Heights University Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE ZEBRA EXCH .025****

Facility

$442.00

Hospital Charge Code	270600944
Hospital Revenue Code	272
Min. Negotiated Rate	$57.46
Max. Negotiated Rate	$221.00
Rate for Payer: Aetna Commercial	$132.60
Rate for Payer: Aetna Medicare Advantage	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.71
Rate for Payer: Cigna Commercial	$221.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.46
Rate for Payer: Oxford Commercial	$221.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.30
Rate for Payer: UnitedHealthcare Commercial	$221.00

GUIDEWR ASAHI 6X300CM 14938-01

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270636224
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

GUIDEWR ASAHI 6X300CM 14938-01

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270636224
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

GUIDEWRE ASH AST 30 PAGH18M371

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116C
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

GUIDEWRE ASH AST 30 PAGH18M371

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116C
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

GUIDEWRE AZ 260 THSCF352603AES

Facility

$149.65

Hospital Charge Code	270624718
Hospital Revenue Code	278
Min. Negotiated Rate	$22.45
Max. Negotiated Rate	$36.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.22
Rate for Payer: Qualcare PPO/HMO/WC	$22.45

GUIDEWRE AZ 260 THSCF352603AES

Facility

$149.65

Hospital Charge Code	270624718
Hospital Revenue Code	278
Min. Negotiated Rate	$22.45
Max. Negotiated Rate	$74.83
Rate for Payer: Aetna Commercial	$44.90
Rate for Payer: Aetna Medicare Advantage	$44.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.16
Rate for Payer: Cigna Commercial	$74.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.22
Rate for Payer: Qualcare PPO/HMO/WC	$22.45

GUIDEWRE CHOICE PT 300 1215401

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270637189
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWRE CHOICE PT 300 1215401

Facility

$475.00

Service Code	HCPCS C1769
Hospital Charge Code	270637189N
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

GUIDEWRE CHOICE PT 300 1215401

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270637189
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$129.00
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDEWRE CHOICE PT 300 1215401

Facility

$475.00

Service Code	HCPCS C1769
Hospital Charge Code	270637189N
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

GUIDEWRE CR XT200 300 103313H

Facility

$775.00

Hospital Charge Code	270636704
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$232.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

GUIDEWRE CR XT200 300 103313H

Facility

$775.00

Hospital Charge Code	270636704
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

GUIDEWRE HBS 1.0x125mm 2635100

Facility

$225.00

Hospital Charge Code	270643921
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

GUIDEWRE HBS 1.0x125mm 2635100

Facility

$225.00

Hospital Charge Code	270643921
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$67.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

GUIDEWR STAR 035 150 3J 49182

Facility

$68.65

Hospital Charge Code	270626619V
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.61
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

GUIDEWR STAR 035 150 3J 49182

Facility

$68.65

Hospital Charge Code	270626619V
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$34.33
Rate for Payer: Aetna Commercial	$20.59
Rate for Payer: Aetna Medicare Advantage	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.51
Rate for Payer: Cigna Commercial	$34.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.61
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

GUIDEWR WHISP 014 300 1005359H

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638395C
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

GUIDEWR WHISP 014 300 1005359H

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638395C
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

GUIDWIRE THREDED 2.0x250 27590

Facility

$625.00

Hospital Charge Code	270639193
Hospital Revenue Code	272
Min. Negotiated Rate	$81.25
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$187.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.25
Rate for Payer: Oxford Commercial	$312.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$312.50

GUIDWIRE THREDED 2.0x250 27590

Facility

$625.00

Hospital Charge Code	270639193
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

GUIDWIRE - TRAPEASE 6FR 502521

Facility

$34.75

Hospital Charge Code	270629861
Hospital Revenue Code	278
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$17.38
Rate for Payer: Aetna Commercial	$10.43
Rate for Payer: Aetna Medicare Advantage	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.86
Rate for Payer: Cigna Commercial	$17.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.41
Rate for Payer: Qualcare PPO/HMO/WC	$5.21

GUIDWIRE - TRAPEASE 6FR 502521

Facility

$34.75

Hospital Charge Code	270629861
Hospital Revenue Code	278
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$8.41
Rate for Payer: Qualcare PPO/HMO/WC	$5.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.41

GUIDWIR NON THRD 2.0x250 27591

Facility

$690.00

Service Code	HCPCS C1769
Hospital Charge Code	270639194
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$166.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

GUIDWIR NON THRD 2.0x250 27591

Facility

$690.00

Service Code	HCPCS C1769
Hospital Charge Code	270639194
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna Commercial	$207.00
Rate for Payer: Aetna Medicare Advantage	$207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.95
Rate for Payer: Cigna Commercial	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

Know your out-of-pocket cost for care.

All Charges