Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WIRE COMP 2.8x20MM/200MM

Facility

$253.00

Service Code	HCPCS C1713
Hospital Charge Code	270683073
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

WIRE COMP 2.8x20MM/200MM

Facility

$253.00

Service Code	HCPCS C1713
Hospital Charge Code	270683073
Hospital Revenue Code	278
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$61.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

WIRE COMPR 10MM THD 1.6x150MM

Facility

$189.00

Hospital Charge Code	270677233
Hospital Revenue Code	272
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna Commercial	$71.82
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.14
Rate for Payer: Oxford Commercial	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$37.80
Rate for Payer: UnitedHealthcare Community & State	$5.97
Rate for Payer: Wellpoint Medicaid Managed Care	$5.37

WIRE COMPR 10MM THD 1.6x150MM

Facility

$189.00

Hospital Charge Code	270677233
Hospital Revenue Code	272
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

WIRE COMPR 15MM THD 150MM

Facility

$200.50

Hospital Charge Code	270675951
Hospital Revenue Code	272
Min. Negotiated Rate	$30.07
Max. Negotiated Rate	$30.07
Rate for Payer: Qualcare PPO/HMO/WC	$30.07

WIRE COMPR 15MM THD 150MM

Facility

$200.50

Hospital Charge Code	270675951
Hospital Revenue Code	272
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$100.25
Rate for Payer: Aetna Commercial	$76.19
Rate for Payer: Aetna Medicare Advantage	$60.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.13
Rate for Payer: Cigna Commercial	$100.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.13
Rate for Payer: Oxford Commercial	$40.10
Rate for Payer: Qualcare PPO/HMO/WC	$30.07
Rate for Payer: UnitedHealthcare Commercial	$40.10
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

WIRE COMPR 1.6MM 30x150MM

Facility

$223.60

Hospital Charge Code	270677509
Hospital Revenue Code	272
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$111.80
Rate for Payer: Aetna Commercial	$84.97
Rate for Payer: Aetna Medicare Advantage	$67.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.02
Rate for Payer: Cigna Commercial	$111.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.14
Rate for Payer: Oxford Commercial	$44.72
Rate for Payer: Qualcare PPO/HMO/WC	$33.54
Rate for Payer: UnitedHealthcare Commercial	$44.72
Rate for Payer: UnitedHealthcare Community & State	$7.07
Rate for Payer: Wellpoint Medicaid Managed Care	$6.35

WIRE COMPR 1.6MM 30x150MM

Facility

$223.60

Hospital Charge Code	270677509
Hospital Revenue Code	272
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$33.54
Rate for Payer: Qualcare PPO/HMO/WC	$33.54

WIRE COMPR 20MM THD 1.6x150MM

Facility

$200.50

Hospital Charge Code	270675217
Hospital Revenue Code	272
Min. Negotiated Rate	$30.07
Max. Negotiated Rate	$30.07
Rate for Payer: Qualcare PPO/HMO/WC	$30.07

WIRE COMPR 20MM THD 1.6x150MM

Facility

$200.50

Hospital Charge Code	270675217
Hospital Revenue Code	272
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$100.25
Rate for Payer: Aetna Commercial	$76.19
Rate for Payer: Aetna Medicare Advantage	$60.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.13
Rate for Payer: Cigna Commercial	$100.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.13
Rate for Payer: Oxford Commercial	$40.10
Rate for Payer: Qualcare PPO/HMO/WC	$30.07
Rate for Payer: UnitedHealthcare Commercial	$40.10
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.69

WIRE COMPR 25MM THD 1.6x150MM

Facility

$189.00

Hospital Charge Code	270676223
Hospital Revenue Code	272
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna Commercial	$71.82
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.14
Rate for Payer: Oxford Commercial	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$37.80
Rate for Payer: UnitedHealthcare Community & State	$5.97
Rate for Payer: Wellpoint Medicaid Managed Care	$5.37

WIRE COMPR 25MM THD 1.6x150MM

Facility

$189.00

Hospital Charge Code	270676223
Hospital Revenue Code	272
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

WIRE COMPRES 2.8x15mm/200mm

Facility

$253.00

Service Code	HCPCS C1713
Hospital Charge Code	270681462
Hospital Revenue Code	278
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$61.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

WIRE COMPRES 2.8x15mm/200mm

Facility

$253.00

Service Code	HCPCS C1713
Hospital Charge Code	270681462
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

WIRE COMPRES 2.8x25mm/200mm

Facility

$662.00

Service Code	HCPCS C1713
Hospital Charge Code	270681460
Hospital Revenue Code	278
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$160.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.30

WIRE COMPRES 2.8x25mm/200mm

Facility

$662.00

Service Code	HCPCS C1713
Hospital Charge Code	270681460
Hospital Revenue Code	278
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$331.00
Rate for Payer: Aetna Commercial	$251.56
Rate for Payer: Aetna Medicare Advantage	$198.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.81
Rate for Payer: Cigna Commercial	$331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.30
Rate for Payer: UnitedHealthcare Community & State	$20.92
Rate for Payer: Wellpoint Medicaid Managed Care	$18.80

WIRE COMPRESSION ALPS SHORT

Facility

$165.00

Service Code	HCPCS C1713
Hospital Charge Code	270694040
Hospital Revenue Code	278
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$39.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.93
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

WIRE COMPRESSION ALPS SHORT

Facility

$165.00

Service Code	HCPCS C1713
Hospital Charge Code	270694040
Hospital Revenue Code	278
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$82.50
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.93
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Community & State	$5.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

WIRE CONNORS J .035 260CM

Facility

$255.00

Hospital Charge Code	270677087
Hospital Revenue Code	272
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.25
Rate for Payer: UnitedHealthcare Commercial	$51.00
Rate for Payer: UnitedHealthcare Community & State	$8.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.24

WIRE CONNORS J .035 260CM

Facility

$255.00

Hospital Charge Code	270677087
Hospital Revenue Code	272
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$38.25
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

WIRE DYNANTIE 1.6 DBL TIP

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270689953
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

WIRE DYNANTIE 1.6 DBL TIP

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	270689953
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

WIRE EMBOSHIELD WORKHORSE 315

Facility

$625.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423S
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

WIRE EMBOSHIELD WORKHORSE 315

Facility

$625.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423S
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

WIRE EMBOSHIELD WORKHORSE 315

Facility

$140.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423N
Hospital Revenue Code	278
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

Know your out-of-pocket cost for care.

All Charges