Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EXTRACTOR STONE CAPTURA 2.5FR

Facility

$883.05

Hospital Charge Code	270658544
Hospital Revenue Code	272
Min. Negotiated Rate	$132.46
Max. Negotiated Rate	$132.46
Rate for Payer: Qualcare PPO/HMO/WC	$132.46

EXTRACTOR STONE NGAGE NITINOL

Facility

$1,029.00

Hospital Charge Code	270653935
Hospital Revenue Code	271
Min. Negotiated Rate	$29.22
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$391.02
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.54
Rate for Payer: Oxford Commercial	$205.80
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Commercial	$205.80
Rate for Payer: UnitedHealthcare Community & State	$32.52
Rate for Payer: Wellpoint Medicaid Managed Care	$29.22

EXTRACTOR STONE NGAGE NITINOL

Facility

$1,029.00

Hospital Charge Code	270653935
Hospital Revenue Code	271
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$154.35
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

EXTRACTOR STONE NIT 1.7F 115CM

Facility

$1,044.05

Hospital Charge Code	270698292
Hospital Revenue Code	272
Min. Negotiated Rate	$156.61
Max. Negotiated Rate	$156.61
Rate for Payer: Qualcare PPO/HMO/WC	$156.61

EXTRACTOR STONE NIT 1.7F 115CM

Facility

$1,044.05

Hospital Charge Code	270698292
Hospital Revenue Code	272
Min. Negotiated Rate	$29.65
Max. Negotiated Rate	$522.02
Rate for Payer: Aetna Commercial	$396.74
Rate for Payer: Aetna Medicare Advantage	$313.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.23
Rate for Payer: Cigna Commercial	$522.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.45
Rate for Payer: Oxford Commercial	$208.81
Rate for Payer: Qualcare PPO/HMO/WC	$156.61
Rate for Payer: UnitedHealthcare Commercial	$208.81
Rate for Payer: UnitedHealthcare Community & State	$32.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.65

EXTRACTOR STONE NITINOL 10 FR

Facility

$472.50

Hospital Charge Code	270669757
Hospital Revenue Code	272
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$70.88
Rate for Payer: Qualcare PPO/HMO/WC	$70.88

EXTRACTOR STONE NITINOL 10 FR

Facility

$472.50

Hospital Charge Code	270669757
Hospital Revenue Code	272
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Commercial	$179.55
Rate for Payer: Aetna Medicare Advantage	$141.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.49
Rate for Payer: Cigna Commercial	$236.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.85
Rate for Payer: Oxford Commercial	$94.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.88
Rate for Payer: UnitedHealthcare Commercial	$94.50
Rate for Payer: UnitedHealthcare Community & State	$14.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.42

EXTRACTOR STONE RETR XL 6

Facility

$550.00

Hospital Charge Code	270604772
Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

EXTRACTOR STONE RETR XL 6

Facility

$550.00

Hospital Charge Code	270604772
Hospital Revenue Code	272
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Oxford Commercial	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$110.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

EXTRACTRSTRIPSCREW2MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695331
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRACTRSTRIPSCREW2MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695331
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

EXTRACTRSTRIPSCREW4MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695332
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

EXTRACTRSTRIPSCREW4MMSINGLEUSE

Facility

$1,700.00

Hospital Charge Code	270695332
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

EXTRAOCULAR PROCEDURES EXCEPT ORBIT

Facility

$67,957.56

Service Code	MSDRG 115
Min. Negotiated Rate	$20,692.21
Max. Negotiated Rate	$67,957.56
Rate for Payer: Aetna Commercial	$50,258.68
Rate for Payer: Aetna Medicare Advantage	$67,957.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,219.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,219.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,781.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,219.80
Rate for Payer: Cigna Commercial	$34,217.53
Rate for Payer: Cigna Medicare Advantage	$21,781.27
Rate for Payer: Clover Medicare Advantage	$20,692.21
Rate for Payer: EmblemHealth Commercial	$65,343.81
Rate for Payer: Humana Medicare Advantage	$22,434.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,781.27
Rate for Payer: Oxford Commercial	$27,044.94
Rate for Payer: UnitedHealthcare Commercial	$36,200.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,781.27
Rate for Payer: Wellcare Medicare Advantage	$21,781.27

