Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EXPRESS MINI-GLAUCOMA S DEVICE

Facility

$4,300.00

Hospital Charge Code	270339103
Hospital Revenue Code	274
Min. Negotiated Rate	$645.00
Max. Negotiated Rate	$1,040.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,040.60
Rate for Payer: Qualcare PPO/HMO/WC	$645.00

EXPRESS MINI-GLAUCOMA S DEVICE

Facility

$4,300.00

Hospital Charge Code	270339103
Hospital Revenue Code	274
Min. Negotiated Rate	$122.12
Max. Negotiated Rate	$2,150.00
Rate for Payer: Aetna Commercial	$1,634.00
Rate for Payer: Aetna Medicare Advantage	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,096.50
Rate for Payer: Cigna Commercial	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,040.60
Rate for Payer: Qualcare PPO/HMO/WC	$645.00
Rate for Payer: UnitedHealthcare Community & State	$135.88
Rate for Payer: Wellpoint Medicaid Managed Care	$122.12

EXP SPACER 10X28X10-16MM 15D

Facility

$35,000.00

Hospital Charge Code	270703475
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$8,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,470.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,250.00

EXP SPACER 10X28X10-16MM 15D

Facility

$35,000.00

Hospital Charge Code	270703475
Hospital Revenue Code	278
Min. Negotiated Rate	$994.00
Max. Negotiated Rate	$17,500.00
Rate for Payer: Aetna Commercial	$13,300.00
Rate for Payer: Aetna Medicare Advantage	$10,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,925.00
Rate for Payer: Cigna Commercial	$17,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,470.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,250.00
Rate for Payer: UnitedHealthcare Community & State	$1,106.00
Rate for Payer: Wellpoint Medicaid Managed Care	$994.00

EXSTENSIVE PROSTATE SURGERY

Facility

$22,051.00

Service Code	HCPCS 55840
Hospital Charge Code	1600000443
Hospital Revenue Code	360
Min. Negotiated Rate	$3,307.65
Max. Negotiated Rate	$3,307.65
Rate for Payer: Qualcare PPO/HMO/WC	$3,307.65

EXSTENSIVE PROSTATE SURGERY

Facility

$22,051.00

Service Code	HCPCS 55840
Hospital Charge Code	1600000443
Hospital Revenue Code	360
Min. Negotiated Rate	$626.25
Max. Negotiated Rate	$11,025.50
Rate for Payer: Aetna Commercial	$8,379.38
Rate for Payer: Aetna Medicare Advantage	$6,615.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,623.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,623.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,623.01
Rate for Payer: Cigna Commercial	$11,025.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,733.26
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,307.65
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$696.81
Rate for Payer: Wellpoint Medicaid Managed Care	$626.25

EX TAB 5.5X40MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705051
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

EX TAB 5.5X40MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705051
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

EX TAB 56.5X40MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705052
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

EX TAB 56.5X40MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705052
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

EX TAB 6.5X35MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705053
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

EX TAB 6.5X35MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705053
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

EXTENDER REAR TIP 2.0CM

Facility

$1,272.60

Hospital Charge Code	270661190
Hospital Revenue Code	278
Min. Negotiated Rate	$190.89
Max. Negotiated Rate	$307.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.97
Rate for Payer: Qualcare PPO/HMO/WC	$190.89

EXTENDER REAR TIP 2.0CM

Facility

$1,272.60

Hospital Charge Code	270661190
Hospital Revenue Code	278
Min. Negotiated Rate	$36.14
Max. Negotiated Rate	$636.30
Rate for Payer: Aetna Commercial	$483.59
Rate for Payer: Aetna Medicare Advantage	$381.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$324.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$324.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$324.51
Rate for Payer: Cigna Commercial	$636.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.97
Rate for Payer: Qualcare PPO/HMO/WC	$190.89
Rate for Payer: UnitedHealthcare Community & State	$40.21
Rate for Payer: Wellpoint Medicaid Managed Care	$36.14

EXTENDER TAB 6642007

Facility

$3,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270696284
Hospital Revenue Code	278
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$1,577.50
Rate for Payer: Aetna Commercial	$1,198.90
Rate for Payer: Aetna Medicare Advantage	$946.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$804.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$804.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$804.52
Rate for Payer: Cigna Commercial	$1,577.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$763.51
Rate for Payer: Qualcare PPO/HMO/WC	$473.25
Rate for Payer: UnitedHealthcare Community & State	$99.70
Rate for Payer: Wellpoint Medicaid Managed Care	$89.60

EXTENDER TAB 6642007

Facility

$3,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270696284
Hospital Revenue Code	278
Min. Negotiated Rate	$473.25
Max. Negotiated Rate	$763.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$763.51
Rate for Payer: Qualcare PPO/HMO/WC	$473.25

EXTEND TAB TULIP MODULAR MIS

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270696743
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

EXTEND TAB TULIP MODULAR MIS

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270696743
Hospital Revenue Code	278
Min. Negotiated Rate	$191.42
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$212.98
Rate for Payer: Wellpoint Medicaid Managed Care	$191.42

EXTENSION MODULAR 13x10MM

Facility

$2,140.00

Hospital Charge Code	270677208
Hospital Revenue Code	278
Min. Negotiated Rate	$321.00
Max. Negotiated Rate	$517.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: Qualcare PPO/HMO/WC	$321.00

EXTENSION MODULAR 13x10MM

Facility

$2,140.00

Hospital Charge Code	270677208
Hospital Revenue Code	278
Min. Negotiated Rate	$60.78
Max. Negotiated Rate	$1,070.00
Rate for Payer: Aetna Commercial	$813.20
Rate for Payer: Aetna Medicare Advantage	$642.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$545.70
Rate for Payer: Cigna Commercial	$1,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: Qualcare PPO/HMO/WC	$321.00
Rate for Payer: UnitedHealthcare Community & State	$67.62
Rate for Payer: Wellpoint Medicaid Managed Care	$60.78

EXTENSION STEM INSTRUMENT SET

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689819
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

EXTENSION STEM INSTRUMENT SET

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689819
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

EXTENSION STEM SET

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688396
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

EXTENSION STEM SET

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688396
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

EXTENSION TUBE FR EPIDURAL INJ

Facility

$182.00

Hospital Charge Code	270325400
Hospital Revenue Code	272
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial	$69.16
Rate for Payer: Aetna Medicare Advantage	$54.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.41
Rate for Payer: Cigna Commercial	$91.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.32
Rate for Payer: Oxford Commercial	$36.40
Rate for Payer: Qualcare PPO/HMO/WC	$27.30
Rate for Payer: UnitedHealthcare Commercial	$36.40
Rate for Payer: UnitedHealthcare Community & State	$5.75
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

Know your out-of-pocket cost for care.

All Charges