Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719S
Hospital Revenue Code	278
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Community & State	$3.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719S
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719C
Hospital Revenue Code	278
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Community & State	$3.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

GUIDEWIRE ASAHI GRANDSLAM 180J

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270644719C
Hospital Revenue Code	278
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$27.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.83
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

GUIDEWIRE ASAHI GRNDSLM 300

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512S
Hospital Revenue Code	278
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) NJ Health	$75.00
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	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

GUIDEWIRE ASAHI GRNDSLM 300

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512S
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE ASAHI PTCA MICRACLIB

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270651834
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 PTCA MICRACLIB

Facility

$675.00

Service Code	HCPCS C1769
Hospital Charge Code	270651834
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 ASHAI ASTATO 30

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

GUIDEWIRE ASHAI ASTATO 30

Facility

$800.00

Service Code	HCPCS C1769
Hospital Charge Code	270643116
Hospital Revenue Code	278
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: Wellpoint Medicaid Managed Care	$22.72

GUIDEWIRE ASHAI TREASURE 12

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270643115C
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

GUIDEWIRE ASHAI TREASURE 12

Facility

$750.00

Service Code	HCPCS C1769
Hospital Charge Code	270643115C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GUIDEWIRE ASHI GSL 300 1494001

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512
Hospital Revenue Code	278
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) NJ Health	$75.00
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	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

GUIDEWIRE ASHI GSL 300 1494001

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638512
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$414.80

Service Code	HCPCS C1769
Hospital Charge Code	270637325N
Hospital Revenue Code	278
Min. Negotiated Rate	$62.22
Max. Negotiated Rate	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.38
Rate for Payer: Qualcare PPO/HMO/WC	$62.22

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$414.80

Service Code	HCPCS C1769
Hospital Charge Code	270637325N
Hospital Revenue Code	278
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$207.40
Rate for Payer: Aetna Commercial	$157.62
Rate for Payer: Aetna Medicare Advantage	$124.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.77
Rate for Payer: Cigna Commercial	$207.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.38
Rate for Payer: Qualcare PPO/HMO/WC	$62.22
Rate for Payer: UnitedHealthcare Community & State	$13.11
Rate for Payer: Wellpoint Medicaid Managed Care	$11.78

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$362.75

Service Code	HCPCS C1769
Hospital Charge Code	270637325
Hospital Revenue Code	278
Min. Negotiated Rate	$54.41
Max. Negotiated Rate	$87.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.79
Rate for Payer: Qualcare PPO/HMO/WC	$54.41

GUIDEWIRE ATW FLOPPY J 300CM

Facility

$362.75

Service Code	HCPCS C1769
Hospital Charge Code	270637325
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$181.38
Rate for Payer: Aetna Commercial	$137.84
Rate for Payer: Aetna Medicare Advantage	$108.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.50
Rate for Payer: Cigna Commercial	$181.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.79
Rate for Payer: Qualcare PPO/HMO/WC	$54.41
Rate for Payer: UnitedHealthcare Community & State	$11.46
Rate for Payer: Wellpoint Medicaid Managed Care	$10.30

GUIDEWIRE BALL NOSE3.0MMX100CM

Facility

$528.70

Service Code	HCPCS C1713
Hospital Charge Code	270673675
Hospital Revenue Code	278
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$264.35
Rate for Payer: Aetna Commercial	$200.91
Rate for Payer: Aetna Medicare Advantage	$158.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.82
Rate for Payer: Cigna Commercial	$264.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.95
Rate for Payer: Qualcare PPO/HMO/WC	$79.31
Rate for Payer: UnitedHealthcare Community & State	$16.71
Rate for Payer: Wellpoint Medicaid Managed Care	$15.02

GUIDEWIRE BALL NOSE3.0MMX100CM

Facility

$528.70

Service Code	HCPCS C1713
Hospital Charge Code	270673675
Hospital Revenue Code	278
Min. Negotiated Rate	$79.31
Max. Negotiated Rate	$127.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.95
Rate for Payer: Qualcare PPO/HMO/WC	$79.31

GUIDEWIRE BALL NOSE 3.0MMX80CM

Facility

$747.50

Service Code	HCPCS C1713
Hospital Charge Code	270695828
Hospital Revenue Code	278
Min. Negotiated Rate	$112.12
Max. Negotiated Rate	$180.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.90
Rate for Payer: Qualcare PPO/HMO/WC	$112.12

GUIDEWIRE BALL NOSE 3.0MMX80CM

Facility

$747.50

Service Code	HCPCS C1713
Hospital Charge Code	270695828
Hospital Revenue Code	278
Min. Negotiated Rate	$21.23
Max. Negotiated Rate	$373.75
Rate for Payer: Aetna Commercial	$284.05
Rate for Payer: Aetna Medicare Advantage	$224.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$190.61
Rate for Payer: Cigna Commercial	$373.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.90
Rate for Payer: Qualcare PPO/HMO/WC	$112.12
Rate for Payer: UnitedHealthcare Community & State	$23.62
Rate for Payer: Wellpoint Medicaid Managed Care	$21.23

GUIDE WIRE BALL TIP 03x1000mm

Facility

$1,084.45

Service Code	HCPCS C1769
Hospital Charge Code	270645790
Hospital Revenue Code	278
Min. Negotiated Rate	$162.67
Max. Negotiated Rate	$262.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.44
Rate for Payer: Qualcare PPO/HMO/WC	$162.67

GUIDE WIRE BALL TIP 03x1000mm

Facility

$1,084.45

Service Code	HCPCS C1769
Hospital Charge Code	270645790
Hospital Revenue Code	278
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$542.23
Rate for Payer: Aetna Commercial	$412.09
Rate for Payer: Aetna Medicare Advantage	$325.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.53
Rate for Payer: Cigna Commercial	$542.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.44
Rate for Payer: Qualcare PPO/HMO/WC	$162.67
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: Wellpoint Medicaid Managed Care	$30.80

GUIDE WIRE BALL TIPPED

Facility

$2,297.75

Hospital Charge Code	270661241
Hospital Revenue Code	278
Min. Negotiated Rate	$65.26
Max. Negotiated Rate	$1,148.88
Rate for Payer: Aetna Commercial	$873.14
Rate for Payer: Aetna Medicare Advantage	$689.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.93
Rate for Payer: Cigna Commercial	$1,148.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.06
Rate for Payer: Qualcare PPO/HMO/WC	$344.66
Rate for Payer: UnitedHealthcare Community & State	$72.61
Rate for Payer: Wellpoint Medicaid Managed Care	$65.26

Know your out-of-pocket cost for care.

All Charges