Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE V-18 8x200cm

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V-18 8x200cm

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V-18 8x200cm

Facility

$375.00

Hospital Charge Code	270638880C
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE V-18 8x200cm

Facility

$17,975.00

Hospital Charge Code	270641201C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,696.25
Max. Negotiated Rate	$8,987.50
Rate for Payer: Aetna Commercial	$5,392.50
Rate for Payer: Aetna Medicare Advantage	$5,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,583.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,583.62
Rate for Payer: Cigna Commercial	$8,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,349.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,696.25

GUIDEWIRE V-18 8X200CM

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048C
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V-18 8X200CM

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048N
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
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) NJ Health	$75.00
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	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE V-18 8X200CM

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048C
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V-18 8X200CM

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270628048N
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE V-18 8x300cm

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270623260
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V-18 8x300cm

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270623260
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V18 8X300CM

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270623260S
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE V18 8X300CM

Facility

$420.00

Service Code	HCPCS C1769
Hospital Charge Code	270623260S
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

GUIDEWIRE VASC .014IN 185CM

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270696459S
Hospital Revenue Code	278
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Commercial	$124.50
Rate for Payer: Aetna Medicare Advantage	$124.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.83
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

GUIDEWIRE VASC .014IN 185CM

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270696459S
Hospital Revenue Code	278
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$100.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

GUIDEWIRE VASC.038IN150CM1.5MM

Facility

$43.00

Service Code	HCPCS C1769
Hospital Charge Code	270646396
Hospital Revenue Code	272
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$12.90
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.59
Rate for Payer: Oxford Commercial	$21.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$21.50

GUIDEWIRE VASC.038IN150CM1.5MM

Facility

$43.00

Service Code	HCPCS C1769
Hospital Charge Code	270646396
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

GUIDEWIRE VERSACORE MOD J 145

Facility

$550.00

Hospital Charge Code	270644640C
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

GUIDEWIRE VERSACORE MOD J 145

Facility

$550.00

Hospital Charge Code	270644641C
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

GUIDEWIRE VERSACORE MOD J 145

Facility

$550.00

Hospital Charge Code	270644640C
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$165.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

GUIDEWIRE VERSACORE MOD J 145

Facility

$550.00

Hospital Charge Code	270644641C
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

GUIDEWIRE VERSACORE MOD J 300

Facility

$4,625.00

Hospital Charge Code	270643991C
Hospital Revenue Code	278
Min. Negotiated Rate	$693.75
Max. Negotiated Rate	$1,119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.25
Rate for Payer: Qualcare PPO/HMO/WC	$693.75

GUIDEWIRE VERSACORE MOD J 300

Facility

$4,625.00

Hospital Charge Code	270643991C
Hospital Revenue Code	278
Min. Negotiated Rate	$693.75
Max. Negotiated Rate	$2,312.50
Rate for Payer: Aetna Commercial	$1,387.50
Rate for Payer: Aetna Medicare Advantage	$1,387.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,179.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,179.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,179.38
Rate for Payer: Cigna Commercial	$2,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.25
Rate for Payer: Qualcare PPO/HMO/WC	$693.75

GUIDEWIRE VICTORY .014X300MM

Facility

$1,055.75

Service Code	HCPCS C1769
Hospital Charge Code	270670087
Hospital Revenue Code	278
Min. Negotiated Rate	$158.36
Max. Negotiated Rate	$255.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.49
Rate for Payer: Qualcare PPO/HMO/WC	$158.36

GUIDEWIRE VICTORY .014X300MM

Facility

$1,055.75

Service Code	HCPCS C1769
Hospital Charge Code	270670087
Hospital Revenue Code	278
Min. Negotiated Rate	$158.36
Max. Negotiated Rate	$527.88
Rate for Payer: Aetna Commercial	$316.73
Rate for Payer: Aetna Medicare Advantage	$316.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.22
Rate for Payer: Cigna Commercial	$527.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.49
Rate for Payer: Qualcare PPO/HMO/WC	$158.36

GUIDEWIRE VICTORY 18 300CM 30G

Facility

$1,004.25

Service Code	HCPCS C1769
Hospital Charge Code	270670165
Hospital Revenue Code	278
Min. Negotiated Rate	$150.64
Max. Negotiated Rate	$243.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.03
Rate for Payer: Qualcare PPO/HMO/WC	$150.64

Know your out-of-pocket cost for care.

All Charges