Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WIRE EMBOSHIELD WORKHORSE 315

Facility

$625.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423
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

$140.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423N
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

WIRE EMBOSHIELD WORKHORSE 315

Facility

$625.00

Service Code	HCPCS C1884
Hospital Charge Code	270643423
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 ENTRY GUIDE 3.2X320MM

Facility

$800.00

Hospital Charge Code	270678876
Hospital Revenue Code	272
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) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: Wellpoint Medicaid Managed Care	$22.72

WIRE ENTRY GUIDE 3.2X320MM

Facility

$800.00

Hospital Charge Code	270678876
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

WIRE EXT W OLIVE TIP 1.8X450MM

Facility

$652.70

Service Code	HCPCS C1713
Hospital Charge Code	270699598
Hospital Revenue Code	278
Min. Negotiated Rate	$18.54
Max. Negotiated Rate	$326.35
Rate for Payer: Aetna Commercial	$248.03
Rate for Payer: Aetna Medicare Advantage	$195.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.44
Rate for Payer: Cigna Commercial	$326.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$97.91
Rate for Payer: UnitedHealthcare Community & State	$20.63
Rate for Payer: Wellpoint Medicaid Managed Care	$18.54

WIRE EXT W OLIVE TIP 1.8X450MM

Facility

$652.70

Service Code	HCPCS C1713
Hospital Charge Code	270699598
Hospital Revenue Code	278
Min. Negotiated Rate	$97.91
Max. Negotiated Rate	$157.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$97.91

WIRE EXT W OLIVE TIP 2.0X450MM

Facility

$674.05

Service Code	HCPCS C1713
Hospital Charge Code	270699599
Hospital Revenue Code	278
Min. Negotiated Rate	$101.11
Max. Negotiated Rate	$163.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.12
Rate for Payer: Qualcare PPO/HMO/WC	$101.11

WIRE EXT W OLIVE TIP 2.0X450MM

Facility

$674.05

Service Code	HCPCS C1713
Hospital Charge Code	270699599
Hospital Revenue Code	278
Min. Negotiated Rate	$19.14
Max. Negotiated Rate	$337.02
Rate for Payer: Aetna Commercial	$256.14
Rate for Payer: Aetna Medicare Advantage	$202.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.88
Rate for Payer: Cigna Commercial	$337.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.12
Rate for Payer: Qualcare PPO/HMO/WC	$101.11
Rate for Payer: UnitedHealthcare Community & State	$21.30
Rate for Payer: Wellpoint Medicaid Managed Care	$19.14

WIRE FIBER SIZE #2

Facility

$110.00

Hospital Charge Code	270624619
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$55.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.60
Rate for Payer: Oxford Commercial	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

WIRE FIBER SIZE #2

Facility

$110.00

Hospital Charge Code	270624619
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

WIRE FIBER SIZE #5 AR7211

Facility

$200.00

Hospital Charge Code	270642317
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

WIRE FIBER SIZE #5 AR7211

Facility

$200.00

Hospital Charge Code	270642317
Hospital Revenue Code	272
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) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$6.32
Rate for Payer: Wellpoint Medicaid Managed Care	$5.68

WIRE FIBER SZ1

Facility

$105.00

Hospital Charge Code	270676891
Hospital Revenue Code	272
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

WIRE FIBER SZ1

Facility

$105.00

Hospital Charge Code	270676891
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

WIRE GUIDE .018x60cm

Facility

$107.50

Service Code	HCPCS C1789
Hospital Charge Code	270653109
Hospital Revenue Code	278
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare Advantage	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.41
Rate for Payer: Cigna Commercial	$53.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.12
Rate for Payer: UnitedHealthcare Community & State	$3.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

WIRE GUIDE .018x60cm

Facility

$107.50

Service Code	HCPCS C1789
Hospital Charge Code	270653109
Hospital Revenue Code	278
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.12

WIRE GUIDE .035 260CM EXCH STR

Facility

$405.50

Service Code	HCPCS C1769
Hospital Charge Code	270616498
Hospital Revenue Code	279
Min. Negotiated Rate	$60.83
Max. Negotiated Rate	$60.83
Rate for Payer: Qualcare PPO/HMO/WC	$60.83

WIRE GUIDE .035 260CM EXCH STR

Facility

$405.50

Service Code	HCPCS C1769
Hospital Charge Code	270616498
Hospital Revenue Code	279
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$202.75
Rate for Payer: Aetna Commercial	$154.09
Rate for Payer: Aetna Medicare Advantage	$121.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.40
Rate for Payer: Cigna Commercial	$202.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.43
Rate for Payer: Oxford Commercial	$81.10
Rate for Payer: Qualcare PPO/HMO/WC	$60.83
Rate for Payer: UnitedHealthcare Commercial	$81.10
Rate for Payer: UnitedHealthcare Community & State	$12.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.52

WIRE GUIDE .035 X 260CM

Facility

$135.00

Hospital Charge Code	270667764
Hospital Revenue Code	272
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$27.00
Rate for Payer: UnitedHealthcare Community & State	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.83

WIRE GUIDE .035 X 260CM

Facility

$135.00

Hospital Charge Code	270667764
Hospital Revenue Code	272
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

WIREGUIDE 035x260x3 LQT 256898

Facility

$2,500.00

Hospital Charge Code	270623285
Hospital Revenue Code	272
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) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

WIREGUIDE 035x260x3 LQT 256898

Facility

$2,500.00

Hospital Charge Code	270623285
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

WIRE GUIDE 1.0

Facility

$456.00

Service Code	HCPCS C1769
Hospital Charge Code	270665338
Hospital Revenue Code	278
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$228.00
Rate for Payer: Aetna Commercial	$173.28
Rate for Payer: Aetna Medicare Advantage	$136.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.28
Rate for Payer: Cigna Commercial	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.35
Rate for Payer: Qualcare PPO/HMO/WC	$68.40
Rate for Payer: UnitedHealthcare Community & State	$14.41
Rate for Payer: Wellpoint Medicaid Managed Care	$12.95

WIRE GUIDE 1.0

Facility

$456.00

Service Code	HCPCS C1769
Hospital Charge Code	270665338
Hospital Revenue Code	278
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$110.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.35
Rate for Payer: Qualcare PPO/HMO/WC	$68.40

Know your out-of-pocket cost for care.

All Charges