Heights University Hospital

All Charges

Charge

Type

Setting

Price

Wire Guides

Facility

$1,135.00

Service Code	HCPCS C1769
Hospital Charge Code	270685513
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$340.50
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

Wire Guides

Facility

$1,135.00

Service Code	HCPCS C1769
Hospital Charge Code	270685512
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

Wire Guides

Facility

$1,135.00

Service Code	HCPCS C1769
Hospital Charge Code	270685512
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$340.50
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

Wire Guides

Facility

$1,135.00

Service Code	HCPCS C1769
Hospital Charge Code	270685513
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

WIRE GUIDE TEF TSCM38 145.3***

Facility

$51.00

Hospital Charge Code	1604438
Hospital Revenue Code	272
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

WIRE GUIDE TEF TSCM38 145.3***

Facility

$51.00

Hospital Charge Code	1604438
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$15.30
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.63
Rate for Payer: Oxford Commercial	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$25.50

WIRE GUIDE THREADED 3.2x300MM

Facility

$1,020.00

Hospital Charge Code	270648949
Hospital Revenue Code	272
Min. Negotiated Rate	$132.60
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$306.00
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.60
Rate for Payer: Oxford Commercial	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Commercial	$510.00

WIRE GUIDE THREADED 3.2x300MM

Facility

$1,020.00

Hospital Charge Code	270648949
Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

WIRE G W/ DBL TRCR TIP .45

Facility

$145.00

Hospital Charge Code	270688769
Hospital Revenue Code	272
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

WIRE G W/ DBL TRCR TIP .45

Facility

$145.00

Hospital Charge Code	270688769
Hospital Revenue Code	272
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$43.50
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.85
Rate for Payer: Oxford Commercial	$72.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$72.50

WIRE HMD GUIDE 3 750 3371-1015

Facility

$1,104.85

Hospital Charge Code	270611707
Hospital Revenue Code	278
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$267.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

WIRE HMD GUIDE 3 750 3371-1015

Facility

$1,104.85

Hospital Charge Code	270611707
Hospital Revenue Code	278
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$331.45
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.37
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

WIRE HMD K .062 9 3813-3090

Facility

$54.45

Hospital Charge Code	270619736
Hospital Revenue Code	272
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$27.23
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.88
Rate for Payer: Cigna Commercial	$27.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.08
Rate for Payer: Oxford Commercial	$27.23
Rate for Payer: Qualcare PPO/HMO/WC	$8.17
Rate for Payer: UnitedHealthcare Commercial	$27.23

WIRE HMD K .062 9 3813-3090

Facility

$54.45

Hospital Charge Code	270619736
Hospital Revenue Code	272
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

WIRE HMD K 3.2 450MM 3371

Facility

$460.85

Hospital Charge Code	270611706
Hospital Revenue Code	278
Min. Negotiated Rate	$69.13
Max. Negotiated Rate	$230.43
Rate for Payer: Aetna Commercial	$138.25
Rate for Payer: Aetna Medicare Advantage	$138.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.52
Rate for Payer: Cigna Commercial	$230.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.53
Rate for Payer: Qualcare PPO/HMO/WC	$69.13

WIRE HMD K 3.2 450MM 3371

Facility

$460.85

Hospital Charge Code	270611706
Hospital Revenue Code	278
Min. Negotiated Rate	$69.13
Max. Negotiated Rate	$111.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.53
Rate for Payer: Qualcare PPO/HMO/WC	$69.13

WIRE INSERTION TOOL 25/BX

Facility

$21.50

Hospital Charge Code	2709002685
Hospital Revenue Code	272
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$10.75
Rate for Payer: Aetna Commercial	$6.45
Rate for Payer: Aetna Medicare Advantage	$6.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.48
Rate for Payer: Cigna Commercial	$10.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$10.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.23
Rate for Payer: UnitedHealthcare Commercial	$10.75

WIRE INSERTION TOOL 25/BX

Facility

$21.50

Hospital Charge Code	2709002685
Hospital Revenue Code	272
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$3.23
Rate for Payer: Qualcare PPO/HMO/WC	$3.23

WIRE JAGTAIL EXT .035 200 5690

Facility

$446.45

Hospital Charge Code	270627948
Hospital Revenue Code	278
Min. Negotiated Rate	$66.97
Max. Negotiated Rate	$108.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.97

WIRE JAGTAIL EXT .035 200 5690

Facility

$446.45

Hospital Charge Code	270627948
Hospital Revenue Code	278
Min. Negotiated Rate	$66.97
Max. Negotiated Rate	$223.22
Rate for Payer: Aetna Commercial	$133.94
Rate for Payer: Aetna Medicare Advantage	$133.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.84
Rate for Payer: Cigna Commercial	$223.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.04
Rate for Payer: Qualcare PPO/HMO/WC	$66.97

WIRE K .062 KW062

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270635657
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

WIRE K .062 KW062

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270635657
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$21.00
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

WIRE K 0.8

Facility

$250.00

Hospital Charge Code	270665992
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

WIRE K 0.8

Facility

$250.00

Hospital Charge Code	270665992
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$75.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$125.00

WIRE K 1.2

Facility

$250.00

Hospital Charge Code	270665993
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges