Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMPICILLIN/SULBACTAM

Facility

$70.82

Service Code	HCPCS J0295
Hospital Charge Code	6006571
Hospital Revenue Code	636
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$26.91
Rate for Payer: Aetna Medicare Advantage	$21.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.06
Rate for Payer: Cigna Commercial	$35.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.14
Rate for Payer: Qualcare PPO/HMO/WC	$10.62
Rate for Payer: UnitedHealthcare Community & State	$2.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.01

AMPLATZER VASCULAR PLUG II 8MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679200O
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

AMPLATZER VASCULAR PLUG II 8MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679200
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

AMPLATZER VASCULAR PLUG II 8MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679200
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

AMPLATZER VASCULAR PLUG II 8MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679200O
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

AMPLATZER VASCUL PLUG II 10MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679201
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

AMPLATZER VASCUL PLUG II 10MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679201
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

AMPLATZER VASCUL PLUG II 10MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679201O
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

AMPLATZER VASCUL PLUG II 10MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679201O
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

AMPLATZER VASCUL PLUG II 12mm

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679202
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

AMPLATZER VASCUL PLUG II 12mm

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679202
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

AMPLATZER VASCUL PLUG II 12MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679202C
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

AMPLATZER VASCUL PLUG II 12MM

Facility

$5,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270679202C
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

AMPLATZ SUPER STIFF GUIDE WIRE

Facility

$107.50

Hospital Charge Code	270653645
Hospital Revenue Code	278
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare Advantage	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.41
Rate for Payer: Cigna Commercial	$53.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.12
Rate for Payer: UnitedHealthcare Community & State	$3.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

AMPLATZ SUPER STIFF GUIDE WIRE

Facility

$107.50

Hospital Charge Code	270653645
Hospital Revenue Code	278
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.12

AMPLATZ SUPER STIFF GUIDE WIRE

Facility

$107.50

Hospital Charge Code	270653643
Hospital Revenue Code	278
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$53.75
Rate for Payer: Aetna Commercial	$40.85
Rate for Payer: Aetna Medicare Advantage	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.41
Rate for Payer: Cigna Commercial	$53.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.12
Rate for Payer: UnitedHealthcare Community & State	$3.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.05

AMPLATZ SUPER STIFF GUIDE WIRE

Facility

$107.50

Hospital Charge Code	270653643
Hospital Revenue Code	278
Min. Negotiated Rate	$16.12
Max. Negotiated Rate	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.12

AMPLIFICATION FST 2 SEQUENCES

Facility

$236.00

Service Code	HCPCS 83900
Hospital Charge Code	38478081
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

AMPLIFICATION FST 2 SEQUENCES

Facility

$236.00

Service Code	HCPCS 83900
Hospital Charge Code	38478081
Hospital Revenue Code	301
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

AMPLIFICATION PAT NUCLEIC

Facility

$236.00

Service Code	HCPCS 83900
Hospital Charge Code	38472940
Hospital Revenue Code	301
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

AMPLIFICATION PAT NUCLEIC

Facility

$236.00

Service Code	HCPCS 83900
Hospital Charge Code	38472940
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

AMPLIFICATION PAT NUCLEIC ACID

Facility

$236.00

Service Code	HCPCS 83900
Hospital Charge Code	38472803
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

AMPLIFICATION PAT NUCLEIC ACID

Facility

$236.00

Service Code	HCPCS 83900
Hospital Charge Code	38472803
Hospital Revenue Code	301
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

AMPLIFICTION PAT NUC ACID

Facility

$236.00

Service Code	HCPCS 83900
Hospital Charge Code	38479423
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

AMPLIFICTION PAT NUC ACID

Facility

$236.00

Service Code	HCPCS 83900
Hospital Charge Code	38479423
Hospital Revenue Code	301
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

Know your out-of-pocket cost for care.

All Charges