Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ALEUTAIN CX 11X14MM LOR 7MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270670150
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

ALEUTAIN CX 11X14MM LOR 7MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270670150
Hospital Revenue Code	278
Min. Negotiated Rate	$185.59
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$206.51
Rate for Payer: Wellpoint Medicaid Managed Care	$185.59

ALEUTAIN CX 11X14MM LOR 8MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270670152
Hospital Revenue Code	278
Min. Negotiated Rate	$185.59
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$206.51
Rate for Payer: Wellpoint Medicaid Managed Care	$185.59

ALEUTAIN CX 11X14MM LOR 8MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270670152
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

ALEUTAIN CX 11X14MM LOR 9MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270670154
Hospital Revenue Code	278
Min. Negotiated Rate	$185.59
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$206.51
Rate for Payer: Wellpoint Medicaid Managed Care	$185.59

ALEUTAIN CX 11X14MM LOR 9MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270670154
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

ALEUTAIN CX 13X16MM LOR 10MM

Facility

$7,080.00

Hospital Charge Code	270670180
Hospital Revenue Code	278
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,690.40
Rate for Payer: Aetna Medicare Advantage	$2,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,805.40
Rate for Payer: Cigna Commercial	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00
Rate for Payer: UnitedHealthcare Community & State	$223.73
Rate for Payer: Wellpoint Medicaid Managed Care	$201.07

ALEUTAIN CX 13X16MM LOR 10MM

Facility

$7,080.00

Hospital Charge Code	270670180
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,713.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00

ALEUTAIN CX 13X16MM LOR 11MM

Facility

$7,080.00

Hospital Charge Code	270670181
Hospital Revenue Code	278
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,690.40
Rate for Payer: Aetna Medicare Advantage	$2,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,805.40
Rate for Payer: Cigna Commercial	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00
Rate for Payer: UnitedHealthcare Community & State	$223.73
Rate for Payer: Wellpoint Medicaid Managed Care	$201.07

ALEUTAIN CX 13X16MM LOR 11MM

Facility

$7,080.00

Hospital Charge Code	270670181
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,713.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00

ALEUTAIN CX 13X16MM LOR 12MM

Facility

$7,080.00

Hospital Charge Code	270670182
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,713.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00

ALEUTAIN CX 13X16MM LOR 12MM

Facility

$7,080.00

Hospital Charge Code	270670182
Hospital Revenue Code	278
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,690.40
Rate for Payer: Aetna Medicare Advantage	$2,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,805.40
Rate for Payer: Cigna Commercial	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00
Rate for Payer: UnitedHealthcare Community & State	$223.73
Rate for Payer: Wellpoint Medicaid Managed Care	$201.07

ALEUTAIN CX 13X16MM LOR 5MM

Facility

$7,080.00

Hospital Charge Code	270670175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,713.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00

ALEUTAIN CX 13X16MM LOR 5MM

Facility

$7,080.00

Hospital Charge Code	270670175
Hospital Revenue Code	278
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,690.40
Rate for Payer: Aetna Medicare Advantage	$2,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,805.40
Rate for Payer: Cigna Commercial	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00
Rate for Payer: UnitedHealthcare Community & State	$223.73
Rate for Payer: Wellpoint Medicaid Managed Care	$201.07

ALEUTAIN CX 13X16MM LOR 6MM

Facility

$7,080.00

Hospital Charge Code	270670176
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,713.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00

ALEUTAIN CX 13X16MM LOR 6MM

Facility

$7,080.00

Hospital Charge Code	270670176
Hospital Revenue Code	278
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,690.40
Rate for Payer: Aetna Medicare Advantage	$2,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,805.40
Rate for Payer: Cigna Commercial	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00
Rate for Payer: UnitedHealthcare Community & State	$223.73
Rate for Payer: Wellpoint Medicaid Managed Care	$201.07

ALEUTAIN CX 13X16MM LOR 7MM

Facility

$7,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270670177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,713.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00

ALEUTAIN CX 13X16MM LOR 7MM

Facility

$7,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270670177
Hospital Revenue Code	278
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,690.40
Rate for Payer: Aetna Medicare Advantage	$2,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,805.40
Rate for Payer: Cigna Commercial	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00
Rate for Payer: UnitedHealthcare Community & State	$223.73
Rate for Payer: Wellpoint Medicaid Managed Care	$201.07

ALEUTAIN CX 13X16MM LOR 8MM

Facility

$7,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270670178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,713.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00

ALEUTAIN CX 13X16MM LOR 8MM

Facility

$7,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270670178
Hospital Revenue Code	278
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,690.40
Rate for Payer: Aetna Medicare Advantage	$2,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,805.40
Rate for Payer: Cigna Commercial	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00
Rate for Payer: UnitedHealthcare Community & State	$223.73
Rate for Payer: Wellpoint Medicaid Managed Care	$201.07

ALEUTAIN CX 13X16MM LOR 9MM

Facility

$7,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270670179
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,713.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00

ALEUTAIN CX 13X16MM LOR 9MM

Facility

$7,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270670179
Hospital Revenue Code	278
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$3,540.00
Rate for Payer: Aetna Commercial	$2,690.40
Rate for Payer: Aetna Medicare Advantage	$2,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,805.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,805.40
Rate for Payer: Cigna Commercial	$3,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,713.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,062.00
Rate for Payer: UnitedHealthcare Community & State	$223.73
Rate for Payer: Wellpoint Medicaid Managed Care	$201.07

ALEUTIAN 28X36MM 15DG LOR 13MM

Facility

$23,515.00

Service Code	HCPCS C1713
Hospital Charge Code	270670112
Hospital Revenue Code	278
Min. Negotiated Rate	$667.83
Max. Negotiated Rate	$11,757.50
Rate for Payer: Aetna Commercial	$8,935.70
Rate for Payer: Aetna Medicare Advantage	$7,054.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,996.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,996.32
Rate for Payer: Cigna Commercial	$11,757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25
Rate for Payer: UnitedHealthcare Community & State	$743.07
Rate for Payer: Wellpoint Medicaid Managed Care	$667.83

ALEUTIAN 28X36MM 15DG LOR 13MM

Facility

$23,515.00

Service Code	HCPCS C1713
Hospital Charge Code	270670112
Hospital Revenue Code	278
Min. Negotiated Rate	$3,527.25
Max. Negotiated Rate	$5,690.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,703.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,690.63
Rate for Payer: Qualcare PPO/HMO/WC	$3,527.25

ALEXIS CONTAINED EXTRACT 14 MM

Facility

$1,625.00

Hospital Charge Code	270692199
Hospital Revenue Code	272
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$422.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$325.00
Rate for Payer: UnitedHealthcare Community & State	$51.35
Rate for Payer: Wellpoint Medicaid Managed Care	$46.15

Know your out-of-pocket cost for care.

All Charges