Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WIRE SP FLT FX SPD2-US-050-320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270640584C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

WIRE SP FLT FX SPD2-US-050-320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270640584A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

WIRE SP FLT FX SPD2-US-050-320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270640584A
Hospital Revenue Code	278
Min. Negotiated Rate	$198.09
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$220.41
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

WIRE SP FLT FX SPD2-US-050-320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270640584C
Hospital Revenue Code	278
Min. Negotiated Rate	$198.09
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$220.41
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

WIRE SPIDER FILTER FX 3.0x320

Facility

$6,000.00

Service Code	HCPCS C1884
Hospital Charge Code	270643589N
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

WIRE SPIDER FILTER FX 3.0x320

Facility

$6,000.00

Service Code	HCPCS C1884
Hospital Charge Code	270643589
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

WIRE SPIDER FILTER FX 3.0x320

Facility

$6,000.00

Service Code	HCPCS C1884
Hospital Charge Code	270643589
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

WIRE SPIDER FILTER FX 3.0x320

Facility

$6,000.00

Service Code	HCPCS C1884
Hospital Charge Code	270643589N
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

WIRE SPIDER FILTER FX 40X320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

WIRE SPIDER FILTER FX 40X320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590
Hospital Revenue Code	278
Min. Negotiated Rate	$198.09
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$220.41
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

WIRE SPIDER FILTER FX 4.0x320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

WIRE SPIDER FILTER FX 4.0x320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

WIRE SPIDER FILTER FX 4.0x320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590A
Hospital Revenue Code	278
Min. Negotiated Rate	$198.09
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$220.41
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

WIRE SPIDER FILTER FX 4.0x320

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590C
Hospital Revenue Code	278
Min. Negotiated Rate	$198.09
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$220.41
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

WIRE SPIDER FILTER FX 5.0x320

Facility

$6,000.00

Service Code	HCPCS C1884
Hospital Charge Code	270640584
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

WIRE SPIDER FILTER FX 5.0x320

Facility

$6,000.00

Service Code	HCPCS C1884
Hospital Charge Code	270640584
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

WIRE SPIDER FILTER FX 6.0X180

Facility

$6,000.00

Hospital Charge Code	270639251
Hospital Revenue Code	272
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

WIRE SPIDER FILTER FX 6.0X180

Facility

$6,000.00

Hospital Charge Code	270639251
Hospital Revenue Code	272
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.00
Rate for Payer: Oxford Commercial	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Commercial	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

WIRE STIFF 0.035/260C

Facility

$169.95

Service Code	HCPCS C1769
Hospital Charge Code	270662309S
Hospital Revenue Code	278
Min. Negotiated Rate	$25.49
Max. Negotiated Rate	$41.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.13
Rate for Payer: Qualcare PPO/HMO/WC	$25.49

WIRE STIFF 0.035/260C

Facility

$169.95

Service Code	HCPCS C1769
Hospital Charge Code	270662309
Hospital Revenue Code	278
Min. Negotiated Rate	$25.49
Max. Negotiated Rate	$41.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.13
Rate for Payer: Qualcare PPO/HMO/WC	$25.49

WIRE STIFF 0.035/260C

Facility

$169.95

Service Code	HCPCS C1769
Hospital Charge Code	270662309
Hospital Revenue Code	278
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$84.97
Rate for Payer: Aetna Commercial	$64.58
Rate for Payer: Aetna Medicare Advantage	$50.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.34
Rate for Payer: Cigna Commercial	$84.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.13
Rate for Payer: Qualcare PPO/HMO/WC	$25.49
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.83

WIRE STIFF 0.035/260C

Facility

$280.00

Service Code	HCPCS C1769
Hospital Charge Code	270662309N
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.76
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

WIRE STIFF 0.035/260C

Facility

$169.95

Service Code	HCPCS C1769
Hospital Charge Code	270662309S
Hospital Revenue Code	278
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$84.97
Rate for Payer: Aetna Commercial	$64.58
Rate for Payer: Aetna Medicare Advantage	$50.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.34
Rate for Payer: Cigna Commercial	$84.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.13
Rate for Payer: Qualcare PPO/HMO/WC	$25.49
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.83

WIRE STIFF 0.035/260C

Facility

$280.00

Service Code	HCPCS C1769
Hospital Charge Code	270662309N
Hospital Revenue Code	278
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.76
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Community & State	$8.85
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

WIRE SUPER STIFF .035 X 260 MM

Facility

$750.00

Service Code	HCPCS C1874
Hospital Charge Code	270688532
Hospital Revenue Code	272
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

Know your out-of-pocket cost for care.

All Charges