Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

E-Z PAQUE

Facility

$4.00

Service Code	NDC 32909075003
Hospital Charge Code	60635826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

E-Z PAQUE

Facility

$4.00

Service Code	NDC 32909075003
Hospital Charge Code	60635826
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

EZ SPAND 9X23X10D 10-14.5MM

Facility

$80,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698074
Hospital Revenue Code	278
Min. Negotiated Rate	$2,272.00
Max. Negotiated Rate	$40,000.00
Rate for Payer: Aetna Commercial	$30,400.00
Rate for Payer: Aetna Medicare Advantage	$24,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,400.00
Rate for Payer: Cigna Commercial	$40,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,000.00
Rate for Payer: UnitedHealthcare Community & State	$2,528.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2,272.00

EZ SPAND 9X23X10D 10-14.5MM

Facility

$80,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698074
Hospital Revenue Code	278
Min. Negotiated Rate	$12,000.00
Max. Negotiated Rate	$19,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$12,000.00

F3D LATERAL 18X45MM 8DEG

Facility

$28,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704787
Hospital Revenue Code	278
Min. Negotiated Rate	$4,312.50
Max. Negotiated Rate	$6,957.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,957.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,312.50

F3D LATERAL 18X45MM 8DEG

Facility

$28,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704787
Hospital Revenue Code	278
Min. Negotiated Rate	$816.50
Max. Negotiated Rate	$14,375.00
Rate for Payer: Aetna Commercial	$10,925.00
Rate for Payer: Aetna Medicare Advantage	$8,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,331.25
Rate for Payer: Cigna Commercial	$14,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,957.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,312.50
Rate for Payer: UnitedHealthcare Community & State	$908.50
Rate for Payer: Wellpoint Medicaid Managed Care	$816.50

FABULOUS FACES (MASKS)

Facility

$112.95

Hospital Charge Code	270663156
Hospital Revenue Code	270
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$56.48
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Aetna Medicare Advantage	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.80
Rate for Payer: Cigna Commercial	$56.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.37
Rate for Payer: Oxford Commercial	$22.59
Rate for Payer: Qualcare PPO/HMO/WC	$16.94
Rate for Payer: UnitedHealthcare Commercial	$22.59
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

FABULOUS FACES (MASKS)

Facility

$112.95

Hospital Charge Code	270663156
Hospital Revenue Code	270
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.94

FACE MASK DISP.

Facility

$1,285.00

Hospital Charge Code	270656059
Hospital Revenue Code	271
Min. Negotiated Rate	$36.49
Max. Negotiated Rate	$642.50
Rate for Payer: Aetna Commercial	$488.30
Rate for Payer: Aetna Medicare Advantage	$385.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$327.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$327.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$327.68
Rate for Payer: Cigna Commercial	$642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.10
Rate for Payer: Oxford Commercial	$257.00
Rate for Payer: Qualcare PPO/HMO/WC	$192.75
Rate for Payer: UnitedHealthcare Commercial	$257.00
Rate for Payer: UnitedHealthcare Community & State	$40.61
Rate for Payer: Wellpoint Medicaid Managed Care	$36.49

FACE MASK DISP.

Facility

$1,285.00

Hospital Charge Code	270656059
Hospital Revenue Code	271
Min. Negotiated Rate	$192.75
Max. Negotiated Rate	$192.75
Rate for Payer: Qualcare PPO/HMO/WC	$192.75

FACET JOINT BLOCK 1ST LEVEL

Facility

$2,043.00

Service Code	HCPCS 64475
Hospital Charge Code	84506035
Hospital Revenue Code	361
Min. Negotiated Rate	$58.02
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$776.34
Rate for Payer: Aetna Medicare Advantage	$612.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.97
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	$520.97
Rate for Payer: Cigna Commercial	$1,021.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.18
Rate for Payer: Qualcare PPO/HMO/WC	$306.45
Rate for Payer: UnitedHealthcare Community & State	$64.56
Rate for Payer: Wellpoint Medicaid Managed Care	$58.02

FACET JOINT BLOCK 1ST LEVEL

Facility

$2,043.00

Service Code	HCPCS 64475
Hospital Charge Code	84506035
Hospital Revenue Code	361
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

FACET JOINT BLOCK EA ADD'L LVL

Facility

$1,905.00

Service Code	HCPCS 64476
Hospital Charge Code	84506040
Hospital Revenue Code	361
Min. Negotiated Rate	$285.75
Max. Negotiated Rate	$285.75
Rate for Payer: Qualcare PPO/HMO/WC	$285.75

FACET JOINT BLOCK EA ADD'L LVL

Facility

$1,905.00

Service Code	HCPCS 64476
Hospital Charge Code	84506040
Hospital Revenue Code	361
Min. Negotiated Rate	$54.10
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$723.90
Rate for Payer: Aetna Medicare Advantage	$571.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$485.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$485.77
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	$485.77
Rate for Payer: Cigna Commercial	$952.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.30
Rate for Payer: Qualcare PPO/HMO/WC	$285.75
Rate for Payer: UnitedHealthcare Community & State	$60.20
Rate for Payer: Wellpoint Medicaid Managed Care	$54.10

FACET SCREW 4.5X25MM

Facility

$4,975.00

Hospital Charge Code	270702453
Hospital Revenue Code	278
Min. Negotiated Rate	$141.29
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Community & State	$157.21
Rate for Payer: Wellpoint Medicaid Managed Care	$141.29

FACET SCREW 4.5X25MM

Facility

$4,975.00

Hospital Charge Code	270702453
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

FACET SCREW 4.5X30MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703887
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

FACET SCREW 4.5X30MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703887
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

FACET SCREW 4.5X40MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703886
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

FACET SCREW 4.5X40MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703886
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

FACET SCREW 4.5X45MM

Facility

$4,975.00

Hospital Charge Code	270702454
Hospital Revenue Code	278
Min. Negotiated Rate	$141.29
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Community & State	$157.21
Rate for Payer: Wellpoint Medicaid Managed Care	$141.29

FACET SCREW 4.5X45MM

Facility

$4,975.00

Hospital Charge Code	270702454
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$17,669.93

Service Code	APR-DRG 0921
Min. Negotiated Rate	$17,323.46
Max. Negotiated Rate	$17,669.93
Rate for Payer: UnitedHealthcare Community & State	$17,323.46
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,669.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17,323.46

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$22,600.69

Service Code	APR-DRG 0922
Min. Negotiated Rate	$22,157.54
Max. Negotiated Rate	$22,600.69
Rate for Payer: UnitedHealthcare Community & State	$22,157.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,600.69
Rate for Payer: Wellpoint Medicaid Managed Care	$22,157.54

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$63,305.26

Service Code	APR-DRG 0924
Min. Negotiated Rate	$62,063.98
Max. Negotiated Rate	$63,305.26
Rate for Payer: UnitedHealthcare Community & State	$62,063.98
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$63,305.26
Rate for Payer: Wellpoint Medicaid Managed Care	$62,063.98

Know your out-of-pocket cost for care.

All Charges