Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EXTRACTOR NCIRCLE STONE

Facility

$1,011.40

Hospital Charge Code	270653910
Hospital Revenue Code	272
Min. Negotiated Rate	$28.72
Max. Negotiated Rate	$505.70
Rate for Payer: Aetna Commercial	$384.33
Rate for Payer: Aetna Medicare Advantage	$303.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$257.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$257.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$257.91
Rate for Payer: Cigna Commercial	$505.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.96
Rate for Payer: Oxford Commercial	$202.28
Rate for Payer: Qualcare PPO/HMO/WC	$151.71
Rate for Payer: UnitedHealthcare Commercial	$202.28
Rate for Payer: UnitedHealthcare Community & State	$31.96
Rate for Payer: Wellpoint Medicaid Managed Care	$28.72

EXTRACTOR NCIRCLE STONE

Facility

$1,011.40

Hospital Charge Code	270653910
Hospital Revenue Code	272
Min. Negotiated Rate	$151.71
Max. Negotiated Rate	$151.71
Rate for Payer: Qualcare PPO/HMO/WC	$151.71

EXTRACTOR NCIRCLE STONE 2.4FR

Facility

$1,127.65

Hospital Charge Code	270658550
Hospital Revenue Code	278
Min. Negotiated Rate	$169.15
Max. Negotiated Rate	$272.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.89
Rate for Payer: Qualcare PPO/HMO/WC	$169.15

EXTRACTOR NCIRCLE STONE 2.4FR

Facility

$1,127.65

Hospital Charge Code	270658550
Hospital Revenue Code	278
Min. Negotiated Rate	$32.03
Max. Negotiated Rate	$563.83
Rate for Payer: Aetna Commercial	$428.51
Rate for Payer: Aetna Medicare Advantage	$338.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.55
Rate for Payer: Cigna Commercial	$563.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.89
Rate for Payer: Qualcare PPO/HMO/WC	$169.15
Rate for Payer: UnitedHealthcare Community & State	$35.63
Rate for Payer: Wellpoint Medicaid Managed Care	$32.03

EXTRACTOR RX 9-12mm BALLN 4693

Facility

$775.00

Hospital Charge Code	270644048
Hospital Revenue Code	272
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.50
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$155.00
Rate for Payer: UnitedHealthcare Community & State	$24.49
Rate for Payer: Wellpoint Medicaid Managed Care	$22.01

EXTRACTOR RX 9-12mm BALLN 4693

Facility

$775.00

Hospital Charge Code	270644048
Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

EXTRACTOR S9 BROKEN 2MM DISP

Facility

$1,700.00

Hospital Charge Code	270696266
Hospital Revenue Code	272
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$53.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48.28

EXTRACTOR S9 BROKEN 2MM DISP

Facility

$1,700.00

Hospital Charge Code	270696266
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTOR S9 BROKEN 3MM DISP

Facility

$1,700.00

Hospital Charge Code	270696267
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTOR S9 BROKEN 3MM DISP

Facility

$1,700.00

Hospital Charge Code	270696267
Hospital Revenue Code	272
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$53.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48.28

EXTRACTOR S9 BROKEN 4MM DISP

Facility

$1,700.00

Hospital Charge Code	270696268
Hospital Revenue Code	272
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$53.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48.28

EXTRACTOR S9 BROKEN 4MM DISP

Facility

$1,700.00

Hospital Charge Code	270696268
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTOR S9 STRIPPED 2MM DISP

Facility

$1,700.00

Hospital Charge Code	270696263
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTOR S9 STRIPPED 2MM DISP

Facility

$1,700.00

Hospital Charge Code	270696263
Hospital Revenue Code	272
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$53.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48.28

EXTRACTOR S9 STRIPPED 4MM DISP

Facility

$1,700.00

Hospital Charge Code	270696264
Hospital Revenue Code	272
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$53.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48.28

EXTRACTOR S9 STRIPPED 4MM DISP

Facility

$1,700.00

Hospital Charge Code	270696264
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTOR SCREW 6MM SINGLE USE

Facility

$1,700.00

Hospital Charge Code	270695327
Hospital Revenue Code	272
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.00
Rate for Payer: Oxford Commercial	$340.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Commercial	$340.00
Rate for Payer: UnitedHealthcare Community & State	$53.72
Rate for Payer: Wellpoint Medicaid Managed Care	$48.28

EXTRACTOR SCREW 6MM SINGLE USE

Facility

$1,700.00

Hospital Charge Code	270695327
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTOR SCREW STRIPPED 7 MM

Facility

$1,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270688296
Hospital Revenue Code	278
Min. Negotiated Rate	$44.02
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Community & State	$48.98
Rate for Payer: Wellpoint Medicaid Managed Care	$44.02

EXTRACTOR SCREW STRIPPED 7 MM

Facility

$1,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270688296
Hospital Revenue Code	278
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$375.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

EXTRACTOR STAPLE

Facility

$5.00

Hospital Charge Code	270014130
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

EXTRACTOR STAPLE

Facility

$5.00

Hospital Charge Code	270014130
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

EXTRACTOR STONE ATLAS WIRE 3FR

Facility

$1,100.00

Hospital Charge Code	270660562
Hospital Revenue Code	272
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

EXTRACTOR STONE ATLAS WIRE 3FR

Facility

$1,100.00

Hospital Charge Code	270660562
Hospital Revenue Code	272
Min. Negotiated Rate	$31.24
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.00
Rate for Payer: Oxford Commercial	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Commercial	$220.00
Rate for Payer: UnitedHealthcare Community & State	$34.76
Rate for Payer: Wellpoint Medicaid Managed Care	$31.24

EXTRACTOR STONE CAPTURA 2.5FR

Facility

$883.05

Hospital Charge Code	270658544
Hospital Revenue Code	272
Min. Negotiated Rate	$25.08
Max. Negotiated Rate	$441.52
Rate for Payer: Aetna Commercial	$335.56
Rate for Payer: Aetna Medicare Advantage	$264.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.18
Rate for Payer: Cigna Commercial	$441.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.59
Rate for Payer: Oxford Commercial	$176.61
Rate for Payer: Qualcare PPO/HMO/WC	$132.46
Rate for Payer: UnitedHealthcare Commercial	$176.61
Rate for Payer: UnitedHealthcare Community & State	$27.90
Rate for Payer: Wellpoint Medicaid Managed Care	$25.08

Know your out-of-pocket cost for care.

All Charges