Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE ARIST14SFTEXCH300CM

Facility

$2,775.00

Service Code	HCPCS C1769
Hospital Charge Code	270694238S
Hospital Revenue Code	278
Min. Negotiated Rate	$416.25
Max. Negotiated Rate	$671.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.55
Rate for Payer: Qualcare PPO/HMO/WC	$416.25

GUIDEWIRE ARIST14STDEXCH300CM

Facility

$2,775.00

Service Code	HCPCS C1769
Hospital Charge Code	270694239S
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

GUIDEWIRE ARIST14STDEXCH300CM

Facility

$2,775.00

Service Code	HCPCS C1769
Hospital Charge Code	270694239S
Hospital Revenue Code	278
Min. Negotiated Rate	$416.25
Max. Negotiated Rate	$671.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$671.55
Rate for Payer: Qualcare PPO/HMO/WC	$416.25

GUIDEWIRE ARISTOT 14 SFT 200CM

Facility

$2,625.00

Service Code	HCPCS C1769
Hospital Charge Code	270694054S
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

GUIDEWIRE ARISTOT 14 SFT 200CM

Facility

$2,625.00

Service Code	HCPCS C1769
Hospital Charge Code	270694054S
Hospital Revenue Code	278
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

GUIDEWIRE ARISTOT 14 STD 200CM

Facility

$2,625.00

Service Code	HCPCS C1769
Hospital Charge Code	270694237S
Hospital Revenue Code	278
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

GUIDEWIRE ARISTOT 14 STD 200CM

Facility

$2,625.00

Service Code	HCPCS C1769
Hospital Charge Code	270694237S
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

GUIDEWIRE ARISTOT 18 SFT 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694240S
Hospital Revenue Code	278
Min. Negotiated Rate	$98.69
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$109.81
Rate for Payer: Wellpoint Medicaid Managed Care	$98.69

GUIDEWIRE ARISTOT 18 SFT 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694240S
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

GUIDEWIRE ARISTOT 18 STD 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694241S
Hospital Revenue Code	278
Min. Negotiated Rate	$98.69
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$109.81
Rate for Payer: Wellpoint Medicaid Managed Care	$98.69

GUIDEWIRE ARISTOT 18 STD 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694241S
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

GUIDEWIRE ARISTOT 18 SUP 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694242S
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

GUIDEWIRE ARISTOT 18 SUP 200CM

Facility

$3,475.00

Service Code	HCPCS C1769
Hospital Charge Code	270694242S
Hospital Revenue Code	278
Min. Negotiated Rate	$98.69
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$109.81
Rate for Payer: Wellpoint Medicaid Managed Care	$98.69

GUIDEWIRE ARISTOT 24 SFT 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694243S
Hospital Revenue Code	278
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

GUIDEWIRE ARISTOT 24 SFT 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694243S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ARISTOT 24 STD 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694245S
Hospital Revenue Code	278
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

GUIDEWIRE ARISTOT 24 STD 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694245S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ARISTOT 24 SUP 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694244S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GUIDEWIRE ARISTOT 24 SUP 200CM

Facility

$3,975.00

Service Code	HCPCS C1769
Hospital Charge Code	270694244S
Hospital Revenue Code	278
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

GUIDEWIRE ASAHI CHIKAI 200CM

Facility

$2,745.00

Service Code	HCPCS C1769
Hospital Charge Code	270694474S
Hospital Revenue Code	278
Min. Negotiated Rate	$77.96
Max. Negotiated Rate	$1,372.50
Rate for Payer: Aetna Commercial	$1,043.10
Rate for Payer: Aetna Medicare Advantage	$823.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.98
Rate for Payer: Cigna Commercial	$1,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.29
Rate for Payer: Qualcare PPO/HMO/WC	$411.75
Rate for Payer: UnitedHealthcare Community & State	$86.74
Rate for Payer: Wellpoint Medicaid Managed Care	$77.96

GUIDEWIRE ASAHI CHIKAI 200CM

Facility

$2,745.00

Service Code	HCPCS C1769
Hospital Charge Code	270694474S
Hospital Revenue Code	278
Min. Negotiated Rate	$411.75
Max. Negotiated Rate	$664.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$664.29
Rate for Payer: Qualcare PPO/HMO/WC	$411.75

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270636225N
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270636225C
Hospital Revenue Code	278
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270636225C
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

GUIDEWIRE ASAHI CONFIANZA 300

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270636225N
Hospital Revenue Code	278
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

Know your out-of-pocket cost for care.

All Charges