Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HOOK WIDE BLADE EXT 6.5X55MM

Facility

$4,132.50

Service Code	HCPCS C1713
Hospital Charge Code	270695969
Hospital Revenue Code	278
Min. Negotiated Rate	$117.36
Max. Negotiated Rate	$2,066.25
Rate for Payer: Aetna Commercial	$1,570.35
Rate for Payer: Aetna Medicare Advantage	$1,239.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,053.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,053.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$826.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,053.79
Rate for Payer: Cigna Commercial	$2,066.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,000.07
Rate for Payer: Qualcare PPO/HMO/WC	$619.88
Rate for Payer: UnitedHealthcare Community & State	$130.59
Rate for Payer: Wellpoint Medicaid Managed Care	$117.36

HOOK WIDE BLADE EXT 6.5X55MM

Facility

$4,132.50

Service Code	HCPCS C1713
Hospital Charge Code	270695969
Hospital Revenue Code	278
Min. Negotiated Rate	$619.88
Max. Negotiated Rate	$1,000.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$826.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,000.07
Rate for Payer: Qualcare PPO/HMO/WC	$619.88

HOOP SHIMS

Facility

$6,156.70

Hospital Charge Code	270657303
Hospital Revenue Code	270
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$923.50
Rate for Payer: Qualcare PPO/HMO/WC	$923.50

HOOP SHIMS

Facility

$6,156.70

Hospital Charge Code	270657303
Hospital Revenue Code	270
Min. Negotiated Rate	$174.85
Max. Negotiated Rate	$3,078.35
Rate for Payer: Aetna Commercial	$2,339.55
Rate for Payer: Aetna Medicare Advantage	$1,847.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,569.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,569.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,569.96
Rate for Payer: Cigna Commercial	$3,078.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,600.74
Rate for Payer: Oxford Commercial	$1,231.34
Rate for Payer: Qualcare PPO/HMO/WC	$923.50
Rate for Payer: UnitedHealthcare Commercial	$1,231.34
Rate for Payer: UnitedHealthcare Community & State	$194.55
Rate for Payer: Wellpoint Medicaid Managed Care	$174.85

HOT TEMP

Facility

$81.00

Hospital Charge Code	270335110
Hospital Revenue Code	272
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.06
Rate for Payer: Oxford Commercial	$16.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Commercial	$16.20
Rate for Payer: UnitedHealthcare Community & State	$2.56
Rate for Payer: Wellpoint Medicaid Managed Care	$2.30

HOT TEMP

Facility

$81.00

Hospital Charge Code	270335110
Hospital Revenue Code	272
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

HOT TEMP DISP STR WARMNG SET

Facility

$58.49

Hospital Charge Code	270650477
Hospital Revenue Code	272
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$8.77
Rate for Payer: Qualcare PPO/HMO/WC	$8.77

HOT TEMP DISP STR WARMNG SET

Facility

$58.49

Hospital Charge Code	270650477
Hospital Revenue Code	272
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Commercial	$22.23
Rate for Payer: Aetna Medicare Advantage	$17.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.91
Rate for Payer: Cigna Commercial	$29.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.21
Rate for Payer: Oxford Commercial	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.77
Rate for Payer: UnitedHealthcare Commercial	$11.70
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

HOUSE APPROVED WIRE LOOP SS

Facility

$277.00

Hospital Charge Code	270330532
Hospital Revenue Code	272
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$138.50
Rate for Payer: Aetna Commercial	$105.26
Rate for Payer: Aetna Medicare Advantage	$83.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.64
Rate for Payer: Cigna Commercial	$138.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.02
Rate for Payer: Oxford Commercial	$55.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$55.40
Rate for Payer: UnitedHealthcare Community & State	$8.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.87

HOUSE APPROVED WIRE LOOP SS

Facility

$277.00

Hospital Charge Code	270330532
Hospital Revenue Code	272
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.55

HP 45 BLACK INK CARTRIDGE

Facility

$224.95

Hospital Charge Code	270662427
Hospital Revenue Code	270
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$33.74
Rate for Payer: Qualcare PPO/HMO/WC	$33.74

