Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ELECT STIMULATION-ATTNDED-15 M

Facility

$247.00

Service Code	HCPCS 97032GO
Hospital Charge Code	1008165
Hospital Revenue Code	430
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

ELECT STIM-UNATTENDED NOT WC

Facility

$206.00

Service Code	HCPCS 97014GO
Hospital Charge Code	1008135
Hospital Revenue Code	430
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$78.28
Rate for Payer: Aetna Medicare Advantage	$61.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.53
Rate for Payer: Cigna Commercial	$103.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.56
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$5.85

ELECT STIM-UNATTENDED NOT WC

Facility

$206.00

Service Code	HCPCS 97014GO
Hospital Charge Code	1008135
Hospital Revenue Code	430
Min. Negotiated Rate	$30.90
Max. Negotiated Rate	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.90

Elevate Anterior Apical Prolap

Facility

$12,620.00

Hospital Charge Code	270666116
Hospital Revenue Code	278
Min. Negotiated Rate	$1,893.00
Max. Negotiated Rate	$3,054.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,054.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,893.00

Elevate Anterior Apical Prolap

Facility

$12,620.00

Hospital Charge Code	270666116
Hospital Revenue Code	278
Min. Negotiated Rate	$358.41
Max. Negotiated Rate	$6,310.00
Rate for Payer: Aetna Commercial	$4,795.60
Rate for Payer: Aetna Medicare Advantage	$3,786.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,218.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,218.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,218.10
Rate for Payer: Cigna Commercial	$6,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,054.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,893.00
Rate for Payer: UnitedHealthcare Community & State	$398.79
Rate for Payer: Wellpoint Medicaid Managed Care	$358.41

ELEVATOR PERIOSTEAL 3MM

Facility

$766.30

Hospital Charge Code	270655333
Hospital Revenue Code	272
Min. Negotiated Rate	$21.76
Max. Negotiated Rate	$383.15
Rate for Payer: Aetna Commercial	$291.19
Rate for Payer: Aetna Medicare Advantage	$229.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.41
Rate for Payer: Cigna Commercial	$383.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.24
Rate for Payer: Oxford Commercial	$153.26
Rate for Payer: Qualcare PPO/HMO/WC	$114.94
Rate for Payer: UnitedHealthcare Commercial	$153.26
Rate for Payer: UnitedHealthcare Community & State	$24.22
Rate for Payer: Wellpoint Medicaid Managed Care	$21.76

ELEVATOR PERIOSTEAL 3MM

Facility

$766.30

Hospital Charge Code	270655333
Hospital Revenue Code	272
Min. Negotiated Rate	$114.94
Max. Negotiated Rate	$114.94
Rate for Payer: Qualcare PPO/HMO/WC	$114.94

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Service Code	HCPCS C1713
Hospital Charge Code	270651708
Hospital Revenue Code	272
Min. Negotiated Rate	$133.95
Max. Negotiated Rate	$133.95
Rate for Payer: Qualcare PPO/HMO/WC	$133.95

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Service Code	HCPCS C1713
Hospital Charge Code	270651708
Hospital Revenue Code	272
Min. Negotiated Rate	$25.36
Max. Negotiated Rate	$446.50
Rate for Payer: Aetna Commercial	$339.34
Rate for Payer: Aetna Medicare Advantage	$267.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.72
Rate for Payer: Cigna Commercial	$446.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.18
Rate for Payer: Oxford Commercial	$178.60
Rate for Payer: Qualcare PPO/HMO/WC	$133.95
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: UnitedHealthcare Community & State	$28.22
Rate for Payer: Wellpoint Medicaid Managed Care	$25.36

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Hospital Charge Code	270614782
Hospital Revenue Code	272
Min. Negotiated Rate	$133.95
Max. Negotiated Rate	$133.95
Rate for Payer: Qualcare PPO/HMO/WC	$133.95

ELEVATOR PERIOSTEAL 6mm CRVD

Facility

$893.00

Hospital Charge Code	270614782
Hospital Revenue Code	272
Min. Negotiated Rate	$25.36
Max. Negotiated Rate	$446.50
Rate for Payer: Aetna Commercial	$339.34
Rate for Payer: Aetna Medicare Advantage	$267.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.72
Rate for Payer: Cigna Commercial	$446.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.18
Rate for Payer: Oxford Commercial	$178.60
Rate for Payer: Qualcare PPO/HMO/WC	$133.95
Rate for Payer: UnitedHealthcare Commercial	$178.60
Rate for Payer: UnitedHealthcare Community & State	$28.22
Rate for Payer: Wellpoint Medicaid Managed Care	$25.36

