Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE 2X200mm

Facility

$700.00

Service Code	HCPCS C1769
Hospital Charge Code	270681218
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

GUIDE WIRE 3.2

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270687656
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

GUIDE WIRE 3.2

Facility

$1,250.00

Service Code	HCPCS C1769
Hospital Charge Code	270687656
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

GUIDE WIRE 3.2MM

Facility

$578.45

Hospital Charge Code	270659946
Hospital Revenue Code	278
Min. Negotiated Rate	$86.77
Max. Negotiated Rate	$139.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.77

GUIDE WIRE 3.2MM

Facility

$578.45

Hospital Charge Code	270659946
Hospital Revenue Code	278
Min. Negotiated Rate	$16.43
Max. Negotiated Rate	$289.23
Rate for Payer: Aetna Commercial	$219.81
Rate for Payer: Aetna Medicare Advantage	$173.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.50
Rate for Payer: Cigna Commercial	$289.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.77
Rate for Payer: UnitedHealthcare Community & State	$18.28
Rate for Payer: Wellpoint Medicaid Managed Care	$16.43

GUIDEWIRE 3.2MM

Facility

$1,031.25

Service Code	HCPCS C1769
Hospital Charge Code	270696027
Hospital Revenue Code	278
Min. Negotiated Rate	$29.29
Max. Negotiated Rate	$515.62
Rate for Payer: Aetna Commercial	$391.88
Rate for Payer: Aetna Medicare Advantage	$309.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.97
Rate for Payer: Cigna Commercial	$515.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.56
Rate for Payer: Qualcare PPO/HMO/WC	$154.69
Rate for Payer: UnitedHealthcare Community & State	$32.59
Rate for Payer: Wellpoint Medicaid Managed Care	$29.29

GUIDEWIRE 3.2MM

Facility

$1,031.25

Service Code	HCPCS C1769
Hospital Charge Code	270696027
Hospital Revenue Code	278
Min. Negotiated Rate	$154.69
Max. Negotiated Rate	$249.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.56
Rate for Payer: Qualcare PPO/HMO/WC	$154.69

GUIDE WIRE 3.2mm X290MM

Facility

$413.75

Service Code	HCPCS C1769
Hospital Charge Code	270675117
Hospital Revenue Code	278
Min. Negotiated Rate	$11.75
Max. Negotiated Rate	$206.88
Rate for Payer: Aetna Commercial	$157.22
Rate for Payer: Aetna Medicare Advantage	$124.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.51
Rate for Payer: Cigna Commercial	$206.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.06
Rate for Payer: UnitedHealthcare Community & State	$13.07
Rate for Payer: Wellpoint Medicaid Managed Care	$11.75

GUIDE WIRE 3.2mm X290MM

Facility

$413.75

Service Code	HCPCS C1769
Hospital Charge Code	270675117
Hospital Revenue Code	278
Min. Negotiated Rate	$62.06
Max. Negotiated Rate	$100.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.13
Rate for Payer: Qualcare PPO/HMO/WC	$62.06

GUIDE WIRE 3.2X230MM SINGLE

Facility

$190.00

Service Code	HCPCS C1769
Hospital Charge Code	270662003
Hospital Revenue Code	278
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$72.20
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Community & State	$6.00
Rate for Payer: Wellpoint Medicaid Managed Care	$5.40

GUIDE WIRE 3.2X230MM SINGLE

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	270673600
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

GUIDE WIRE 3.2X230MM SINGLE

Facility

$190.00

Service Code	HCPCS C1769
Hospital Charge Code	270662003
Hospital Revenue Code	278
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$45.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

GUIDE WIRE 3.2X230MM SINGLE

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	270673600
Hospital Revenue Code	278
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
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) NJ Health	$40.00
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	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Community & State	$6.32
Rate for Payer: Wellpoint Medicaid Managed Care	$5.68

GUIDEWIRE 3.2x400MM

Facility

$1,270.00

Service Code	HCPCS C1769
Hospital Charge Code	270633464
Hospital Revenue Code	278
Min. Negotiated Rate	$190.50
Max. Negotiated Rate	$307.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.34
Rate for Payer: Qualcare PPO/HMO/WC	$190.50

GUIDEWIRE 3.2x400MM

Facility

$578.45

Service Code	HCPCS C1769
Hospital Charge Code	270660158
Hospital Revenue Code	278
Min. Negotiated Rate	$86.77
Max. Negotiated Rate	$139.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.77

GUIDEWIRE 3.2x400MM

Facility

$1,270.00

Service Code	HCPCS C1769
Hospital Charge Code	270633464
Hospital Revenue Code	278
Min. Negotiated Rate	$36.07
Max. Negotiated Rate	$635.00
Rate for Payer: Aetna Commercial	$482.60
Rate for Payer: Aetna Medicare Advantage	$381.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$323.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$323.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$323.85
Rate for Payer: Cigna Commercial	$635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.34
Rate for Payer: Qualcare PPO/HMO/WC	$190.50
Rate for Payer: UnitedHealthcare Community & State	$40.13
Rate for Payer: Wellpoint Medicaid Managed Care	$36.07

GUIDEWIRE 3.2x400MM

Facility

$578.45

Service Code	HCPCS C1769
Hospital Charge Code	270660158
Hospital Revenue Code	278
Min. Negotiated Rate	$16.43
Max. Negotiated Rate	$289.23
Rate for Payer: Aetna Commercial	$219.81
Rate for Payer: Aetna Medicare Advantage	$173.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.50
Rate for Payer: Cigna Commercial	$289.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.98
Rate for Payer: Qualcare PPO/HMO/WC	$86.77
Rate for Payer: UnitedHealthcare Community & State	$18.28
Rate for Payer: Wellpoint Medicaid Managed Care	$16.43

GUIDE WIRE 3.2X400MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693266
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

GUIDE WIRE 3.2X400MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693266
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

GUIDE WIRE 3x800 1806-0080S

Facility

$935.00

Hospital Charge Code	270638646
Hospital Revenue Code	272
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.10
Rate for Payer: Oxford Commercial	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Commercial	$187.00
Rate for Payer: UnitedHealthcare Community & State	$29.55
Rate for Payer: Wellpoint Medicaid Managed Care	$26.55

GUIDE WIRE 3x800 1806-0080S

Facility

$935.00

Hospital Charge Code	270638646
Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$140.25
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

GUIDEWIRE .86MM LASER LINE

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270689954
Hospital Revenue Code	278
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

GUIDEWIRE .86MM LASER LINE

Facility

$75.00

Service Code	HCPCS C1713
Hospital Charge Code	270689954
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GUIDEWIRE .86MM W/LASER LINE

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270662158
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

GUIDEWIRE .86MM W/LASER LINE

Facility

$75.00

Service Code	HCPCS C1769
Hospital Charge Code	270662158
Hospital Revenue Code	278
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

Know your out-of-pocket cost for care.

All Charges