Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GUIDEWR WHISP 014 300 1005359H

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270638395C
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

GUIDWIR NON THRD 2.0x250 27591

Facility

$690.00

Service Code	HCPCS C1769
Hospital Charge Code	270639194
Hospital Revenue Code	278
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna Commercial	$262.20
Rate for Payer: Aetna Medicare Advantage	$207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.95
Rate for Payer: Cigna Commercial	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: Qualcare PPO/HMO/WC	$103.50
Rate for Payer: UnitedHealthcare Community & State	$21.80
Rate for Payer: Wellpoint Medicaid Managed Care	$19.60

GUIDWIR NON THRD 2.0x250 27591

Facility

$690.00

Service Code	HCPCS C1769
Hospital Charge Code	270639194
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$166.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

GUIDWR BMW UNV II 190c1009664J

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270642950
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

GUIDWR BMW UNV II 190c1009664J

Facility

$3,750.00

Service Code	HCPCS C1769
Hospital Charge Code	270642950
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

GUIDZEBRA UROLOGICAL

Facility

$453.77

Hospital Charge Code	270653658
Hospital Revenue Code	271
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$226.88
Rate for Payer: Aetna Commercial	$172.43
Rate for Payer: Aetna Medicare Advantage	$136.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.71
Rate for Payer: Cigna Commercial	$226.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.98
Rate for Payer: Oxford Commercial	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$68.07
Rate for Payer: UnitedHealthcare Commercial	$90.75
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$12.89

GUIDZEBRA UROLOGICAL

Facility

$453.77

Hospital Charge Code	270653658
Hospital Revenue Code	271
Min. Negotiated Rate	$68.07
Max. Negotiated Rate	$68.07
Rate for Payer: Qualcare PPO/HMO/WC	$68.07

GUN INFLATION ALLIANCE II

Facility

$778.95

Hospital Charge Code	270658166
Hospital Revenue Code	278
Min. Negotiated Rate	$116.84
Max. Negotiated Rate	$188.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.51
Rate for Payer: Qualcare PPO/HMO/WC	$116.84

GUN INFLATION ALLIANCE II

Facility

$778.95

Hospital Charge Code	270658166
Hospital Revenue Code	278
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$389.48
Rate for Payer: Aetna Commercial	$296.00
Rate for Payer: Aetna Medicare Advantage	$233.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.63
Rate for Payer: Cigna Commercial	$389.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.51
Rate for Payer: Qualcare PPO/HMO/WC	$116.84
Rate for Payer: UnitedHealthcare Community & State	$24.61
Rate for Payer: Wellpoint Medicaid Managed Care	$22.12

GUN MAXCORE 18G 16cm

Facility

$177.09

Hospital Charge Code	270624452
Hospital Revenue Code	272
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$88.55
Rate for Payer: Aetna Commercial	$67.29
Rate for Payer: Aetna Medicare Advantage	$53.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.16
Rate for Payer: Cigna Commercial	$88.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.04
Rate for Payer: Oxford Commercial	$35.42
Rate for Payer: Qualcare PPO/HMO/WC	$26.56
Rate for Payer: UnitedHealthcare Commercial	$35.42
Rate for Payer: UnitedHealthcare Community & State	$5.60
Rate for Payer: Wellpoint Medicaid Managed Care	$5.03

GUN MAXCORE 18G 16cm

Facility

$177.09

Hospital Charge Code	270624452
Hospital Revenue Code	272
Min. Negotiated Rate	$26.56
Max. Negotiated Rate	$26.56
Rate for Payer: Qualcare PPO/HMO/WC	$26.56

GUN MAXCORE 18GX25cm MC1825

Facility

$260.00

Hospital Charge Code	270662000
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

GUN MAXCORE 18GX25cm MC1825

Facility

$260.00

Hospital Charge Code	270662000
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$52.00
Rate for Payer: UnitedHealthcare Community & State	$8.22
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

