Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

WIRE SYN GUIDE 3.2 292.69

Facility

$362.50

Service Code	HCPCS C1769
Hospital Charge Code	270611969
Hospital Revenue Code	278
Min. Negotiated Rate	$54.38
Max. Negotiated Rate	$87.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.72
Rate for Payer: Qualcare PPO/HMO/WC	$54.38

WIRE SYN GUIDE 3.2 292.69

Facility

$362.50

Service Code	HCPCS C1769
Hospital Charge Code	270611969
Hospital Revenue Code	278
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$181.25
Rate for Payer: Aetna Commercial	$137.75
Rate for Payer: Aetna Medicare Advantage	$108.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.44
Rate for Payer: Cigna Commercial	$181.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.72
Rate for Payer: Qualcare PPO/HMO/WC	$54.38
Rate for Payer: UnitedHealthcare Community & State	$11.46
Rate for Payer: Wellpoint Medicaid Managed Care	$10.29

WIRE SYN K 1.25 285MM 292.13

Facility

$44.75

Hospital Charge Code	270604415
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$22.38
Rate for Payer: Aetna Commercial	$17.00
Rate for Payer: Aetna Medicare Advantage	$13.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.41
Rate for Payer: Cigna Commercial	$22.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.63
Rate for Payer: Oxford Commercial	$8.95
Rate for Payer: Qualcare PPO/HMO/WC	$6.71
Rate for Payer: UnitedHealthcare Commercial	$8.95
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

WIRE SYN K 1.25 285MM 292.13

Facility

$44.75

Hospital Charge Code	270604415
Hospital Revenue Code	272
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$6.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.71

WIRE TAC SMOOTH OLIVE 1.6X30MM

Facility

$465.00

Hospital Charge Code	270698542
Hospital Revenue Code	272
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Oxford Commercial	$93.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Commercial	$93.00
Rate for Payer: UnitedHealthcare Community & State	$14.69
Rate for Payer: Wellpoint Medicaid Managed Care	$13.21

WIRE TAC SMOOTH OLIVE 1.6X30MM

Facility

$465.00

Hospital Charge Code	270698542
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

WIRE THRD TIP 3.2x460mm

Facility

$780.00

Service Code	HCPCS C1769
Hospital Charge Code	270641740
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

WIRE THRD TIP 3.2x460mm

Facility

$780.00

Service Code	HCPCS C1769
Hospital Charge Code	270641740
Hospital Revenue Code	278
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Community & State	$24.65
Rate for Payer: Wellpoint Medicaid Managed Care	$22.15

WIRE THREADED .035x4

Facility

$150.00

Hospital Charge Code	270673752
Hospital Revenue Code	272
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

WIRE THREADED .035x4

Facility

$150.00

Hospital Charge Code	270673752
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

WIRE TIGHTENER W/EYE

Facility

$1,566.00

Hospital Charge Code	270672159
Hospital Revenue Code	272
Min. Negotiated Rate	$234.90
Max. Negotiated Rate	$234.90
Rate for Payer: Qualcare PPO/HMO/WC	$234.90

WIRE TIGHTENER W/EYE

Facility

$1,566.00

Hospital Charge Code	270672159
Hospital Revenue Code	272
Min. Negotiated Rate	$44.47
Max. Negotiated Rate	$783.00
Rate for Payer: Aetna Commercial	$595.08
Rate for Payer: Aetna Medicare Advantage	$469.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.33
Rate for Payer: Cigna Commercial	$783.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.16
Rate for Payer: Oxford Commercial	$313.20
Rate for Payer: Qualcare PPO/HMO/WC	$234.90
Rate for Payer: UnitedHealthcare Commercial	$313.20
Rate for Payer: UnitedHealthcare Community & State	$49.49
Rate for Payer: Wellpoint Medicaid Managed Care	$44.47

WIRE TIP NITI 1.1 2 ZONE

Facility

$695.00

Service Code	HCPCS C1713
Hospital Charge Code	270690432
Hospital Revenue Code	278
Min. Negotiated Rate	$19.74
Max. Negotiated Rate	$347.50
Rate for Payer: Aetna Commercial	$264.10
Rate for Payer: Aetna Medicare Advantage	$208.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.22
Rate for Payer: Cigna Commercial	$347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.19
Rate for Payer: Qualcare PPO/HMO/WC	$104.25
Rate for Payer: UnitedHealthcare Community & State	$21.96
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

WIRE TIP NITI 1.1 2 ZONE

Facility

$695.00

Service Code	HCPCS C1713
Hospital Charge Code	270690432
Hospital Revenue Code	278
Min. Negotiated Rate	$104.25
Max. Negotiated Rate	$168.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.19
Rate for Payer: Qualcare PPO/HMO/WC	$104.25

WIRE TREASURE 12FR 0.018X300

Facility

$875.00

Service Code	HCPCS C1769
Hospital Charge Code	270643115
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

WIRE TREASURE 12FR 0.018X300

Facility

$875.00

Service Code	HCPCS C1769
Hospital Charge Code	270643115
Hospital Revenue Code	278
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

WIRE UNIGLIDE ANGL .035x150

Facility

$175.00

Hospital Charge Code	270677155
Hospital Revenue Code	272
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

WIRE UNIGLIDE ANGL .035x150

Facility

$175.00

Hospital Charge Code	270677155
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

WIRE UNIGLIDE ANGL .035x180

Facility

$1,092.45

Hospital Charge Code	270677156
Hospital Revenue Code	272
Min. Negotiated Rate	$163.87
Max. Negotiated Rate	$163.87
Rate for Payer: Qualcare PPO/HMO/WC	$163.87

WIRE UNIGLIDE ANGL .035x180

Facility

$175.00

Hospital Charge Code	270677156N
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

WIRE UNIGLIDE ANGL .035x180

Facility

$1,092.45

Hospital Charge Code	270677156
Hospital Revenue Code	272
Min. Negotiated Rate	$31.03
Max. Negotiated Rate	$546.23
Rate for Payer: Aetna Commercial	$415.13
Rate for Payer: Aetna Medicare Advantage	$327.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.57
Rate for Payer: Cigna Commercial	$546.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.04
Rate for Payer: Oxford Commercial	$218.49
Rate for Payer: Qualcare PPO/HMO/WC	$163.87
Rate for Payer: UnitedHealthcare Commercial	$218.49
Rate for Payer: UnitedHealthcare Community & State	$34.52
Rate for Payer: Wellpoint Medicaid Managed Care	$31.03

WIRE UNIGLIDE ANGL .035x180

Facility

$175.00

Hospital Charge Code	270677156N
Hospital Revenue Code	272
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

WIRE UNIGLIDE ANGL .035x260

Facility

$175.00

Hospital Charge Code	270677157
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

WIRE UNIGLIDE ANGL .035x260

Facility

$175.00

Hospital Charge Code	270677157N
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

Know your out-of-pocket cost for care.

All Charges