ELIGARD LEUPROLIDE ACET 7.5 MG

Facility

$3,631.60

Service Code	HCPCS J9217
Hospital Charge Code	6063943351
Hospital Revenue Code	636
Min. Negotiated Rate	$544.74
Max. Negotiated Rate	$878.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.85
Rate for Payer: Qualcare PPO/HMO/WC	$544.74

ELIGARD LEUPROLIDE ACET 7.5 MG

Facility

$3,631.60

Service Code	HCPCS J9217
Hospital Charge Code	6063943351
Hospital Revenue Code	636
Min. Negotiated Rate	$103.14
Max. Negotiated Rate	$878.85
Rate for Payer: Aetna Commercial	$479.26
Rate for Payer: Aetna Medicare Advantage	$570.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$639.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$639.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$176.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$186.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$639.17
Rate for Payer: Cigna Medicare Advantage	$176.20
Rate for Payer: Clover Medicare Advantage	$167.39
Rate for Payer: EmblemHealth Commercial	$528.60
Rate for Payer: Humana Medicare Advantage	$181.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$176.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.85
Rate for Payer: Qualcare PPO/HMO/WC	$544.74
Rate for Payer: UnitedHealthcare Community & State	$114.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.20
Rate for Payer: Wellcare Medicare Advantage	$176.20
Rate for Payer: Wellpoint Medicaid Managed Care	$103.14

ELITE 30X20X20MM STRAIGHT BRID

Facility

$8,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270682113
Hospital Revenue Code	278
Min. Negotiated Rate	$1,203.75
Max. Negotiated Rate	$1,942.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,942.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75

ELITE 30X20X20MM STRAIGHT BRID

Facility

$8,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270682113
Hospital Revenue Code	278
Min. Negotiated Rate	$227.91
Max. Negotiated Rate	$4,012.50
Rate for Payer: Aetna Commercial	$3,049.50
Rate for Payer: Aetna Medicare Advantage	$2,407.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,046.38
Rate for Payer: Cigna Commercial	$4,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,942.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75
Rate for Payer: UnitedHealthcare Community & State	$253.59
Rate for Payer: Wellpoint Medicaid Managed Care	$227.91

ELITE COMPRESS IMPLANT 18X18X1

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270681552
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

ELITE COMPRESS IMPLANT 18X18X1

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270681552
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

ELITE COMPRESS IMPLANT 20X20X2

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681553
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

ELITE COMPRESS IMPLANT 20X20X2

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270681553
Hospital Revenue Code	278
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25
Rate for Payer: UnitedHealthcare Community & State	$248.85
Rate for Payer: Wellpoint Medicaid Managed Care	$223.65

ELITE COMPRESSION IMPLANTKIT 4

Facility

$8,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270682437
Hospital Revenue Code	278
Min. Negotiated Rate	$227.91
Max. Negotiated Rate	$4,012.50
Rate for Payer: Aetna Commercial	$3,049.50
Rate for Payer: Aetna Medicare Advantage	$2,407.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,046.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,046.38
Rate for Payer: Cigna Commercial	$4,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,942.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75
Rate for Payer: UnitedHealthcare Community & State	$253.59
Rate for Payer: Wellpoint Medicaid Managed Care	$227.91

ELITE COMPRESSION IMPLANTKIT 4

Facility

$8,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270682437
Hospital Revenue Code	278
Min. Negotiated Rate	$1,203.75
Max. Negotiated Rate	$1,942.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,942.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,203.75

ELITECROSS 132CM ANG

Facility

$1,125.00

Hospital Charge Code	270687002N
Hospital Revenue Code	272
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.95

ELITECROSS 132CM ANG

Facility

$1,125.00

Hospital Charge Code	270687002S
Hospital Revenue Code	272
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.95

ELITECROSS 132CM ANG

Facility

$1,125.00

Hospital Charge Code	270687002S
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

ELITECROSS 132CM ANG

Facility

$1,125.00

Hospital Charge Code	270687002N
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

Know your out-of-pocket cost for care.

All Charges