EXTRCTR PRO RPD 15-18M00547020

Facility

$742.00

Hospital Charge Code	270646921
Hospital Revenue Code	272
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$111.30
Rate for Payer: Qualcare PPO/HMO/WC	$111.30

EXTRCTR PRO RPD 15-18M00547020

Facility

$742.00

Hospital Charge Code	270646921
Hospital Revenue Code	272
Min. Negotiated Rate	$21.07
Max. Negotiated Rate	$371.00
Rate for Payer: Aetna Commercial	$281.96
Rate for Payer: Aetna Medicare Advantage	$222.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.21
Rate for Payer: Cigna Commercial	$371.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.92
Rate for Payer: Oxford Commercial	$148.40
Rate for Payer: Qualcare PPO/HMO/WC	$111.30
Rate for Payer: UnitedHealthcare Commercial	$148.40
Rate for Payer: UnitedHealthcare Community & State	$23.45
Rate for Payer: Wellpoint Medicaid Managed Care	$21.07

EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE

Facility

$207,240.95

Service Code	MSDRG 790
Min. Negotiated Rate	$6,236.00
Max. Negotiated Rate	$207,240.95
Rate for Payer: Aetna Commercial	$149,457.90
Rate for Payer: Aetna Medicare Advantage	$207,240.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$66,423.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166,230.00
Rate for Payer: Cigna Commercial	$132,498.45
Rate for Payer: Cigna Medicare Advantage	$66,423.38
Rate for Payer: Clover Medicare Advantage	$63,102.21
Rate for Payer: EmblemHealth Commercial	$199,270.14
Rate for Payer: Humana Medicare Advantage	$68,416.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$66,423.38
Rate for Payer: Oxford Commercial	$6,236.00
Rate for Payer: UnitedHealthcare Commercial	$7,078.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$66,423.38
Rate for Payer: Wellcare Medicare Advantage	$66,423.38

EXTREMITY ANGIO-LT

Facility

$15,468.50

Service Code	HCPCS 75710LT
Hospital Charge Code	366875710L
Hospital Revenue Code	323
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

EXTREMITY ANGIO-LT

Facility

$15,468.50

Service Code	HCPCS 75710LT
Hospital Charge Code	366875710L
Hospital Revenue Code	323
Min. Negotiated Rate	$439.31
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$5,878.03
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,021.81
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$488.80
Rate for Payer: Wellpoint Medicaid Managed Care	$439.31

EXTREMITY ANGIO-LT

Facility

$15,468.50

Service Code	HCPCS 75710LT
Hospital Charge Code	411075710L
Hospital Revenue Code	323
Min. Negotiated Rate	$439.31
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$5,878.03
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,021.81
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$488.80
Rate for Payer: Wellpoint Medicaid Managed Care	$439.31

EXTREMITY ANGIO-LT

Facility

$15,468.50

Service Code	HCPCS 75710LT
Hospital Charge Code	321075710L
Hospital Revenue Code	323
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

EXTREMITY ANGIO-LT

Facility

$15,468.50

Service Code	HCPCS 75710LT
Hospital Charge Code	411075710L
Hospital Revenue Code	323
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

EXTREMITY ANGIO-LT

Facility

$15,468.50

Service Code	HCPCS 75710LT
Hospital Charge Code	321075710L
Hospital Revenue Code	323
Min. Negotiated Rate	$439.31
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$5,878.03
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,021.81
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$488.80
Rate for Payer: Wellpoint Medicaid Managed Care	$439.31

EXTREMITY ANGIO-LT

Facility

$15,468.50

Service Code	HCPCS 75710LT
Hospital Charge Code	2691865
Hospital Revenue Code	323
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

EXTREMITY ANGIO-LT

Facility

$15,468.50

Service Code	HCPCS 75710LT
Hospital Charge Code	2691865
Hospital Revenue Code	323
Min. Negotiated Rate	$439.31
Max. Negotiated Rate	$7,734.25
Rate for Payer: Aetna Commercial	$5,878.03
Rate for Payer: Aetna Medicare Advantage	$4,640.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,944.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,944.47
Rate for Payer: Cigna Commercial	$7,734.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,021.81
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$488.80
Rate for Payer: Wellpoint Medicaid Managed Care	$439.31

Know your out-of-pocket cost for care.

All Charges