Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE SYNCHRO 300CM

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270685070
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270685070
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270685070S
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM STAND

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270685071
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM STAND

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270685071S
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM STAND

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270685071
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,125.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRO 300CM STAND

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270685071S
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDEWIRE SYNCHRON 300CM

Facility

$3,562.50

Service Code	HCPCS C1769
Hospital Charge Code	270685071C
Hospital Revenue Code	278
Min. Negotiated Rate	$534.38
Max. Negotiated Rate	$862.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$862.12
Rate for Payer: Qualcare PPO/HMO/WC	$534.38

GUIDEWIRE SYNCHRON 300CM

Facility

$3,562.50

Service Code	HCPCS C1769
Hospital Charge Code	270685071C
Hospital Revenue Code	278
Min. Negotiated Rate	$534.38
Max. Negotiated Rate	$1,781.25
Rate for Payer: Aetna Commercial	$1,068.75
Rate for Payer: Aetna Medicare Advantage	$1,068.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$908.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$908.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$908.44
Rate for Payer: Cigna Commercial	$1,781.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$862.12
Rate for Payer: Qualcare PPO/HMO/WC	$534.38

GUIDE WIRE TEAR DROP 3.2X100CM

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270698024
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

GUIDE WIRE TEAR DROP 3.2X100CM

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270698024
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 TEARDROP 3MMX100CM

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	270698027
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 TEARDROP 3MMX100CM

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	270698027
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

GUIDE WIRE THD 1.25x150MM

Facility

$129.70

Service Code	HCPCS C1769
Hospital Charge Code	270642840
Hospital Revenue Code	278
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$64.85
Rate for Payer: Aetna Commercial	$38.91
Rate for Payer: Aetna Medicare Advantage	$38.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.07
Rate for Payer: Cigna Commercial	$64.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.39
Rate for Payer: Qualcare PPO/HMO/WC	$19.45

GUIDE WIRE THD 1.25x150MM

Facility

$129.70

Service Code	HCPCS C1769
Hospital Charge Code	270642840
Hospital Revenue Code	278
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$31.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.39
Rate for Payer: Qualcare PPO/HMO/WC	$19.45

GUIDE WIRE THD 1.4x150MM STER

Facility

$57.08

Hospital Charge Code	270665827
Hospital Revenue Code	278
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$28.54
Rate for Payer: Aetna Commercial	$17.12
Rate for Payer: Aetna Medicare Advantage	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.56
Rate for Payer: Cigna Commercial	$28.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.81
Rate for Payer: Qualcare PPO/HMO/WC	$8.56

GUIDE WIRE THD 1.4x150MM STER

Facility

$57.08

Hospital Charge Code	270665827
Hospital Revenue Code	278
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.81
Rate for Payer: Qualcare PPO/HMO/WC	$8.56

GUIDEWIRE THD 2.5x230mm

Facility

$205.50

Service Code	HCPCS C1769
Hospital Charge Code	270652340
Hospital Revenue Code	278
Min. Negotiated Rate	$30.82
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna Commercial	$61.65
Rate for Payer: Aetna Medicare Advantage	$61.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.40
Rate for Payer: Cigna Commercial	$102.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$30.82

GUIDEWIRE THD 2.5x230mm

Facility

$205.50

Service Code	HCPCS C1769
Hospital Charge Code	270652340
Hospital Revenue Code	278
Min. Negotiated Rate	$30.82
Max. Negotiated Rate	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$30.82

GUIDEWIRE THD W/TROCAR TIP

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270672351
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$39.00
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

GUIDEWIRE THD W/TROCAR TIP

Facility

$130.00

Service Code	HCPCS C1769
Hospital Charge Code	270672351
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

GUIDEWIRE THRD 1.4MMX150MM

Facility

$500.50

Service Code	HCPCS C1713
Hospital Charge Code	270697386
Hospital Revenue Code	278
Min. Negotiated Rate	$75.08
Max. Negotiated Rate	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.12
Rate for Payer: Qualcare PPO/HMO/WC	$75.08

GUIDEWIRE THRD 1.4MMX150MM

Facility

$500.50

Service Code	HCPCS C1713
Hospital Charge Code	270697386
Hospital Revenue Code	278
Min. Negotiated Rate	$75.08
Max. Negotiated Rate	$250.25
Rate for Payer: Aetna Commercial	$150.15
Rate for Payer: Aetna Medicare Advantage	$150.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.63
Rate for Payer: Cigna Commercial	$250.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.12
Rate for Payer: Qualcare PPO/HMO/WC	$75.08

GUIDEWIRE THRD 1.6MMX220MM

Facility

$544.50

Service Code	HCPCS C1713
Hospital Charge Code	270697382
Hospital Revenue Code	278
Min. Negotiated Rate	$81.67
Max. Negotiated Rate	$131.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.77
Rate for Payer: Qualcare PPO/HMO/WC	$81.67

GUIDEWIRE THRD 1.6MMX220MM

Facility

$544.50

Service Code	HCPCS C1713
Hospital Charge Code	270697382
Hospital Revenue Code	278
Min. Negotiated Rate	$81.67
Max. Negotiated Rate	$272.25
Rate for Payer: Aetna Commercial	$163.35
Rate for Payer: Aetna Medicare Advantage	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.85
Rate for Payer: Cigna Commercial	$272.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.77
Rate for Payer: Qualcare PPO/HMO/WC	$81.67

Know your out-of-pocket cost for care.

All Charges