Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

18MM UNIPLATE

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270680085
Hospital Revenue Code	278
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$177.75
Rate for Payer: Wellpoint Medicaid Managed Care	$159.75

1/8 QUICK REL DRL STERILE 2PK

Facility

$480.00

Service Code	HCPCS C1768
Hospital Charge Code	270639355
Hospital Revenue Code	272
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.80
Rate for Payer: Oxford Commercial	$96.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$96.00
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.63

1/8 QUICK REL DRL STERILE 2PK

Facility

$480.00

Service Code	HCPCS C1768
Hospital Charge Code	270639355
Hospital Revenue Code	272
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

18 X 30CM STRAIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683832
Hospital Revenue Code	278
Min. Negotiated Rate	$85.63
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna Commercial	$1,145.70
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: Cigna Commercial	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$95.27
Rate for Payer: Wellpoint Medicaid Managed Care	$85.63

18 X 30CM STRAIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683832
Hospital Revenue Code	278
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

18X50MM 15D 14HEIGHT IMP

Facility

$32,500.00

Hospital Charge Code	270704021
Hospital Revenue Code	272
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$4,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

18X50MM 15D 14HEIGHT IMP

Facility

$32,500.00

Hospital Charge Code	270704021
Hospital Revenue Code	272
Min. Negotiated Rate	$923.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,450.00
Rate for Payer: Oxford Commercial	$6,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Commercial	$6,500.00
Rate for Payer: UnitedHealthcare Community & State	$1,027.00
Rate for Payer: Wellpoint Medicaid Managed Care	$923.00

1948/58 ISOFLEX OPTIMLEADS

Facility

$3,000.00

Hospital Charge Code	270656342
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

1948/58 ISOFLEX OPTIMLEADS

Facility

$3,000.00

Hospital Charge Code	270656342
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

1 OS-8 SUTURE

Facility

$125.65

Hospital Charge Code	270703734
Hospital Revenue Code	279
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$18.85
Rate for Payer: Qualcare PPO/HMO/WC	$18.85

1 OS-8 SUTURE

Facility

$125.65

Hospital Charge Code	270703734
Hospital Revenue Code	279
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$62.83
Rate for Payer: Aetna Commercial	$47.75
Rate for Payer: Aetna Medicare Advantage	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.04
Rate for Payer: Cigna Commercial	$62.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Oxford Commercial	$25.13
Rate for Payer: Qualcare PPO/HMO/WC	$18.85
Rate for Payer: UnitedHealthcare Commercial	$25.13
Rate for Payer: UnitedHealthcare Community & State	$3.97
Rate for Payer: Wellpoint Medicaid Managed Care	$3.57

1 PEG PATELLA 35MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677345
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

1 PEG PATELLA 35MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677345
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

1' PROFUNDUS TENDON REPAIR

Facility

$26,471.80

Service Code	HCPCS 26370
Hospital Charge Code	16000411
Hospital Revenue Code	360
Min. Negotiated Rate	$3,970.77
Max. Negotiated Rate	$3,970.77
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77

1' PROFUNDUS TENDON REPAIR

Facility

$26,471.80

Service Code	HCPCS 26370
Hospital Charge Code	16000411
Hospital Revenue Code	360
Min. Negotiated Rate	$751.80
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,882.67
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$836.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$751.80

1' REPR/SUTR LEG EXTSOR TENDON

Facility

$30,663.00

Service Code	HCPCS 27664
Hospital Charge Code	16000895
Hospital Revenue Code	360
Min. Negotiated Rate	$4,599.45
Max. Negotiated Rate	$4,599.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,599.45

1' REPR/SUTR LEG EXTSOR TENDON

Facility

$30,663.00

Service Code	HCPCS 27664
Hospital Charge Code	16000895
Hospital Revenue Code	360
Min. Negotiated Rate	$870.83
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,972.38
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,599.45
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$968.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$870.83

1' REPR/SUTR LEG FLEXOR TENDON

Facility

$19,467.90

Service Code	HCPCS 27658
Hospital Charge Code	16000713
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

1' REPR/SUTR LEG FLEXOR TENDON

Facility

$19,467.90

Service Code	HCPCS 27658
Hospital Charge Code	16000713
Hospital Revenue Code	360
Min. Negotiated Rate	$552.89
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,061.65
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$615.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$552.89

1STDAYHOSP CARE HIGH SEV

Facility

$350.00

Service Code	HCPCS 99223
Hospital Charge Code	83246205
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

1STDAYHOSP CARE HIGH SEV

Facility

$350.00

Service Code	HCPCS 99223
Hospital Charge Code	83246205
Hospital Revenue Code	919
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

1STDAYHOSP CARE LOW SEV

Facility

$350.00

Service Code	HCPCS 99221
Hospital Charge Code	83246195
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

1STDAYHOSP CARE LOW SEV

Facility

$350.00

Service Code	HCPCS 99221
Hospital Charge Code	83246195
Hospital Revenue Code	919
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

1STDAYHOSP CARE MED SEV

Facility

$350.00

Service Code	HCPCS 99222
Hospital Charge Code	83246200
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

1STDAYHOSP CARE MED SEV

Facility

$350.00

Service Code	HCPCS 99222
Hospital Charge Code	83246200
Hospital Revenue Code	919
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

Know your out-of-pocket cost for care.

All Charges