Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GLIDESHEATH SLENDER 5F 80-1050

Facility

$325.00

Service Code	HCPCS C1894
Hospital Charge Code	270696640V
Hospital Revenue Code	278
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Community & State	$10.27
Rate for Payer: Wellpoint Medicaid Managed Care	$9.23

GLIDESHEATH SLENDER 5F 80-1050

Facility

$325.00

Service Code	HCPCS C1894
Hospital Charge Code	270696640V
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

GLIDE SHEATH SLENDER 5 FR

Facility

$240.00

Hospital Charge Code	270675359
Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

GLIDE SHEATH SLENDER 5 FR

Facility

$240.00

Hospital Charge Code	270675359
Hospital Revenue Code	272
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: UnitedHealthcare Community & State	$7.58
Rate for Payer: Wellpoint Medicaid Managed Care	$6.82

GLIDE SHEATH SLENDER 6FR x 10c

Facility

$531.25

Hospital Charge Code	270665133S
Hospital Revenue Code	270
Min. Negotiated Rate	$15.09
Max. Negotiated Rate	$265.62
Rate for Payer: Aetna Commercial	$201.88
Rate for Payer: Aetna Medicare Advantage	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.47
Rate for Payer: Cigna Commercial	$265.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.12
Rate for Payer: Oxford Commercial	$106.25
Rate for Payer: Qualcare PPO/HMO/WC	$79.69
Rate for Payer: UnitedHealthcare Commercial	$106.25
Rate for Payer: UnitedHealthcare Community & State	$16.79
Rate for Payer: Wellpoint Medicaid Managed Care	$15.09

GLIDE SHEATH SLENDER 6FR x 10c

Facility

$531.25

Hospital Charge Code	270665133S
Hospital Revenue Code	270
Min. Negotiated Rate	$79.69
Max. Negotiated Rate	$79.69
Rate for Payer: Qualcare PPO/HMO/WC	$79.69

GLIDE SHEATH SLENDER 6FR x 10c

Facility

$375.00

Hospital Charge Code	270665133N
Hospital Revenue Code	270
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GLIDE SHEATH SLENDER 6FR x 10c

Facility

$375.00

Hospital Charge Code	270665133N
Hospital Revenue Code	270
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
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) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

GLIDE SHEATH SLENDER 6FR x 10c

Facility

$531.25

Hospital Charge Code	270665133
Hospital Revenue Code	270
Min. Negotiated Rate	$15.09
Max. Negotiated Rate	$265.62
Rate for Payer: Aetna Commercial	$201.88
Rate for Payer: Aetna Medicare Advantage	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$135.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$135.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$135.47
Rate for Payer: Cigna Commercial	$265.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.12
Rate for Payer: Oxford Commercial	$106.25
Rate for Payer: Qualcare PPO/HMO/WC	$79.69
Rate for Payer: UnitedHealthcare Commercial	$106.25
Rate for Payer: UnitedHealthcare Community & State	$16.79
Rate for Payer: Wellpoint Medicaid Managed Care	$15.09

GLIDE SHEATH SLENDER 6FR x 10c

Facility

$531.25

Hospital Charge Code	270665133
Hospital Revenue Code	270
Min. Negotiated Rate	$79.69
Max. Negotiated Rate	$79.69
Rate for Payer: Qualcare PPO/HMO/WC	$79.69

Glidewire 0.035 180cm STIF ANG

Facility

$264.05

Service Code	HCPCS C1769
Hospital Charge Code	270638738N
Hospital Revenue Code	278
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$132.03
Rate for Payer: Aetna Commercial	$100.34
Rate for Payer: Aetna Medicare Advantage	$79.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.33
Rate for Payer: Cigna Commercial	$132.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.61
Rate for Payer: UnitedHealthcare Community & State	$8.34
Rate for Payer: Wellpoint Medicaid Managed Care	$7.50

Glidewire 0.035 180cm STIF ANG

Facility

$1,700.00

Hospital Charge Code	270638738
Hospital Revenue Code	279
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

