Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FRAGMENT 2.5 X 18

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687652
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

FRAGMENT 2.5 X 18

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687652
Hospital Revenue Code	278
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.95

FRAGMENT 2.5 X20

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687653
Hospital Revenue Code	278
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.95

FRAGMENT 2.5 X20

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270687653
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

FRAGMENT SCREW DRILL

Facility

$525.00

Hospital Charge Code	270687655
Hospital Revenue Code	272
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Commercial	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

FRAGMENT SCREW DRILL

Facility

$525.00

Hospital Charge Code	270687655
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

FRAGMIN 5000IU/0.2ML SYRINGE

Facility

$309.81

Service Code	HCPCS J1645
Hospital Charge Code	606390261
Hospital Revenue Code	636
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$154.91
Rate for Payer: Aetna Commercial	$117.73
Rate for Payer: Aetna Medicare Advantage	$92.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.00
Rate for Payer: Cigna Commercial	$154.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.97
Rate for Payer: Qualcare PPO/HMO/WC	$46.47
Rate for Payer: UnitedHealthcare Community & State	$9.79
Rate for Payer: Wellpoint Medicaid Managed Care	$8.80

FRAGMIN 5000IU/0.2ML SYRINGE

Facility

$309.81

Service Code	HCPCS J1645
Hospital Charge Code	606390261
Hospital Revenue Code	636
Min. Negotiated Rate	$46.47
Max. Negotiated Rate	$74.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.97
Rate for Payer: Qualcare PPO/HMO/WC	$46.47

FRAME FIXATOR

Facility

$3,560.85

Hospital Charge Code	270673791
Hospital Revenue Code	272
Min. Negotiated Rate	$101.13
Max. Negotiated Rate	$1,780.42
Rate for Payer: Aetna Commercial	$1,353.12
Rate for Payer: Aetna Medicare Advantage	$1,068.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$908.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$908.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$908.02
Rate for Payer: Cigna Commercial	$1,780.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.82
Rate for Payer: Oxford Commercial	$712.17
Rate for Payer: Qualcare PPO/HMO/WC	$534.13
Rate for Payer: UnitedHealthcare Commercial	$712.17
Rate for Payer: UnitedHealthcare Community & State	$112.52
Rate for Payer: Wellpoint Medicaid Managed Care	$101.13

FRAME FIXATOR

Facility

$3,560.85

Hospital Charge Code	270673791
Hospital Revenue Code	272
Min. Negotiated Rate	$534.13
Max. Negotiated Rate	$534.13
Rate for Payer: Qualcare PPO/HMO/WC	$534.13

FREEDOM CONSTR HD 36MM T1 STD

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270692097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.00
Max. Negotiated Rate	$1,916.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00

FREEDOM CONSTR HD 36MM T1 STD

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270692097
Hospital Revenue Code	278
Min. Negotiated Rate	$224.93
Max. Negotiated Rate	$3,960.00
Rate for Payer: Aetna Commercial	$3,009.60
Rate for Payer: Aetna Medicare Advantage	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.60
Rate for Payer: Cigna Commercial	$3,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00
Rate for Payer: UnitedHealthcare Community & State	$250.27
Rate for Payer: Wellpoint Medicaid Managed Care	$224.93

FREEING OF BOWEL ADHESION

Facility

$15,014.00

Service Code	HCPCS 44005
Hospital Charge Code	16000162
Hospital Revenue Code	360
Min. Negotiated Rate	$2,252.10
Max. Negotiated Rate	$2,252.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,252.10

FREEING OF BOWEL ADHESION

Facility

$15,014.00

Service Code	HCPCS 44005
Hospital Charge Code	16000162
Hospital Revenue Code	360
Min. Negotiated Rate	$426.40
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,705.32
Rate for Payer: Aetna Medicare Advantage	$4,504.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,828.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,828.57
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	$3,828.57
Rate for Payer: Cigna Commercial	$7,507.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,903.64
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,252.10
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$474.44
Rate for Payer: Wellpoint Medicaid Managed Care	$426.40

FREE KAPPA/LAMBDA RND UR I

Facility

$93.45

Service Code	HCPCS 8388391
Hospital Charge Code	39990014A
Hospital Revenue Code	301
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

FREE KAPPA/LAMBDA RND UR I

Facility

$93.45

Service Code	HCPCS 8388391
Hospital Charge Code	39990014A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.51
Rate for Payer: Aetna Medicare Advantage	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.83
Rate for Payer: Cigna Commercial	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.30
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.02
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

FREE KAPPA/LAMBDA RND UR II

Facility

$93.45

Service Code	HCPCS 8388391
Hospital Charge Code	39990014B
Hospital Revenue Code	301
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$14.02
Rate for Payer: Qualcare PPO/HMO/WC	$14.02

FREE KAPPA/LAMBDA RND UR II

Facility

$93.45

Service Code	HCPCS 8388391
Hospital Charge Code	39990014B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.51
Rate for Payer: Aetna Medicare Advantage	$28.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.83
Rate for Payer: Cigna Commercial	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.30
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.02
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

FREE KAPPA & LAMBDA W/ RA I

Facility

$390.00

Service Code	HCPCS 8388391
Hospital Charge Code	39990013A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FREE KAPPA & LAMBDA W/ RA I

Facility

$390.00

Service Code	HCPCS 8388391
Hospital Charge Code	39990013A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FREE KAPPA & LAMBDA W/ RA II

Facility

$390.00

Service Code	HCPCS 8388391
Hospital Charge Code	39990013B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FREE KAPPA & LAMBDA W/ RA II

Facility

$390.00

Service Code	HCPCS 8388391
Hospital Charge Code	39990013B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FREELINK REMOTE CONTROL KIT

Facility

$6,750.00

Service Code	HCPCS C1787
Hospital Charge Code	270696218
Hospital Revenue Code	271
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

FREELINK REMOTE CONTROL KIT

Facility

$6,750.00

Service Code	HCPCS C1787
Hospital Charge Code	270696218
Hospital Revenue Code	271
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,755.00
Rate for Payer: Oxford Commercial	$1,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Commercial	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

FREE T3

Facility

$390.00

Service Code	HCPCS 84481
Hospital Charge Code	39900506
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges