Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FILTER SYSTEM ELITE VENA CAVA

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294N
Hospital Revenue Code	278
Min. Negotiated Rate	$127.09
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$141.41
Rate for Payer: Wellpoint Medicaid Managed Care	$127.09

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294
Hospital Revenue Code	278
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

FILTER TRI LUMEN TUBE CHARCOAL

Facility

$2,626.50

Hospital Charge Code	270686722
Hospital Revenue Code	272
Min. Negotiated Rate	$393.98
Max. Negotiated Rate	$393.98
Rate for Payer: Qualcare PPO/HMO/WC	$393.98

FILTER TRI LUMEN TUBE CHARCOAL

Facility

$2,626.50

Hospital Charge Code	270686722
Hospital Revenue Code	272
Min. Negotiated Rate	$74.59
Max. Negotiated Rate	$1,313.25
Rate for Payer: Aetna Commercial	$998.07
Rate for Payer: Aetna Medicare Advantage	$787.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.76
Rate for Payer: Cigna Commercial	$1,313.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.89
Rate for Payer: Oxford Commercial	$525.30
Rate for Payer: Qualcare PPO/HMO/WC	$393.98
Rate for Payer: UnitedHealthcare Commercial	$525.30
Rate for Payer: UnitedHealthcare Community & State	$83.00
Rate for Payer: Wellpoint Medicaid Managed Care	$74.59

FILTER TRIMED IV

Facility

$10.92

Hospital Charge Code	270041080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$5.46
Rate for Payer: Aetna Commercial	$4.15
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.84
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

FILTER TRIMED IV

Facility

$10.92

Hospital Charge Code	270041080
Hospital Revenue Code	272
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

FILTER TRT VENA CAVA 466P306A

Facility

$3,125.00

Service Code	HCPCS C1880
Hospital Charge Code	270627443
Hospital Revenue Code	278
Min. Negotiated Rate	$88.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Community & State	$98.75
Rate for Payer: Wellpoint Medicaid Managed Care	$88.75

FILTER TRT VENA CAVA 466P306A

Facility

$3,125.00

Service Code	HCPCS C1880
Hospital Charge Code	270627443
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

FILTER VENA CAVA FEMORAL 12FR

Facility

$4,994.50

Service Code	HCPCS C1880
Hospital Charge Code	270601106
Hospital Revenue Code	278
Min. Negotiated Rate	$749.17
Max. Negotiated Rate	$1,208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: Qualcare PPO/HMO/WC	$749.17

FILTER VENA CAVA FEMORAL 12FR

Facility

$4,994.50

Service Code	HCPCS C1880
Hospital Charge Code	270601106
Hospital Revenue Code	278
Min. Negotiated Rate	$141.84
Max. Negotiated Rate	$2,497.25
Rate for Payer: Aetna Commercial	$1,897.91
Rate for Payer: Aetna Medicare Advantage	$1,498.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.60
Rate for Payer: Cigna Commercial	$2,497.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: Qualcare PPO/HMO/WC	$749.17
Rate for Payer: UnitedHealthcare Community & State	$157.83
Rate for Payer: Wellpoint Medicaid Managed Care	$141.84

FILTER VENA CAVA JUGULAR 12FR

Facility

$4,994.50

Hospital Charge Code	270601105
Hospital Revenue Code	278
Min. Negotiated Rate	$141.84
Max. Negotiated Rate	$2,497.25
Rate for Payer: Aetna Commercial	$1,897.91
Rate for Payer: Aetna Medicare Advantage	$1,498.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.60
Rate for Payer: Cigna Commercial	$2,497.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: Qualcare PPO/HMO/WC	$749.17
Rate for Payer: UnitedHealthcare Community & State	$157.83
Rate for Payer: Wellpoint Medicaid Managed Care	$141.84

FILTER VENA CAVA JUGULAR 12FR

Facility

$4,994.50

Hospital Charge Code	270601105
Hospital Revenue Code	278
Min. Negotiated Rate	$749.17
Max. Negotiated Rate	$1,208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: Qualcare PPO/HMO/WC	$749.17

FILTER VENA CAVA PLATINUM

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529S
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

FILTER VENA CAVA PLATINUM

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

FILTER VENA CAVA PLATINUM

Facility

$7,625.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.75
Max. Negotiated Rate	$1,845.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75

FILTER VENA CAVA PLATINUM

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

FILTER VENA CAVA PLATINUM

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529S
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

FILTER VENA CAVA PLATINUM

Facility

$7,625.00

Service Code	HCPCS C1880
Hospital Charge Code	270668529N
Hospital Revenue Code	278
Min. Negotiated Rate	$216.55
Max. Negotiated Rate	$3,812.50
Rate for Payer: Aetna Commercial	$2,897.50
Rate for Payer: Aetna Medicare Advantage	$2,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,944.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,944.38
Rate for Payer: Cigna Commercial	$3,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,845.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,143.75
Rate for Payer: UnitedHealthcare Community & State	$240.95
Rate for Payer: Wellpoint Medicaid Managed Care	$216.55

FILTER W/WATER TRAP AVEA DISPO

Facility

$109.33

Hospital Charge Code	270654996
Hospital Revenue Code	270
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$54.66
Rate for Payer: Aetna Commercial	$41.55
Rate for Payer: Aetna Medicare Advantage	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.88
Rate for Payer: Cigna Commercial	$54.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.43
Rate for Payer: Oxford Commercial	$21.87
Rate for Payer: Qualcare PPO/HMO/WC	$16.40
Rate for Payer: UnitedHealthcare Commercial	$21.87
Rate for Payer: UnitedHealthcare Community & State	$3.45
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

FILTER W/WATER TRAP AVEA DISPO

Facility

$109.33

Hospital Charge Code	270654996
Hospital Revenue Code	270
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$16.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.40

FIMBOPLASTY

Facility

$9,165.70

Service Code	HCPCS 58760
Hospital Charge Code	1600000814
Hospital Revenue Code	360
Min. Negotiated Rate	$1,374.86
Max. Negotiated Rate	$1,374.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,374.86

FIMBOPLASTY

Facility

$9,165.70

Service Code	HCPCS 58760
Hospital Charge Code	1600000814
Hospital Revenue Code	360
Min. Negotiated Rate	$260.31
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,482.97
Rate for Payer: Aetna Medicare Advantage	$2,749.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,337.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,337.25
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	$2,337.25
Rate for Payer: Cigna Commercial	$4,582.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,383.08
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,374.86
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$289.64
Rate for Payer: Wellpoint Medicaid Managed Care	$260.31

FINASTERIDE 5 MG TAB

Facility

$20.97

Service Code	NDC 16729009001
Hospital Charge Code	60628191
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$10.48
Rate for Payer: Aetna Commercial	$7.97
Rate for Payer: Aetna Medicare Advantage	$6.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.35
Rate for Payer: Cigna Commercial	$10.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.45
Rate for Payer: Oxford Commercial	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.19
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

FINASTERIDE 5 MG TAB

Facility

$20.97

Service Code	NDC 16729009001
Hospital Charge Code	60628191
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

Know your out-of-pocket cost for care.

All Charges