Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Service Code	HCPCS C1769
Hospital Charge Code	270650770
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

GUIDE WIRE AMPLATZ 0.38

Facility

$160.00

Service Code	HCPCS C1769
Hospital Charge Code	270650770
Hospital Revenue Code	278
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

GUIDEWIRE AMPLATZ SS .035/260

Facility

$116.25

Hospital Charge Code	270633268
Hospital Revenue Code	272
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$17.44
Rate for Payer: Qualcare PPO/HMO/WC	$17.44

GUIDEWIRE AMPLATZ SS .035/260

Facility

$116.25

Hospital Charge Code	270633268
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$58.12
Rate for Payer: Aetna Commercial	$44.17
Rate for Payer: Aetna Medicare Advantage	$34.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.64
Rate for Payer: Cigna Commercial	$58.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.23
Rate for Payer: Oxford Commercial	$23.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.44
Rate for Payer: UnitedHealthcare Commercial	$23.25
Rate for Payer: UnitedHealthcare Community & State	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$3.30

GUIDE WIRE AMPLATZ TORQUE

Facility

$67.50

Service Code	HCPCS C1769
Hospital Charge Code	270655395N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.12

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395S
Hospital Revenue Code	278
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
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) NJ Health	$27.00
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	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.83

GUIDE WIRE AMPLATZ TORQUE

Facility

$67.50

Service Code	HCPCS C1769
Hospital Charge Code	270655395N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna Commercial	$25.65
Rate for Payer: Aetna Medicare Advantage	$20.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.21
Rate for Payer: Cigna Commercial	$33.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Qualcare PPO/HMO/WC	$10.12
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395
Hospital Revenue Code	278
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
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) NJ Health	$27.00
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	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.83

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395S
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

GUIDE WIRE AMPLATZ TORQUE

Facility

$135.00

Service Code	HCPCS C1769
Hospital Charge Code	270655395
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$135.85

Service Code	HCPCS C1769
Hospital Charge Code	270656080
Hospital Revenue Code	278
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$67.92
Rate for Payer: Aetna Commercial	$51.62
Rate for Payer: Aetna Medicare Advantage	$40.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.64
Rate for Payer: Cigna Commercial	$67.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.88
Rate for Payer: Qualcare PPO/HMO/WC	$20.38
Rate for Payer: UnitedHealthcare Community & State	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270601254
Hospital Revenue Code	278
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$135.85

Service Code	HCPCS C1769
Hospital Charge Code	270656080
Hospital Revenue Code	278
Min. Negotiated Rate	$20.38
Max. Negotiated Rate	$32.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.88
Rate for Payer: Qualcare PPO/HMO/WC	$20.38

GUIDEWIRE AMPTLZ STIFF .038 1

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270601254
Hospital Revenue Code	278
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$6.11

GUIDEWIRE ANGLE .035 5FR 15

Facility

$155.00

Hospital Charge Code	270655080
Hospital Revenue Code	278
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$58.90
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Community & State	$4.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

GUIDEWIRE ANGLE .035 5FR 15

Facility

$155.00

Hospital Charge Code	270655080
Hospital Revenue Code	278
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

GUIDEWIRE ANGLED .035X 120CM

Facility

$422.00

Hospital Charge Code	270331884
Hospital Revenue Code	278
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$102.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.12
Rate for Payer: Qualcare PPO/HMO/WC	$63.30

GUIDEWIRE ANGLED .035X 120CM

Facility

$422.00

Hospital Charge Code	270331884
Hospital Revenue Code	278
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$211.00
Rate for Payer: Aetna Commercial	$160.36
Rate for Payer: Aetna Medicare Advantage	$126.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.61
Rate for Payer: Cigna Commercial	$211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.12
Rate for Payer: Qualcare PPO/HMO/WC	$63.30
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11.98

GUIDEWIRE ANGLED .035 X 150CM

Facility

$422.00

Hospital Charge Code	270332352
Hospital Revenue Code	278
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$102.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.12
Rate for Payer: Qualcare PPO/HMO/WC	$63.30

GUIDEWIRE ANGLED .035 X 150CM

Facility

$422.00

Hospital Charge Code	270332352
Hospital Revenue Code	278
Min. Negotiated Rate	$11.98
Max. Negotiated Rate	$211.00
Rate for Payer: Aetna Commercial	$160.36
Rate for Payer: Aetna Medicare Advantage	$126.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.61
Rate for Payer: Cigna Commercial	$211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.12
Rate for Payer: Qualcare PPO/HMO/WC	$63.30
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11.98

GUIDEWIRE APPROACH 25G.014x300

Facility

$765.00

Service Code	HCPCS C1769
Hospital Charge Code	270677086
Hospital Revenue Code	278
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$185.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.13
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

GUIDEWIRE APPROACH 25G.014x300

Facility

$765.00

Service Code	HCPCS C1769
Hospital Charge Code	270677086N
Hospital Revenue Code	278
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$185.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.13
Rate for Payer: Qualcare PPO/HMO/WC	$114.75

GUIDEWIRE APPROACH 25G.014x300

Facility

$765.00

Service Code	HCPCS C1769
Hospital Charge Code	270677086
Hospital Revenue Code	278
Min. Negotiated Rate	$21.73
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.13
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Community & State	$24.17
Rate for Payer: Wellpoint Medicaid Managed Care	$21.73

GUIDEWIRE APPROACH 25G.014x300

Facility

$765.00

Service Code	HCPCS C1769
Hospital Charge Code	270677086N
Hospital Revenue Code	278
Min. Negotiated Rate	$21.73
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$290.70
Rate for Payer: Aetna Medicare Advantage	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.07
Rate for Payer: Cigna Commercial	$382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.13
Rate for Payer: Qualcare PPO/HMO/WC	$114.75
Rate for Payer: UnitedHealthcare Community & State	$24.17
Rate for Payer: Wellpoint Medicaid Managed Care	$21.73

GUIDEWIRE ARIST14SFTEXCH300CM

Facility

$2,775.00

Service Code	HCPCS C1769
Hospital Charge Code	270694238S
Hospital Revenue Code	278
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$1,387.50
Rate for Payer: Aetna Commercial	$1,054.50
Rate for Payer: Aetna Medicare Advantage	$832.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$707.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$707.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$707.62
Rate for Payer: Cigna Commercial	$1,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.55
Rate for Payer: Qualcare PPO/HMO/WC	$416.25
Rate for Payer: UnitedHealthcare Community & State	$87.69
Rate for Payer: Wellpoint Medicaid Managed Care	$78.81

Know your out-of-pocket cost for care.

All Charges