Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ILIAC LIMB

Facility

$225.00

Service Code	HCPCS C1768
Hospital Charge Code	270679253
Hospital Revenue Code	278
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

ILIAC LIMB 10X 120MM

Facility

$23,495.00

Hospital Charge Code	270683415
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

ILIAC LIMB 10X 120MM

Facility

$23,495.00

Hospital Charge Code	270683415
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB 22 X 120MM MM

Facility

$23,495.00

Hospital Charge Code	270683417
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB 22 X 120MM MM

Facility

$23,495.00

Hospital Charge Code	270683417
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

ILIAC LIMB EXTENSION

Facility

$21,145.00

Service Code	HCPCS C1768
Hospital Charge Code	270679763
Hospital Revenue Code	278
Min. Negotiated Rate	$600.52
Max. Negotiated Rate	$10,572.50
Rate for Payer: Aetna Commercial	$8,035.10
Rate for Payer: Aetna Medicare Advantage	$6,343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,391.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,391.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,391.98
Rate for Payer: Cigna Commercial	$10,572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,117.09
Rate for Payer: Qualcare PPO/HMO/WC	$3,171.75
Rate for Payer: UnitedHealthcare Community & State	$668.18
Rate for Payer: Wellpoint Medicaid Managed Care	$600.52

ILIAC LIMB EXTENSION

Facility

$21,145.00

Service Code	HCPCS C1768
Hospital Charge Code	270679763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,171.75
Max. Negotiated Rate	$5,117.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,117.09
Rate for Payer: Qualcare PPO/HMO/WC	$3,171.75

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	366837222
Hospital Revenue Code	361
Min. Negotiated Rate	$637.34
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,834.76
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Community & State	$709.15
Rate for Payer: Wellpoint Medicaid Managed Care	$637.34

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	41037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	321037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	2691340
Hospital Revenue Code	361
Min. Negotiated Rate	$637.34
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,834.76
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Community & State	$709.15
Rate for Payer: Wellpoint Medicaid Managed Care	$637.34

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	321037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$637.34
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,834.76
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Community & State	$709.15
Rate for Payer: Wellpoint Medicaid Managed Care	$637.34

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	366837222
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	41037222L
Hospital Revenue Code	361
Min. Negotiated Rate	$637.34
Max. Negotiated Rate	$11,220.70
Rate for Payer: Aetna Commercial	$8,527.73
Rate for Payer: Aetna Medicare Advantage	$6,732.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,722.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,722.56
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	$5,722.56
Rate for Payer: Cigna Commercial	$11,220.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,834.76
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21
Rate for Payer: UnitedHealthcare Community & State	$709.15
Rate for Payer: Wellpoint Medicaid Managed Care	$637.34

ILIAC PTA ADD EA-LT

Facility

$22,441.40

Service Code	HCPCS 37222LT
Hospital Charge Code	2691340
Hospital Revenue Code	361
Min. Negotiated Rate	$3,366.21
Max. Negotiated Rate	$3,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$3,366.21

ILIAC REVASC

Facility

$20,340.00

Service Code	HCPCS 37254
Hospital Charge Code	1600000629
Hospital Revenue Code	360
Min. Negotiated Rate	$577.66
Max. Negotiated Rate	$24,528.18
Rate for Payer: Aetna Commercial	$18,391.91
Rate for Payer: Aetna Medicare Advantage	$21,908.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,528.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,761.73
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	$24,528.18
Rate for Payer: Cigna Commercial	$13,553.85
Rate for Payer: Cigna Medicare Advantage	$6,761.73
Rate for Payer: Clover Medicare Advantage	$6,423.64
Rate for Payer: EmblemHealth Commercial	$20,285.19
Rate for Payer: Humana Medicare Advantage	$6,964.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,761.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,288.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00
Rate for Payer: UnitedHealthcare Community & State	$642.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,761.73
Rate for Payer: Wellcare Medicare Advantage	$6,761.73
Rate for Payer: Wellpoint Medicaid Managed Care	$577.66

ILIAC REVASC

Facility

$20,340.00

Service Code	HCPCS 37254
Hospital Charge Code	1600000629
Hospital Revenue Code	360
Min. Negotiated Rate	$3,051.00
Max. Negotiated Rate	$3,051.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00

ILIAC REVASC W/STENT-BI

Facility

$61,616.39

Service Code	HCPCS 3722150
Hospital Charge Code	7411139
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

ILIAC REVASC W/STENT-BI

Facility

$61,616.39

Service Code	HCPCS 3722150
Hospital Charge Code	7411139
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	366837221L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	7411141
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	7411141
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

ILIAC REVASC W/STENT-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	366837221L
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC REVASC W/STENT-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	7411143
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

ILIAC REVASC W/STENT-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	7411143
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

Know your out-of-pocket cost for care.

All Charges