Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DURAGEN PLUS 1x1

Facility

$1,395.60

Service Code	HCPCS Q4100
Hospital Charge Code	270677374
Hospital Revenue Code	636
Min. Negotiated Rate	$39.64
Max. Negotiated Rate	$697.80
Rate for Payer: Aetna Commercial	$530.33
Rate for Payer: Aetna Medicare Advantage	$418.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.88
Rate for Payer: Cigna Commercial	$697.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.74
Rate for Payer: Qualcare PPO/HMO/WC	$209.34
Rate for Payer: UnitedHealthcare Community & State	$44.10
Rate for Payer: Wellpoint Medicaid Managed Care	$39.64

DURAGEN PLUS 1x1

Facility

$1,395.60

Service Code	HCPCS Q4100
Hospital Charge Code	270677374
Hospital Revenue Code	636
Min. Negotiated Rate	$209.34
Max. Negotiated Rate	$337.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.74
Rate for Payer: Qualcare PPO/HMO/WC	$209.34

DURAGEN PLUS 3 X3

Facility

$3,962.55

Service Code	HCPCS Q4100
Hospital Charge Code	270658933
Hospital Revenue Code	636
Min. Negotiated Rate	$112.54
Max. Negotiated Rate	$1,981.28
Rate for Payer: Aetna Commercial	$1,505.77
Rate for Payer: Aetna Medicare Advantage	$1,188.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,010.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,010.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,010.45
Rate for Payer: Cigna Commercial	$1,981.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.94
Rate for Payer: Qualcare PPO/HMO/WC	$594.38
Rate for Payer: UnitedHealthcare Community & State	$125.22
Rate for Payer: Wellpoint Medicaid Managed Care	$112.54

DURAGEN PLUS 3 X3

Facility

$3,962.55

Service Code	HCPCS Q4100
Hospital Charge Code	270658933
Hospital Revenue Code	636
Min. Negotiated Rate	$594.38
Max. Negotiated Rate	$958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.94
Rate for Payer: Qualcare PPO/HMO/WC	$594.38

DURAGEN PLUS REGEN MATRIX 5X7

Facility

$8,399.95

Service Code	HCPCS C1889
Hospital Charge Code	270665182
Hospital Revenue Code	278
Min. Negotiated Rate	$238.56
Max. Negotiated Rate	$4,199.98
Rate for Payer: Aetna Commercial	$3,191.98
Rate for Payer: Aetna Medicare Advantage	$2,519.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,141.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,141.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,679.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,141.99
Rate for Payer: Cigna Commercial	$4,199.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,259.99
Rate for Payer: UnitedHealthcare Community & State	$265.44
Rate for Payer: Wellpoint Medicaid Managed Care	$238.56

DURAGEN PLUS REGEN MATRIX 5X7

Facility

$8,399.95

Service Code	HCPCS C1889
Hospital Charge Code	270665182
Hospital Revenue Code	278
Min. Negotiated Rate	$1,259.99
Max. Negotiated Rate	$2,032.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,679.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,259.99

DURASEAL 5ML

Facility

$6,284.00

Hospital Charge Code	270663425
Hospital Revenue Code	272
Min. Negotiated Rate	$942.60
Max. Negotiated Rate	$942.60
Rate for Payer: Qualcare PPO/HMO/WC	$942.60

DURASEAL 5ML

Facility

$6,284.00

Hospital Charge Code	270663425
Hospital Revenue Code	272
Min. Negotiated Rate	$178.47
Max. Negotiated Rate	$3,142.00
Rate for Payer: Aetna Commercial	$2,387.92
Rate for Payer: Aetna Medicare Advantage	$1,885.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,602.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,602.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,602.42
Rate for Payer: Cigna Commercial	$3,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.84
Rate for Payer: Oxford Commercial	$1,256.80
Rate for Payer: Qualcare PPO/HMO/WC	$942.60
Rate for Payer: UnitedHealthcare Commercial	$1,256.80
Rate for Payer: UnitedHealthcare Community & State	$198.57
Rate for Payer: Wellpoint Medicaid Managed Care	$178.47

DUREPAIR REG MATRIX 4X5INCH

Facility

$9,865.00

Service Code	HCPCS C1762
Hospital Charge Code	270660490
Hospital Revenue Code	278
Min. Negotiated Rate	$280.17
Max. Negotiated Rate	$4,932.50
Rate for Payer: Aetna Commercial	$3,748.70
Rate for Payer: Aetna Medicare Advantage	$2,959.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,515.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,515.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,973.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,515.57
Rate for Payer: Cigna Commercial	$4,932.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,387.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.75
Rate for Payer: UnitedHealthcare Community & State	$311.73
Rate for Payer: Wellpoint Medicaid Managed Care	$280.17

DUREPAIR REG MATRIX 4X5INCH

Facility

$9,865.00

Service Code	HCPCS C1762
Hospital Charge Code	270660490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.75
Max. Negotiated Rate	$2,387.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,973.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,387.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.75

