Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DYNANITE STAPLE9WX10L

Facility

$7,475.00

Hospital Charge Code	270686092
Hospital Revenue Code	272
Min. Negotiated Rate	$212.29
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,943.50
Rate for Payer: Oxford Commercial	$1,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$1,495.00
Rate for Payer: UnitedHealthcare Community & State	$236.21
Rate for Payer: Wellpoint Medicaid Managed Care	$212.29

DYNANITE STAPLE9WX10L

Facility

$7,475.00

Hospital Charge Code	270686092
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

DYNANITE STR 12MM W/INSTR

Facility

$9,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690882
Hospital Revenue Code	278
Min. Negotiated Rate	$269.09
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$299.41
Rate for Payer: Wellpoint Medicaid Managed Care	$269.09

DYNANITE STR 12MM W/INSTR

Facility

$9,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690882
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

DYNANITE STR 14MM W/INSTR

Facility

$9,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690883
Hospital Revenue Code	278
Min. Negotiated Rate	$269.09
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$299.41
Rate for Payer: Wellpoint Medicaid Managed Care	$269.09

DYNANITE STR 14MM W/INSTR

Facility

$9,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

DYNAPEN/500MG/TAB

Facility

$18.29

Service Code	NDC 93312501
Hospital Charge Code	60634758
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$2.74
Rate for Payer: Qualcare PPO/HMO/WC	$2.74

DYNAPEN/500MG/TAB

Facility

$18.29

Service Code	NDC 93312501
Hospital Charge Code	60634758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.14
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: Aetna Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.66
Rate for Payer: Cigna Commercial	$9.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.76
Rate for Payer: Oxford Commercial	$3.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.74
Rate for Payer: UnitedHealthcare Commercial	$3.66
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

DYONICS 4.0MM EL ACROMIOBLASTR

Facility

$250.00

Hospital Charge Code	270692788
Hospital Revenue Code	272
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

DYONICS 4.0MM EL ACROMIOBLASTR

Facility

$250.00

Hospital Charge Code	270692788
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

DYSEQUILIBRIUM

Facility

$43,210.35

Service Code	MSDRG 149
Min. Negotiated Rate	$13,157.00
Max. Negotiated Rate	$43,210.35
Rate for Payer: Aetna Commercial	$32,633.40
Rate for Payer: Aetna Medicare Advantage	$43,210.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,501.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,501.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,849.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,501.70
Rate for Payer: Cigna Commercial	$16,755.42
Rate for Payer: Cigna Medicare Advantage	$13,849.47
Rate for Payer: Clover Medicare Advantage	$13,157.00
Rate for Payer: EmblemHealth Commercial	$41,548.41
Rate for Payer: Humana Medicare Advantage	$14,264.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,849.47
Rate for Payer: Oxford Commercial	$13,243.19
Rate for Payer: UnitedHealthcare Commercial	$17,726.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,849.47
Rate for Payer: Wellcare Medicare Advantage	$13,849.47

E1 VNGD PS+ TIB BRG 63/67X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682023
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

E1 VNGD PS+ TIB BRG 63/67X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270682023
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

E1 VNGD PS+ TIB BRG 63/67X16

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683822
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

E1 VNGD PS+ TIB BRG 63/67X16

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683822
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

E1 VNGD PS+ TIB BRG 71/75X12

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676504
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

E1 VNGD PS+ TIB BRG 71/75X12

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676504
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

E1 VNGD PS TIB BRG 71/75X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687301
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

E1 VNGD PS TIB BRG 71/75X14

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687301
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

E 1 VNGD PS+TIB BRG 71/75X18

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685250
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

E 1 VNGD PS+TIB BRG 71/75X18

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685250
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

E7M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Hospital Charge Code	84310165
Hospital Revenue Code	513
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$107.69
Rate for Payer: Aetna Medicare Advantage	$85.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.27
Rate for Payer: Cigna Commercial	$141.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.68
Rate for Payer: Qualcare PPO/HMO/WC	$42.51
Rate for Payer: UnitedHealthcare Community & State	$8.96
Rate for Payer: Wellpoint Medicaid Managed Care	$8.05

E7M LEVEL I ESTAB. 5 MINS

Facility

$283.40

Hospital Charge Code	84310165
Hospital Revenue Code	513
Min. Negotiated Rate	$42.51
Max. Negotiated Rate	$42.51
Rate for Payer: Qualcare PPO/HMO/WC	$42.51

EACH ADDN'L IMMUNIZTION ADMNT

Facility

$45.00

Service Code	HCPCS 90461
Hospital Charge Code	5780275
Hospital Revenue Code	771
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.28

EACH ADDN'L IMMUNIZTION ADMNT

Facility

$45.00

Service Code	HCPCS 90461
Hospital Charge Code	5780275
Hospital Revenue Code	771
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

Know your out-of-pocket cost for care.

All Charges