC	$328.09

GUIDEWIRE STIFF SHAFT/STR TIP

Facility

$2,187.25

Hospital Charge Code	270675205
Hospital Revenue Code	272
Min. Negotiated Rate	$284.34
Max. Negotiated Rate	$1,093.62
Rate for Payer: Aetna Commercial	$656.17
Rate for Payer: Aetna Medicare Advantage	$656.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$557.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$557.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$557.75
Rate for Payer: Cigna Commercial	$1,093.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.34
Rate for Payer: Oxford Commercial	$1,093.62
Rate for Payer: Qualcare PPO/HMO/WC	$328.09
Rate for Payer: UnitedHealthcare Commercial	$1,093.62

GUIDEWIRE STQ .035 203456MJ

Facility

$313.65

Hospital Charge Code	270624010
Hospital Revenue Code	278
Min. Negotiated Rate	$47.05
Max. Negotiated Rate	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.90
Rate for Payer: Qualcare PPO/HMO/WC	$47.05

GUIDEWIRE STQ .035 203456MJ

Facility

$313.65

Hospital Charge Code	270624010
Hospital Revenue Code	278
Min. Negotiated Rate	$47.05
Max. Negotiated Rate	$156.82
Rate for Payer: Aetna Commercial	$94.09
Rate for Payer: Aetna Medicare Advantage	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.98
Rate for Payer: Cigna Commercial	$156.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.90
Rate for Payer: Qualcare PPO/HMO/WC	$47.05

GUIDEWIRE STQ MJ 300c 503456MY

Facility

$396.85

Hospital Charge Code	270624401
Hospital Revenue Code	278
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$96.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.04
Rate for Payer: Qualcare PPO/HMO/WC	$59.53

GUIDEWIRE STQ MJ 300c 503456MY

Facility

$396.85

Hospital Charge Code	270624401
Hospital Revenue Code	278
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$198.43
Rate for Payer: Aetna Commercial	$119.06
Rate for Payer: Aetna Medicare Advantage	$119.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.20
Rate for Payer: Cigna Commercial	$198.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.04
Rate for Payer: Qualcare PPO/HMO/WC	$59.53

GUIDEWIRE STR .035 5FR 150C

Facility

$155.00

Hospital Charge Code	270667806
Hospital Revenue Code	278
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$46.50
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

GUIDEWIRE STR .035 5FR 150C

Facility

$155.00

Hospital Charge Code	270667806
Hospital Revenue Code	278
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

GUIDEWIRE STRAIGHT .038/180CM

Facility

$255.00

Hospital Charge Code	270651267
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$76.50
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

GUIDEWIRE STRAIGHT .038/180CM

Facility

$255.00

Hospital Charge Code	270651267
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

GUIDE WIRE STRAIGHT TIP

Facility

$116.00

Hospital Charge Code	270331521
Hospital Revenue Code	278
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$28.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.07
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

GUIDE WIRE STRAIGHT TIP

Facility

$116.00

Hospital Charge Code	270331521
Hospital Revenue Code	278
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$58.00
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.58
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.07
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

Know your out-of-pocket cost for care.

All Charges