DU TEST

Facility

$66.00

Service Code	HCPCS 86885
Hospital Charge Code	38471088
Hospital Revenue Code	302
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

DU TEST

Facility

$66.00

Service Code	HCPCS 86885
Hospital Charge Code	38471088
Hospital Revenue Code	302
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$15.56
Rate for Payer: Aetna Medicare Advantage	$18.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.75
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$5.72
Rate for Payer: Clover Medicare Advantage	$5.43
Rate for Payer: EmblemHealth Commercial	$17.16
Rate for Payer: Humana Medicare Advantage	$5.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.72
Rate for Payer: Wellcare Medicare Advantage	$5.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

D-VI-SOL (VIT D 400IU/ML) LIQ

Facility

$4.00

Service Code	NDC 87086644
Hospital Charge Code	606390294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

D-VI-SOL (VIT D 400IU/ML) LIQ

Facility

$4.00

Service Code	NDC 87086644
Hospital Charge Code	606390294
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DVR ANATOMIC SHORT LEFT

Facility

$5,395.00

Hospital Charge Code	270638001
Hospital Revenue Code	278
Min. Negotiated Rate	$153.22
Max. Negotiated Rate	$2,697.50
Rate for Payer: Aetna Commercial	$2,050.10
Rate for Payer: Aetna Medicare Advantage	$1,618.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,375.72
Rate for Payer: Cigna Commercial	$2,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: Qualcare PPO/HMO/WC	$809.25
Rate for Payer: UnitedHealthcare Community & State	$170.48
Rate for Payer: Wellpoint Medicaid Managed Care	$153.22

DVR ANATOMIC SHORT LEFT

Facility

$5,395.00

Hospital Charge Code	270638001
Hospital Revenue Code	278
Min. Negotiated Rate	$809.25
Max. Negotiated Rate	$1,305.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: Qualcare PPO/HMO/WC	$809.25

DVR LOCK NARROW L

Facility

$7,525.00

Hospital Charge Code	270681160
Hospital Revenue Code	272
Min. Negotiated Rate	$213.71
Max. Negotiated Rate	$3,762.50
Rate for Payer: Aetna Commercial	$2,859.50
Rate for Payer: Aetna Medicare Advantage	$2,257.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,918.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,918.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,918.88
Rate for Payer: Cigna Commercial	$3,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.50
Rate for Payer: Oxford Commercial	$1,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,128.75
Rate for Payer: UnitedHealthcare Commercial	$1,505.00
Rate for Payer: UnitedHealthcare Community & State	$237.79
Rate for Payer: Wellpoint Medicaid Managed Care	$213.71

DVR LOCK NARROW L

Facility

$7,525.00

Hospital Charge Code	270681160
Hospital Revenue Code	272
Min. Negotiated Rate	$1,128.75
Max. Negotiated Rate	$1,128.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,128.75

DVR LOCK NARROW MINI R

Facility

$3,905.00

Hospital Charge Code	270688188
Hospital Revenue Code	272
Min. Negotiated Rate	$585.75
Max. Negotiated Rate	$585.75
Rate for Payer: Qualcare PPO/HMO/WC	$585.75

DVR LOCK NARROW MINI R

Facility

$3,905.00

Hospital Charge Code	270688188
Hospital Revenue Code	272
Min. Negotiated Rate	$110.90
Max. Negotiated Rate	$1,952.50
Rate for Payer: Aetna Commercial	$1,483.90
Rate for Payer: Aetna Medicare Advantage	$1,171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$995.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$995.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$995.77
Rate for Payer: Cigna Commercial	$1,952.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,015.30
Rate for Payer: Oxford Commercial	$781.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.75
Rate for Payer: UnitedHealthcare Commercial	$781.00
Rate for Payer: UnitedHealthcare Community & State	$123.40
Rate for Payer: Wellpoint Medicaid Managed Care	$110.90

DXA CT BONE DENSITY AXIAL-GL

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	85000310
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DXA CT BONE DENSITY AXIAL-GL

Facility

$5,100.00

Service Code	HCPCS 77080
Hospital Charge Code	85000310
Hospital Revenue Code	320
Min. Negotiated Rate	$86.94
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-BARIUM SWALLOW

Facility

$5,100.00

Service Code	HCPCS 74210
Hospital Charge Code	2008020
Hospital Revenue Code	320
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-BARIUM SWALLOW

Facility

$5,100.00

Service Code	HCPCS 74210
Hospital Charge Code	2008020
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX BONE MARROW BX AND ASPIRAT

Facility

$15,496.15

Service Code	HCPCS 38222
Hospital Charge Code	404138222
Hospital Revenue Code	361
Min. Negotiated Rate	$2,324.42
Max. Negotiated Rate	$2,324.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,324.42

Know your out-of-pocket cost for care.

All Charges