Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GLIDEWIRE STIFF SHAFT

Facility

$242.25

Service Code	HCPCS C1769
Hospital Charge Code	270658279S
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 STR .038

Facility

$300.81

Service Code	HCPCS C1769
Hospital Charge Code	270601256
Hospital Revenue Code	278
Min. Negotiated Rate	$45.12
Max. Negotiated Rate	$72.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$45.12

GLIDEWIRE STR .038

Facility

$300.81

Service Code	HCPCS C1769
Hospital Charge Code	270601256
Hospital Revenue Code	278
Min. Negotiated Rate	$8.54
Max. Negotiated Rate	$150.41
Rate for Payer: Aetna Commercial	$114.31
Rate for Payer: Aetna Medicare Advantage	$90.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.71
Rate for Payer: Cigna Commercial	$150.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$45.12
Rate for Payer: UnitedHealthcare Community & State	$9.51
Rate for Payer: Wellpoint Medicaid Managed Care	$8.54

GLIDEWIRE STRAIGHT .038 X 150

Facility

$679.00

Hospital Charge Code	270331921
Hospital Revenue Code	278
Min. Negotiated Rate	$101.85
Max. Negotiated Rate	$164.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.32
Rate for Payer: Qualcare PPO/HMO/WC	$101.85

GLIDEWIRE STRAIGHT .038 X 150

Facility

$679.00

Hospital Charge Code	270331921
Hospital Revenue Code	278
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$339.50
Rate for Payer: Aetna Commercial	$258.02
Rate for Payer: Aetna Medicare Advantage	$203.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.15
Rate for Payer: Cigna Commercial	$339.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.32
Rate for Payer: Qualcare PPO/HMO/WC	$101.85
Rate for Payer: UnitedHealthcare Community & State	$21.46
Rate for Payer: Wellpoint Medicaid Managed Care	$19.28

GLIDEWR.035 180 ANGL GR3508

Facility

$205.75

Service Code	HCPCS C1769
Hospital Charge Code	270638087A
Hospital Revenue Code	278
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: Qualcare PPO/HMO/WC	$30.86

GLIDEWR.035 180 ANGL GR3508

Facility

$205.75

Service Code	HCPCS C1769
Hospital Charge Code	270638087A
Hospital Revenue Code	278
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$102.88
Rate for Payer: Aetna Commercial	$78.19
Rate for Payer: Aetna Medicare Advantage	$61.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.47
Rate for Payer: Cigna Commercial	$102.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: Qualcare PPO/HMO/WC	$30.86
Rate for Payer: UnitedHealthcare Community & State	$6.50
Rate for Payer: Wellpoint Medicaid Managed Care	$5.84

GLIDEWR.035 180 ANGL GR3508

Facility

$205.75

Service Code	HCPCS C1769
Hospital Charge Code	270638087C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.86
Max. Negotiated Rate	$49.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: Qualcare PPO/HMO/WC	$30.86

GLIDEWR.035 180 ANGL GR3508

Facility

$205.75

Service Code	HCPCS C1769
Hospital Charge Code	270638087C
Hospital Revenue Code	278
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$102.88
Rate for Payer: Aetna Commercial	$78.19
Rate for Payer: Aetna Medicare Advantage	$61.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.47
Rate for Payer: Cigna Commercial	$102.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.79
Rate for Payer: Qualcare PPO/HMO/WC	$30.86
Rate for Payer: UnitedHealthcare Community & State	$6.50
Rate for Payer: Wellpoint Medicaid Managed Care	$5.84

GLIDWIRE .035/450CM ANGELEDTIP

Facility

$186.00

Service Code	HCPCS C1769
Hospital Charge Code	270654318
Hospital Revenue Code	278
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

GLIDWIRE .035/450CM ANGELEDTIP

Facility

$186.00

Service Code	HCPCS C1769
Hospital Charge Code	270654318
Hospital Revenue Code	278
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.28

GLIDWIRE GD 70DEG 018 5 GM1814

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270637733A
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

GLIDWIRE GD 70DEG 018 5 GM1814

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270637733C
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

GLIDWIRE GD 70DEG 018 5 GM1814

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270637733C
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
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
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

GLIDWIRE GD 70DEG 018 5 GM1814

Facility

$625.00

Service Code	HCPCS C1769
Hospital Charge Code	270637733A
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
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
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

GLIMEPIRIDE 2 MG TAB

Facility

$13.00

Service Code	NDC 39022210
Hospital Charge Code	60629107
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

GLIMEPIRIDE 2 MG TAB

Facility

$13.00

Service Code	NDC 39022210
Hospital Charge Code	60629107
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

GLIMEPIRIDE 4 MG TAB

Facility

$8.24

Service Code	NDC 51079042620
Hospital Charge Code	60628622
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Oxford Commercial	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$1.65
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

GLIMEPIRIDE 4 MG TAB

Facility

$8.24

Service Code	NDC 51079042620
Hospital Charge Code	60628622
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

GLIPIZIDE 10 MG SR TAB

Facility

$5.43

Service Code	NDC 591084501
Hospital Charge Code	60628232
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.41
Rate for Payer: Oxford Commercial	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

GLIPIZIDE 10 MG SR TAB

Facility

$5.43

Service Code	NDC 591084501
Hospital Charge Code	60628232
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

GLIPIZIDE 10 MG TAB UD

Facility

$4.49

Service Code	NDC 60505014200
Hospital Charge Code	60629856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.14
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.67
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

GLIPIZIDE 10 MG TAB UD

Facility

$4.49

Service Code	NDC 60505014200
Hospital Charge Code	60629856
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.67

GLIPIZIDE 2.5 MG SR TAB

Facility

$7.77

Service Code	NDC 49017001
Hospital Charge Code	60628936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$2.95
Rate for Payer: Aetna Medicare Advantage	$2.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.98
Rate for Payer: Cigna Commercial	$3.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.02
Rate for Payer: Oxford Commercial	$1.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.17
Rate for Payer: UnitedHealthcare Commercial	$1.55
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

GLIPIZIDE 2.5 MG SR TAB

Facility

$7.77

Service Code	NDC 49017001
Hospital Charge Code	60628936
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$1.17

Know your out-of-pocket cost for care.

All Charges