Heights University Hospital

All Charges

Charge

Type

Setting

Price

GWIRE NIT PLAT 18X40 MAK001N40

Facility

$137.00

Service Code	HCPCS C1769
Hospital Charge Code	270660311N
Hospital Revenue Code	278
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$68.50
Rate for Payer: Aetna Commercial	$41.10
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

GWIRE NIT PLAT 18X40 MAK001N40

Facility

$113.25

Service Code	HCPCS C1769
Hospital Charge Code	270660311
Hospital Revenue Code	278
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.41
Rate for Payer: Qualcare PPO/HMO/WC	$16.99

GWIRE NIT PLAT 18X40 MAK001N40

Facility

$113.25

Service Code	HCPCS C1769
Hospital Charge Code	270660311
Hospital Revenue Code	278
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$56.62
Rate for Payer: Aetna Commercial	$33.98
Rate for Payer: Aetna Medicare Advantage	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.88
Rate for Payer: Cigna Commercial	$56.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.41
Rate for Payer: Qualcare PPO/HMO/WC	$16.99

GWIRE NIT PLAT 18X40 MAK001N40

Facility

$113.25

Service Code	HCPCS C1769
Hospital Charge Code	270660311S
Hospital Revenue Code	278
Min. Negotiated Rate	$16.99
Max. Negotiated Rate	$56.62
Rate for Payer: Aetna Commercial	$33.98
Rate for Payer: Aetna Medicare Advantage	$33.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.88
Rate for Payer: Cigna Commercial	$56.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.41
Rate for Payer: Qualcare PPO/HMO/WC	$16.99

GWIRE NIT PLAT 18X40 MAK001N40

Facility

$137.00

Service Code	HCPCS C1769
Hospital Charge Code	270660311N
Hospital Revenue Code	278
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

GWIRE PROWTR 180CM 1277601

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270636741
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

GWIRE PROWTR 180CM 1277601

Facility

$2,108.00

Service Code	HCPCS C1769
Hospital Charge Code	270636741N
Hospital Revenue Code	278
Min. Negotiated Rate	$316.20
Max. Negotiated Rate	$510.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$421.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.14
Rate for Payer: Qualcare PPO/HMO/WC	$316.20

GWIRE PROWTR 180CM 1277601

Facility

$2,108.00

Service Code	HCPCS C1769
Hospital Charge Code	270636741N
Hospital Revenue Code	278
Min. Negotiated Rate	$316.20
Max. Negotiated Rate	$1,054.00
Rate for Payer: Aetna Commercial	$632.40
Rate for Payer: Aetna Medicare Advantage	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$537.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$537.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$421.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$537.54
Rate for Payer: Cigna Commercial	$1,054.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.14
Rate for Payer: Qualcare PPO/HMO/WC	$316.20

GWIRE PROWTR 180CM 1277601

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270636741
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

G WIRE TIP THD .062X 9.25 MM

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	270691073
Hospital Revenue Code	278
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

G WIRE TIP THD .062X 9.25 MM

Facility

$150.00

Service Code	HCPCS C1769
Hospital Charge Code	270691073
Hospital Revenue Code	278
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$45.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

GWIRE TROC TP 18 IN

Facility

$437.50

Hospital Charge Code	270703007
Hospital Revenue Code	278
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$105.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.88
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

GWIRE TROC TP 18 IN

Facility

$437.50

Hospital Charge Code	270703007
Hospital Revenue Code	278
Min. Negotiated Rate	$65.62
Max. Negotiated Rate	$218.75
Rate for Payer: Aetna Commercial	$131.25
Rate for Payer: Aetna Medicare Advantage	$131.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.56
Rate for Payer: Cigna Commercial	$218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.88
Rate for Payer: Qualcare PPO/HMO/WC	$65.62

GWIRE VIPERWIRE .014DIA 335CM

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270693012
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GWIRE VIPERWIRE .014DIA 335CM

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270693012
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$225.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

G-WIRE W/TRCR TIP.NON THD

Facility

$110.00

Service Code	HCPCS C1769
Hospital Charge Code	270685924
Hospital Revenue Code	278
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$33.00
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

G-WIRE W/TRCR TIP.NON THD

Facility

$110.00

Service Code	HCPCS C1769
Hospital Charge Code	270685924
Hospital Revenue Code	278
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

GW WHISPER .014 190 1005357H

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638396C
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

GW WHISPER .014 190 1005357H

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638396C
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

GYNE-LOTRIMIN/100MG/TAB

Facility

$56.00

Hospital Charge Code	60633061
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$16.80
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.28
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$28.00

GYNE-LOTRIMIN/100MG/TAB

Facility

$56.00

Hospital Charge Code	60633061
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

GYNE-LOTRIMIN 1%/45GM

Facility

$15.00

Hospital Charge Code	60633062
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

GYNE-LOTRIMIN 1%/45GM

Facility

$15.00

Hospital Charge Code	60633062
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.50
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$7.50

H470080A VASCULAR GRAFT

Facility

$10,750.00

Service Code	HCPCS C1768
Hospital Charge Code	270656770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

H470080A VASCULAR GRAFT

Facility

$10,750.00

Service Code	HCPCS C1768
Hospital Charge Code	270656770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$3,225.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

Know your out-of-pocket cost for care.

All Charges