HP 45 BLACK INK CARTRIDGE

Facility

$224.95

Hospital Charge Code	270662427
Hospital Revenue Code	270
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.47
Rate for Payer: Aetna Commercial	$85.48
Rate for Payer: Aetna Medicare Advantage	$67.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.36
Rate for Payer: Cigna Commercial	$112.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.49
Rate for Payer: Oxford Commercial	$44.99
Rate for Payer: Qualcare PPO/HMO/WC	$33.74
Rate for Payer: UnitedHealthcare Commercial	$44.99
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

HP 78 TRI COLOR INK CARTRIDGE

Facility

$237.50

Hospital Charge Code	270662426
Hospital Revenue Code	270
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$118.75
Rate for Payer: Aetna Commercial	$90.25
Rate for Payer: Aetna Medicare Advantage	$71.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.56
Rate for Payer: Cigna Commercial	$118.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.75
Rate for Payer: Oxford Commercial	$47.50
Rate for Payer: Qualcare PPO/HMO/WC	$35.62
Rate for Payer: UnitedHealthcare Commercial	$47.50
Rate for Payer: UnitedHealthcare Community & State	$7.50
Rate for Payer: Wellpoint Medicaid Managed Care	$6.75

HP 78 TRI COLOR INK CARTRIDGE

Facility

$237.50

Hospital Charge Code	270662426
Hospital Revenue Code	270
Min. Negotiated Rate	$35.62
Max. Negotiated Rate	$35.62
Rate for Payer: Qualcare PPO/HMO/WC	$35.62

H-PLATE 1.5MM EXTENDED LEFT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654820
Hospital Revenue Code	278
Min. Negotiated Rate	$28.61
Max. Negotiated Rate	$503.68
Rate for Payer: Aetna Commercial	$382.79
Rate for Payer: Aetna Medicare Advantage	$302.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.87
Rate for Payer: Cigna Commercial	$503.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10
Rate for Payer: UnitedHealthcare Community & State	$31.83
Rate for Payer: Wellpoint Medicaid Managed Care	$28.61

H-PLATE 1.5MM EXTENDED LEFT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654820
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$243.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

H-PLATE 1.5MM EXTENDED RIGHT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654819
Hospital Revenue Code	278
Min. Negotiated Rate	$28.61
Max. Negotiated Rate	$503.68
Rate for Payer: Aetna Commercial	$382.79
Rate for Payer: Aetna Medicare Advantage	$302.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.87
Rate for Payer: Cigna Commercial	$503.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10
Rate for Payer: UnitedHealthcare Community & State	$31.83
Rate for Payer: Wellpoint Medicaid Managed Care	$28.61

H-PLATE 1.5MM EXTENDED RIGHT

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654819
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$243.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

HPV, DNA HIGH RISK

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39900303
Hospital Revenue Code	306
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.71
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

HPV, DNA HIGH RISK

Facility

$241.20

Service Code	HCPCS 87624
Hospital Charge Code	39900303
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

HPV DNA LOW/HIGH RISK II

Facility

$241.20

Service Code	HCPCS 87621
Hospital Charge Code	39990137B
Hospital Revenue Code	306
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$91.66
Rate for Payer: Aetna Medicare Advantage	$72.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.51
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.71
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

HPV DNA LOW/HIGH RISK II

Facility

$241.20

Service Code	HCPCS 87621
Hospital Charge Code	39990137B
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

HPV GENOTYPE 16/18 I

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	39990136A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HPV GENOTYPE 16/18 I

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	39990136A
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$110.30
Rate for Payer: Aetna Medicare Advantage	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.10
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$40.55
Rate for Payer: Clover Medicare Advantage	$38.52
Rate for Payer: EmblemHealth Commercial	$121.65
Rate for Payer: Humana Medicare Advantage	$41.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$40.55
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	$32.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.55
Rate for Payer: Wellcare Medicare Advantage	$40.55
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

HPV GENOTYPE 16/18 II

Facility

$390.00

Service Code	HCPCS 87625
Hospital Charge Code	39990136B
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$110.30
Rate for Payer: Aetna Medicare Advantage	$131.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$40.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.10
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$40.55
Rate for Payer: Clover Medicare Advantage	$38.52
Rate for Payer: EmblemHealth Commercial	$121.65
Rate for Payer: Humana Medicare Advantage	$41.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$40.55
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	$32.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.55
Rate for Payer: Wellcare Medicare Advantage	$40.55
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges