Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWIRE PRIMEWIRE J DS 185CM

Facility

$3,375.00

Service Code	HCPCS C1769
Hospital Charge Code	270646539
Hospital Revenue Code	278
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Community & State	$106.65
Rate for Payer: Wellpoint Medicaid Managed Care	$95.85

GUIDEWIRE PRIMEWIRE J DS 185CM

Facility

$3,375.00

Service Code	HCPCS C1769
Hospital Charge Code	270646539
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

GUIDEWIRE PROWATER 300 1493501

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742
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 PROWATER 300 1493501

Facility

$425.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742N
Hospital Revenue Code	278
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

GUIDEWIRE PROWATER 300 1493501

Facility

$425.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

GUIDEWIRE PROWATER 300 1493501

Facility

$115.00

Service Code	HCPCS C1769
Hospital Charge Code	270636742
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 ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: Qualcare PPO/HMO/WC	$37.48

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803N
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: Qualcare PPO/HMO/WC	$37.48

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803N
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$124.95
Rate for Payer: Aetna Commercial	$94.96
Rate for Payer: Aetna Medicare Advantage	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.72
Rate for Payer: Cigna Commercial	$124.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: Qualcare PPO/HMO/WC	$37.48
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$124.95
Rate for Payer: Aetna Commercial	$94.96
Rate for Payer: Aetna Medicare Advantage	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.72
Rate for Payer: Cigna Commercial	$124.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: Qualcare PPO/HMO/WC	$37.48
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$60.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: Qualcare PPO/HMO/WC	$37.48

GUIDEWIRE ROADRUNNER

Facility

$249.90

Service Code	HCPCS C1769
Hospital Charge Code	270679803
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$124.95
Rate for Payer: Aetna Commercial	$94.96
Rate for Payer: Aetna Medicare Advantage	$74.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.72
Rate for Payer: Cigna Commercial	$124.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.48
Rate for Payer: Qualcare PPO/HMO/WC	$37.48
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

GUIDEWIRE ROSEN .035 180cm

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270623888N
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

GUIDEWIRE ROSEN .035 180cm

Facility

$64.60

Service Code	HCPCS C1769
Hospital Charge Code	270623262
Hospital Revenue Code	278
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$32.30
Rate for Payer: Aetna Commercial	$24.55
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.47
Rate for Payer: Cigna Commercial	$32.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.63
Rate for Payer: Qualcare PPO/HMO/WC	$9.69
Rate for Payer: UnitedHealthcare Community & State	$2.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.83

GUIDEWIRE ROSEN .035 180cm

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270623888S
Hospital Revenue Code	278
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

GUIDEWIRE ROSEN .035 180cm

Facility

$64.60

Service Code	HCPCS C1769
Hospital Charge Code	270623262
Hospital Revenue Code	278
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$15.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.63
Rate for Payer: Qualcare PPO/HMO/WC	$9.69

GUIDEWIRE ROSEN .035 180cm

Facility

$56.80

Service Code	HCPCS C1769
Hospital Charge Code	270623888
Hospital Revenue Code	278
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$28.40
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna Medicare Advantage	$17.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.48
Rate for Payer: Cigna Commercial	$28.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.75
Rate for Payer: Qualcare PPO/HMO/WC	$8.52
Rate for Payer: UnitedHealthcare Community & State	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

GUIDEWIRE ROSEN .035 180cm

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270623888N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

GUIDEWIRE ROSEN .035 180cm

Facility

$70.00

Service Code	HCPCS C1769
Hospital Charge Code	270623888S
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

GUIDEWIRE ROSEN .035 180cm

Facility

$56.80

Service Code	HCPCS C1769
Hospital Charge Code	270623888
Hospital Revenue Code	278
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$13.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.75
Rate for Payer: Qualcare PPO/HMO/WC	$8.52

GUIDEWIRE ROSEN .035 260cm

Facility

$147.50

Service Code	HCPCS C1769
Hospital Charge Code	270624343N
Hospital Revenue Code	278
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$56.05
Rate for Payer: Aetna Medicare Advantage	$44.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.61
Rate for Payer: Cigna Commercial	$73.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Qualcare PPO/HMO/WC	$22.12
Rate for Payer: UnitedHealthcare Community & State	$4.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

GUIDEWIRE ROSEN .035 260cm

Facility

$147.50

Service Code	HCPCS C1769
Hospital Charge Code	270624343N
Hospital Revenue Code	278
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.70
Rate for Payer: Qualcare PPO/HMO/WC	$22.12

GUIDEWIRE ROSEN .035 260cm

Facility

$81.80

Service Code	HCPCS C1769
Hospital Charge Code	270624343S
Hospital Revenue Code	278
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27

GUIDEWIRE ROSEN .035 260cm

Facility

$81.80

Service Code	HCPCS C1769
Hospital Charge Code	270624343
Hospital Revenue Code	278
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27

GUIDEWIRE ROSEN .035 260cm

Facility

$81.80

Service Code	HCPCS C1769
Hospital Charge Code	270624343
Hospital Revenue Code	278
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$40.90
Rate for Payer: Aetna Commercial	$31.08
Rate for Payer: Aetna Medicare Advantage	$24.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.86
Rate for Payer: Cigna Commercial	$40.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27
Rate for Payer: UnitedHealthcare Community & State	$2.58
Rate for Payer: Wellpoint Medicaid Managed Care	$2.32

Know your out-of-pocket cost for care.

All Charges