Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	2691395
Hospital Revenue Code	361
Min. Negotiated Rate	$2,150.94
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
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	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,691.71
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$2,393.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2,150.94

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	2691395
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	7411931
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	321037226R
Hospital Revenue Code	361
Min. Negotiated Rate	$2,150.94
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
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	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,691.71
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$2,393.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2,150.94

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	321037226R
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	7411931
Hospital Revenue Code	361
Min. Negotiated Rate	$2,150.94
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
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	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,691.71
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$2,393.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2,150.94

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	366837226R
Hospital Revenue Code	361
Min. Negotiated Rate	$2,150.94
Max. Negotiated Rate	$37,868.67
Rate for Payer: Aetna Commercial	$28,780.19
Rate for Payer: Aetna Medicare Advantage	$22,721.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,313.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,313.02
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	$19,313.02
Rate for Payer: Cigna Commercial	$37,868.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,691.71
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60
Rate for Payer: UnitedHealthcare Community & State	$2,393.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2,150.94

FEM-POP STENT W/PTA-RT

Facility

$75,737.34

Service Code	HCPCS 37226RT
Hospital Charge Code	366837226R
Hospital Revenue Code	361
Min. Negotiated Rate	$11,360.60
Max. Negotiated Rate	$11,360.60
Rate for Payer: Qualcare PPO/HMO/WC	$11,360.60

FEM PSN PS CMT CCR STD SZ 10L

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698387
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

FEM PSN PS CMT CCR STD SZ 10L

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698387
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMRL FPP NC ECHO POR 12X 40MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691841
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

FEMRL FPP NC ECHO POR 12X 40MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691841
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

FEMRL PS 57.5 LEFT OPEN 183122

Facility

$11,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270650855
Hospital Revenue Code	278
Min. Negotiated Rate	$312.40
Max. Negotiated Rate	$5,500.00
Rate for Payer: Aetna Commercial	$4,180.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$347.60
Rate for Payer: Wellpoint Medicaid Managed Care	$312.40

FEMRL PS 57.5 LEFT OPEN 183122

Facility

$11,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270650855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

FEM ST 12X14 TAPR WPORCOATSZ2

Facility

$9,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270691333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,455.00
Max. Negotiated Rate	$2,347.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.00

FEM ST 12X14 TAPR WPORCOATSZ2

Facility

$9,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270691333
Hospital Revenue Code	278
Min. Negotiated Rate	$275.48
Max. Negotiated Rate	$4,850.00
Rate for Payer: Aetna Commercial	$3,686.00
Rate for Payer: Aetna Medicare Advantage	$2,910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,473.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,473.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,940.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,473.50
Rate for Payer: Cigna Commercial	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.00
Rate for Payer: UnitedHealthcare Community & State	$306.52
Rate for Payer: Wellpoint Medicaid Managed Care	$275.48

FEM STABLIZER RT TRIATH SZ2

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270693302
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$1,751.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

FEM STABLIZER RT TRIATH SZ2

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270693302
Hospital Revenue Code	278
Min. Negotiated Rate	$205.56
Max. Negotiated Rate	$3,618.95
Rate for Payer: Aetna Commercial	$2,750.40
Rate for Payer: Aetna Medicare Advantage	$2,171.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.66
Rate for Payer: Cigna Commercial	$3,618.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68
Rate for Payer: UnitedHealthcare Community & State	$228.72
Rate for Payer: Wellpoint Medicaid Managed Care	$205.56

FEM STEM 12/14 TAP SZ2 STD97MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695674
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

FEM STEM 12/14 TAP SZ2 STD97MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695674
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

FEM STEM 132D SZ6 35MM 111MM

Facility

$13,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270695130
Hospital Revenue Code	278
Min. Negotiated Rate	$386.24
Max. Negotiated Rate	$6,800.00
Rate for Payer: Aetna Commercial	$5,168.00
Rate for Payer: Aetna Medicare Advantage	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,468.00
Rate for Payer: Cigna Commercial	$6,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,291.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.00
Rate for Payer: UnitedHealthcare Community & State	$429.76
Rate for Payer: Wellpoint Medicaid Managed Care	$386.24

FEM STEM 132D SZ6 35MM 111MM

Facility

$13,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270695130
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.00
Max. Negotiated Rate	$3,291.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,291.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.00

FEM STEM STD 12/14 SZ3 108MM

Facility

$9,712.50

Service Code	HCPCS C1776
Hospital Charge Code	270696051
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.88
Max. Negotiated Rate	$2,350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,350.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.88

FEM STEM STD 12/14 SZ3 108MM

Facility

$9,712.50

Service Code	HCPCS C1776
Hospital Charge Code	270696051
Hospital Revenue Code	278
Min. Negotiated Rate	$275.83
Max. Negotiated Rate	$4,856.25
Rate for Payer: Aetna Commercial	$3,690.75
Rate for Payer: Aetna Medicare Advantage	$2,913.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,476.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,476.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,476.69
Rate for Payer: Cigna Commercial	$4,856.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,350.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.88
Rate for Payer: UnitedHealthcare Community & State	$306.92
Rate for Payer: Wellpoint Medicaid Managed Care	$275.83

FEM TOTAL COMP STAB TRIATHLON

Facility

$65,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270691989
Hospital Revenue Code	278
Min. Negotiated Rate	$1,858.35
Max. Negotiated Rate	$32,717.50
Rate for Payer: Aetna Commercial	$24,865.30
Rate for Payer: Aetna Medicare Advantage	$19,630.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,685.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,685.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,087.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,685.92
Rate for Payer: Cigna Commercial	$32,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,835.27
Rate for Payer: Qualcare PPO/HMO/WC	$9,815.25
Rate for Payer: UnitedHealthcare Community & State	$2,067.75
Rate for Payer: Wellpoint Medicaid Managed Care	$1,858.35

Know your out-of-pocket cost for care.

All Charges