Heights University Hospital

All Charges

Charge

Type

Setting

Price

WIRE ENTRY GUIDE 3.2X320MM

Facility

$800.00

Hospital Charge Code	270678876
Hospital Revenue Code	272
Min. Negotiated Rate	$104.00
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) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$400.00

WIRE EXT W OLIVE TIP 1.8X450MM

Facility

$652.70

Service Code	HCPCS C1713
Hospital Charge Code	270699598
Hospital Revenue Code	278
Min. Negotiated Rate	$97.91
Max. Negotiated Rate	$326.35
Rate for Payer: Aetna Commercial	$195.81
Rate for Payer: Aetna Medicare Advantage	$195.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.44
Rate for Payer: Cigna Commercial	$326.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$97.91

WIRE EXT W OLIVE TIP 1.8X450MM

Facility

$652.70

Service Code	HCPCS C1713
Hospital Charge Code	270699598
Hospital Revenue Code	278
Min. Negotiated Rate	$97.91
Max. Negotiated Rate	$157.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$97.91

WIRE EXT W OLIVE TIP 2.0X450MM

Facility

$674.05

Service Code	HCPCS C1713
Hospital Charge Code	270699599
Hospital Revenue Code	278
Min. Negotiated Rate	$101.11
Max. Negotiated Rate	$163.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.12
Rate for Payer: Qualcare PPO/HMO/WC	$101.11

WIRE EXT W OLIVE TIP 2.0X450MM

Facility

$674.05

Service Code	HCPCS C1713
Hospital Charge Code	270699599
Hospital Revenue Code	278
Min. Negotiated Rate	$101.11
Max. Negotiated Rate	$337.02
Rate for Payer: Aetna Commercial	$202.22
Rate for Payer: Aetna Medicare Advantage	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.88
Rate for Payer: Cigna Commercial	$337.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.12
Rate for Payer: Qualcare PPO/HMO/WC	$101.11

WIRE FIBER SIZE #2

Facility

$110.00

Hospital Charge Code	270624619
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

WIRE FIBER SIZE #2

Facility

$110.00

Hospital Charge Code	270624619
Hospital Revenue Code	272
Min. Negotiated Rate	$14.30
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) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.30
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$55.00

WIRE FIBER SIZE #5 AR7211

Facility

$200.00

Hospital Charge Code	270642317
Hospital Revenue Code	272
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$60.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$100.00

WIRE FIBER SIZE #5 AR7211

Facility

$200.00

Hospital Charge Code	270642317
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

WIRE FIBER SZ1

Facility

$105.00

Hospital Charge Code	270676891
Hospital Revenue Code	272
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$52.50

WIRE FIBER SZ1

Facility

$105.00

Hospital Charge Code	270676891
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

WIRE FILTER 190cm 19503-190

Facility

$6,423.25

Hospital Charge Code	270633492
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$1,554.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

WIRE FILTER 190cm 19503-190

Facility

$6,423.25

Hospital Charge Code	270633492
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$3,211.62
Rate for Payer: Aetna Commercial	$1,926.97
Rate for Payer: Aetna Medicare Advantage	$1,926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,637.93
Rate for Payer: Cigna Commercial	$3,211.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

WIRE FILTER EZ 190cc 20100190

Facility

$6,423.25

Hospital Charge Code	270633783
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$3,211.62
Rate for Payer: Aetna Commercial	$1,926.97
Rate for Payer: Aetna Medicare Advantage	$1,926.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,637.93
Rate for Payer: Cigna Commercial	$3,211.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

WIRE FILTER EZ 190cc 20100190

Facility

$6,423.25

Hospital Charge Code	270633783
Hospital Revenue Code	278
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$1,554.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,284.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.43
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

WIRE GLIDE MCV .38 ********

Facility

$673.00

Hospital Charge Code	1604560
Hospital Revenue Code	272
Min. Negotiated Rate	$87.49
Max. Negotiated Rate	$336.50
Rate for Payer: Aetna Commercial	$201.90
Rate for Payer: Aetna Medicare Advantage	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.62
Rate for Payer: Cigna Commercial	$336.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.49
Rate for Payer: Oxford Commercial	$336.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.95
Rate for Payer: UnitedHealthcare Commercial	$336.50

WIRE GLIDE MCV .38 ********

Facility

$673.00

Hospital Charge Code	1604560
Hospital Revenue Code	272
Min. Negotiated Rate	$100.95
Max. Negotiated Rate	$100.95
Rate for Payer: Qualcare PPO/HMO/WC	$100.95

WIREGUARD PAPILLOTON***

Facility

$942.00

Hospital Charge Code	2300564
Hospital Revenue Code	279
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$141.30
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

WIREGUARD PAPILLOTON***

Facility

$942.00

Hospital Charge Code	2300564
Hospital Revenue Code	279
Min. Negotiated Rate	$122.46
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$282.60
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.46
Rate for Payer: Oxford Commercial	$471.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Commercial	$471.00

WIRE GUIDE .018x60cm

Facility

$107.50

Service Code	HCPCS C1789
Hospital Charge Code	270653109
Hospital Revenue Code	278
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$32.25
Rate for Payer: Aetna Medicare Advantage	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.41
Rate for Payer: Cigna Commercial	$53.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.12

WIRE GUIDE .018x60cm

Facility

$107.50

Service Code	HCPCS C1789
Hospital Charge Code	270653109
Hospital Revenue Code	278
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.12

WIRE GUIDE .035 260CM EXCH STR

Facility

$405.50

Service Code	HCPCS C1769
Hospital Charge Code	270616498
Hospital Revenue Code	279
Min. Negotiated Rate	$52.72
Max. Negotiated Rate	$202.75
Rate for Payer: Aetna Commercial	$121.65
Rate for Payer: Aetna Medicare Advantage	$121.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.40
Rate for Payer: Cigna Commercial	$202.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.72
Rate for Payer: Oxford Commercial	$202.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.83
Rate for Payer: UnitedHealthcare Commercial	$202.75

WIRE GUIDE .035 260CM EXCH STR

Facility

$405.50

Service Code	HCPCS C1769
Hospital Charge Code	270616498
Hospital Revenue Code	279
Min. Negotiated Rate	$60.83
Max. Negotiated Rate	$60.83
Rate for Payer: Qualcare PPO/HMO/WC	$60.83

WIRE GUIDE .035 X 260CM

Facility

$135.00

Hospital Charge Code	270667764
Hospital Revenue Code	272
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.55
Rate for Payer: Oxford Commercial	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$67.50

WIRE GUIDE .035 X 260CM

Facility

$135.00

Hospital Charge Code	270667764
Hospital Revenue Code	272
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

Know your out-of-pocket cost for care.

All Charges