Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE IRONMAN 300C 1001311

Facility

$2,175.00

Service Code	HCPCS C1769
Hospital Charge Code	270636706
Hospital Revenue Code	278
Min. Negotiated Rate	$61.77
Max. Negotiated Rate	$1,087.50
Rate for Payer: Aetna Commercial	$826.50
Rate for Payer: Aetna Medicare Advantage	$652.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$554.62
Rate for Payer: Cigna Commercial	$1,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.35
Rate for Payer: Qualcare PPO/HMO/WC	$326.25
Rate for Payer: UnitedHealthcare Community & State	$68.73
Rate for Payer: Wellpoint Medicaid Managed Care	$61.77

GUIDEWIRE J 3MM .035/150CM

Facility

$30.90

Service Code	HCPCS C1769
Hospital Charge Code	270653785N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$15.45
Rate for Payer: Aetna Commercial	$11.74
Rate for Payer: Aetna Medicare Advantage	$9.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.88
Rate for Payer: Cigna Commercial	$15.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.63
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

GUIDEWIRE J 3MM .035/150CM

Facility

$366.00

Hospital Charge Code	270653785
Hospital Revenue Code	279
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$139.08
Rate for Payer: Aetna Medicare Advantage	$109.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.33
Rate for Payer: Cigna Commercial	$183.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.16
Rate for Payer: Oxford Commercial	$73.20
Rate for Payer: Qualcare PPO/HMO/WC	$54.90
Rate for Payer: UnitedHealthcare Commercial	$73.20
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$10.39

GUIDEWIRE J 3MM .035/150CM

Facility

$366.00

Hospital Charge Code	270653785
Hospital Revenue Code	279
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Qualcare PPO/HMO/WC	$54.90

GUIDEWIRE J 3MM .035/150CM

Facility

$30.90

Service Code	HCPCS C1769
Hospital Charge Code	270653785N
Hospital Revenue Code	278
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.63

GUIDEWIRE JAGTOME RX 39 ERCP

Facility

$1,515.00

Service Code	HCPCS C1769
Hospital Charge Code	270687106
Hospital Revenue Code	278
Min. Negotiated Rate	$43.03
Max. Negotiated Rate	$757.50
Rate for Payer: Aetna Commercial	$575.70
Rate for Payer: Aetna Medicare Advantage	$454.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$386.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$386.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$386.32
Rate for Payer: Cigna Commercial	$757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.63
Rate for Payer: Qualcare PPO/HMO/WC	$227.25
Rate for Payer: UnitedHealthcare Community & State	$47.87
Rate for Payer: Wellpoint Medicaid Managed Care	$43.03

GUIDEWIRE JAGTOME RX 39 ERCP

Facility

$1,515.00

Service Code	HCPCS C1769
Hospital Charge Code	270687106
Hospital Revenue Code	278
Min. Negotiated Rate	$227.25
Max. Negotiated Rate	$366.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$303.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.63
Rate for Payer: Qualcare PPO/HMO/WC	$227.25

GUIDEWIRE JOURNEY 300MM STR

Facility

$700.00

Hospital Charge Code	270644823
Hospital Revenue Code	278
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

GUIDEWIRE JOURNEY 300MM STR

Facility

$700.00

Hospital Charge Code	270644823
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

GUIDEWIRE JTIP .14 182CM

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270696459
Hospital Revenue Code	278
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$207.50
Rate for Payer: Aetna Commercial	$157.70
Rate for Payer: Aetna Medicare Advantage	$124.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.83
Rate for Payer: Cigna Commercial	$207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.25
Rate for Payer: UnitedHealthcare Community & State	$13.11
Rate for Payer: Wellpoint Medicaid Managed Care	$11.79

GUIDEWIRE JTIP .14 182CM

Facility

$415.00

Service Code	HCPCS C1769
Hospital Charge Code	270696459
Hospital Revenue Code	278
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$100.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.43
Rate for Payer: Qualcare PPO/HMO/WC	$62.25

GUIDEWIRE J TIP 3MMX7CM

Facility

$154.00

Hospital Charge Code	270331517
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$37.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.27
Rate for Payer: Qualcare PPO/HMO/WC	$23.10

GUIDEWIRE J TIP 3MMX7CM

Facility

$154.00

Hospital Charge Code	270331517
Hospital Revenue Code	278
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$77.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.27
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Community & State	$4.87
Rate for Payer: Wellpoint Medicaid Managed Care	$4.37

GUIDEWIRE K-WIRE 1.35mm DIA

Facility

$205.00

Service Code	HCPCS C1769
Hospital Charge Code	270678268
Hospital Revenue Code	278
Min. Negotiated Rate	$30.75
Max. Negotiated Rate	$49.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.61
Rate for Payer: Qualcare PPO/HMO/WC	$30.75

GUIDEWIRE K-WIRE 1.35mm DIA

Facility

$205.00

Service Code	HCPCS C1769
Hospital Charge Code	270678268
Hospital Revenue Code	278
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$102.50
Rate for Payer: Aetna Commercial	$77.90
Rate for Payer: Aetna Medicare Advantage	$61.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.27
Rate for Payer: Cigna Commercial	$102.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.61
Rate for Payer: Qualcare PPO/HMO/WC	$30.75
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.82

GUIDEWIRE LAG SCREW 27914

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270635349
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

GUIDEWIRE LAG SCREW 27914

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270635349
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

GUIDEWIRE LAG SCREW 3.2x460mm

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270635350
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

GUIDEWIRE LAG SCREW 3.2x460mm

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270635350
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

GUIDEWIRE LG 3.2MM

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	270698445
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 LG 3.2MM

Facility

$200.00

Service Code	HCPCS C1769
Hospital Charge Code	270698445
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 LONG 2.8X450MM

Facility

$369.00

Hospital Charge Code	270670832
Hospital Revenue Code	278
Min. Negotiated Rate	$55.35
Max. Negotiated Rate	$89.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.30
Rate for Payer: Qualcare PPO/HMO/WC	$55.35

GUIDE WIRE LONG 2.8X450MM

Facility

$369.00

Hospital Charge Code	270670832
Hospital Revenue Code	278
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna Commercial	$140.22
Rate for Payer: Aetna Medicare Advantage	$110.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.09
Rate for Payer: Cigna Commercial	$184.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.30
Rate for Payer: Qualcare PPO/HMO/WC	$55.35
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$10.48

GUIDEWIRE LUGE 182cm 1213001

Facility

$2,500.00

Service Code	HCPCS C1769
Hospital Charge Code	270631645
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

GUIDEWIRE LUGE 182cm 1213001

Facility

$2,500.00

Service Code	HCPCS C1769
Hospital Charge Code	270631645
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

Know your out-of-pocket cost for care.

All Charges