GUN MONOPTY 18G 10cm

Facility

$220.00

Hospital Charge Code	270631205
Hospital Revenue Code	272
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.20
Rate for Payer: Oxford Commercial	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Commercial	$44.00
Rate for Payer: UnitedHealthcare Community & State	$6.95
Rate for Payer: Wellpoint Medicaid Managed Care	$6.25

GUN MONOPTY 18G 10cm

Facility

$220.00

Hospital Charge Code	270631205
Hospital Revenue Code	272
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

GUN MONOPTY 18G 20cm BIOPSY

Facility

$132.15

Hospital Charge Code	270627540
Hospital Revenue Code	272
Min. Negotiated Rate	$19.82
Max. Negotiated Rate	$19.82
Rate for Payer: Qualcare PPO/HMO/WC	$19.82

GUN MONOPTY 18G 20cm BIOPSY

Facility

$132.15

Hospital Charge Code	270627540
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$66.08
Rate for Payer: Aetna Commercial	$50.22
Rate for Payer: Aetna Medicare Advantage	$39.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.70
Rate for Payer: Cigna Commercial	$66.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.36
Rate for Payer: Oxford Commercial	$26.43
Rate for Payer: Qualcare PPO/HMO/WC	$19.82
Rate for Payer: UnitedHealthcare Commercial	$26.43
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

GWIRE ANG ZIPWIRE 0.035X180CM

Facility

$211.61

Service Code	HCPCS C1769
Hospital Charge Code	270601268
Hospital Revenue Code	278
Min. Negotiated Rate	$31.74
Max. Negotiated Rate	$51.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.21
Rate for Payer: Qualcare PPO/HMO/WC	$31.74

GWIRE ANG ZIPWIRE 0.035X180CM

Facility

$211.61

Service Code	HCPCS C1769
Hospital Charge Code	270601268
Hospital Revenue Code	278
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$105.81
Rate for Payer: Aetna Commercial	$80.41
Rate for Payer: Aetna Medicare Advantage	$63.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.96
Rate for Payer: Cigna Commercial	$105.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.21
Rate for Payer: Qualcare PPO/HMO/WC	$31.74
Rate for Payer: UnitedHealthcare Community & State	$6.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.01

GWIRE COUG XT190CM CGRXT190HJ

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270636547
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

GWIRE COUG XT190CM CGRXT190HJ

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270636547
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

GWIRE COUG XT190CM CGRXT190HJ

Facility

$719.25

Service Code	HCPCS C1769
Hospital Charge Code	270636547N
Hospital Revenue Code	278
Min. Negotiated Rate	$107.89
Max. Negotiated Rate	$174.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.06
Rate for Payer: Qualcare PPO/HMO/WC	$107.89

GWIRE COUG XT190CM CGRXT190HJ

Facility

$719.25

Service Code	HCPCS C1769
Hospital Charge Code	270636547N
Hospital Revenue Code	278
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$359.62
Rate for Payer: Aetna Commercial	$273.31
Rate for Payer: Aetna Medicare Advantage	$215.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.41
Rate for Payer: Cigna Commercial	$359.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.06
Rate for Payer: Qualcare PPO/HMO/WC	$107.89
Rate for Payer: UnitedHealthcare Community & State	$22.73
Rate for Payer: Wellpoint Medicaid Managed Care	$20.43

GWIRE COUG XT300CM CGRXT300HJ

Facility

$719.25

Service Code	HCPCS C1769
Hospital Charge Code	270636548N
Hospital Revenue Code	278
Min. Negotiated Rate	$20.43
Max. Negotiated Rate	$359.62
Rate for Payer: Aetna Commercial	$273.31
Rate for Payer: Aetna Medicare Advantage	$215.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.41
Rate for Payer: Cigna Commercial	$359.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.06
Rate for Payer: Qualcare PPO/HMO/WC	$107.89
Rate for Payer: UnitedHealthcare Community & State	$22.73
Rate for Payer: Wellpoint Medicaid Managed Care	$20.43

GWIRE COUG XT300CM CGRXT300HJ

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270636548
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

Know your out-of-pocket cost for care.

All Charges