Glidewire 0.035 180cm STIF ANG

Facility

$264.05

Service Code	HCPCS C1769
Hospital Charge Code	270638738N
Hospital Revenue Code	278
Min. Negotiated Rate	$39.61
Max. Negotiated Rate	$63.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.61

Glidewire 0.035 180cm STIF ANG

Facility

$1,700.00

Hospital Charge Code	270638738
Hospital Revenue Code	279
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$53.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48.28

GLIDEWIRE 0.035 180CM STIF ANG

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270638738S
Hospital Revenue Code	278
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: Qualcare PPO/HMO/WC	$36.34

GLIDEWIRE 0.035 180CM STIF ANG

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270638738S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$121.12
Rate for Payer: Aetna Commercial	$92.06
Rate for Payer: Aetna Medicare Advantage	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.77
Rate for Payer: Cigna Commercial	$121.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: Qualcare PPO/HMO/WC	$36.34
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.88

Glidewire 0.035 180cm STIF STR

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270658279
Hospital Revenue Code	278
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: Qualcare PPO/HMO/WC	$36.34

Glidewire 0.035 180cm STIF STR

Facility

$264.05

Service Code	HCPCS C1769
Hospital Charge Code	270658279N
Hospital Revenue Code	278
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$132.03
Rate for Payer: Aetna Commercial	$100.34
Rate for Payer: Aetna Medicare Advantage	$79.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.33
Rate for Payer: Cigna Commercial	$132.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.61
Rate for Payer: UnitedHealthcare Community & State	$8.34
Rate for Payer: Wellpoint Medicaid Managed Care	$7.50

Glidewire 0.035 180cm STIF STR

Facility

$264.05

Service Code	HCPCS C1769
Hospital Charge Code	270658279N
Hospital Revenue Code	278
Min. Negotiated Rate	$39.61
Max. Negotiated Rate	$63.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.61

Glidewire 0.035 180cm STIF STR

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270658279
Hospital Revenue Code	278
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$121.12
Rate for Payer: Aetna Commercial	$92.06
Rate for Payer: Aetna Medicare Advantage	$72.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.77
Rate for Payer: Cigna Commercial	$121.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.62
Rate for Payer: Qualcare PPO/HMO/WC	$36.34
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.88

Glidewire 0.035 180cm STN STR

Facility

$224.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275N
Hospital Revenue Code	278
Min. Negotiated Rate	$33.64
Max. Negotiated Rate	$54.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.27
Rate for Payer: Qualcare PPO/HMO/WC	$33.64

Glidewire 0.035 180cm STN STR

Facility

$258.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275
Hospital Revenue Code	278
Min. Negotiated Rate	$38.74
Max. Negotiated Rate	$62.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$38.74

Glidewire 0.035 180cm STN STR

Facility

$224.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$112.12
Rate for Payer: Aetna Commercial	$85.22
Rate for Payer: Aetna Medicare Advantage	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.18
Rate for Payer: Cigna Commercial	$112.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.27
Rate for Payer: Qualcare PPO/HMO/WC	$33.64
Rate for Payer: UnitedHealthcare Community & State	$7.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.37

Glidewire 0.035 180cm STN STR

Facility

$258.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275
Hospital Revenue Code	278
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$129.12
Rate for Payer: Aetna Commercial	$98.14
Rate for Payer: Aetna Medicare Advantage	$77.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.85
Rate for Payer: Cigna Commercial	$129.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$38.74
Rate for Payer: UnitedHealthcare Community & State	$8.16
Rate for Payer: Wellpoint Medicaid Managed Care	$7.33

GLIDEWIRE 0.035 180CM STN STR

Facility

$258.25

Service Code	HCPCS C1769
Hospital Charge Code	270658275S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$129.12
Rate for Payer: Aetna Commercial	$98.14
Rate for Payer: Aetna Medicare Advantage	$77.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.85
Rate for Payer: Cigna Commercial	$129.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.50
Rate for Payer: Qualcare PPO/HMO/WC	$38.74
Rate for Payer: UnitedHealthcare Community & State	$8.16
Rate for Payer: Wellpoint Medicaid Managed Care	$7.33

Know your out-of-pocket cost for care.

All Charges