Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INCORE 5.9MM X 28MM TI SCREW

Facility

$22,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270692230
Hospital Revenue Code	278
Min. Negotiated Rate	$648.94
Max. Negotiated Rate	$11,425.00
Rate for Payer: Aetna Commercial	$8,683.00
Rate for Payer: Aetna Medicare Advantage	$6,855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,826.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,826.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,826.75
Rate for Payer: Cigna Commercial	$11,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,529.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,427.50
Rate for Payer: UnitedHealthcare Community & State	$722.06
Rate for Payer: Wellpoint Medicaid Managed Care	$648.94

INCORE TORQ LIMIT DVR

Facility

$1,410.00

Hospital Charge Code	270692229
Hospital Revenue Code	272
Min. Negotiated Rate	$211.50
Max. Negotiated Rate	$211.50
Rate for Payer: Qualcare PPO/HMO/WC	$211.50

INCORE TORQ LIMIT DVR

Facility

$1,410.00

Hospital Charge Code	270692229
Hospital Revenue Code	272
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$705.00
Rate for Payer: Aetna Commercial	$535.80
Rate for Payer: Aetna Medicare Advantage	$423.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$359.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$359.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$359.55
Rate for Payer: Cigna Commercial	$705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.60
Rate for Payer: Oxford Commercial	$282.00
Rate for Payer: Qualcare PPO/HMO/WC	$211.50
Rate for Payer: UnitedHealthcare Commercial	$282.00
Rate for Payer: UnitedHealthcare Community & State	$44.56
Rate for Payer: Wellpoint Medicaid Managed Care	$40.04

INCORE TORQ LIMIT DVR 2.0NM

Facility

$1,500.00

Hospital Charge Code	270690352
Hospital Revenue Code	272
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

INCORE TORQ LIMIT DVR 2.0NM

Facility

$1,500.00

Hospital Charge Code	270690352
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

INC & REM FB SQ; COMPL

Facility

$5,638.35

Service Code	HCPCS 10121
Hospital Charge Code	16000381
Hospital Revenue Code	360
Min. Negotiated Rate	$845.75
Max. Negotiated Rate	$845.75
Rate for Payer: Qualcare PPO/HMO/WC	$845.75

INC & REM FB SQ; COMPL

Facility

$5,638.35

Service Code	HCPCS 10121
Hospital Charge Code	16000381
Hospital Revenue Code	360
Min. Negotiated Rate	$178.17
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.97
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$845.75
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$178.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,474.27
Rate for Payer: Wellpoint Medicaid Managed Care	$4,386.54

INC & REM FB SQ, SMPL

Facility

$1,287.45

Service Code	HCPCS 10120
Hospital Charge Code	16000248
Hospital Revenue Code	360
Min. Negotiated Rate	$193.12
Max. Negotiated Rate	$193.12
Rate for Payer: Qualcare PPO/HMO/WC	$193.12

INC & REM FB SQ, SMPL

Facility

$1,287.45

Service Code	HCPCS 10120
Hospital Charge Code	16000248
Hospital Revenue Code	360
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.74
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.12
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$40.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1,037.98

INCUBATION TECHNIQUE

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100583A
Hospital Revenue Code	300
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
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	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

INCUBATION TECHNIQUE

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100583A
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INCUBATION WITH ENZYMES

Facility

$141.00

Service Code	HCPCS 86971
Hospital Charge Code	38471094
Hospital Revenue Code	300
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.00

INCUBATION WITH ENZYMES

Facility

$141.00

Service Code	HCPCS 86971
Hospital Charge Code	38471094
Hospital Revenue Code	300
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

INCUS EAR TRANSPLANT

Facility

$624.00

Hospital Charge Code	270335716
Hospital Revenue Code	278
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$237.12
Rate for Payer: Aetna Medicare Advantage	$187.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.12
Rate for Payer: Cigna Commercial	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.60
Rate for Payer: UnitedHealthcare Community & State	$19.72
Rate for Payer: Wellpoint Medicaid Managed Care	$17.72

INCUS EAR TRANSPLANT

Facility

$624.00

Hospital Charge Code	270335716
Hospital Revenue Code	278
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$151.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.01
Rate for Payer: Qualcare PPO/HMO/WC	$93.60

INDAPAMIDE 2.5 MG TAB

Facility

$5.56

Service Code	NDC 228257111
Hospital Charge Code	60627970
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

INDAPAMIDE 2.5 MG TAB

Facility

$5.56

Service Code	NDC 228257111
Hospital Charge Code	60627970
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna Commercial	$2.11
Rate for Payer: Aetna Medicare Advantage	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.42
Rate for Payer: Cigna Commercial	$2.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Oxford Commercial	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$1.11
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

INDIA INK STAIN

Facility

$390.00

Service Code	HCPCS 87210
Hospital Charge Code	3009347
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INDIA INK STAIN

Facility

$390.00

Service Code	HCPCS 87210
Hospital Charge Code	3009347
Hospital Revenue Code	309
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.83
Rate for Payer: Aetna Medicare Advantage	$18.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.11
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.82
Rate for Payer: Clover Medicare Advantage	$5.53
Rate for Payer: EmblemHealth Commercial	$17.46
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.82
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	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.82
Rate for Payer: Wellcare Medicare Advantage	$5.82
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

INDIGO INJ 0.8%

Facility

$60.30

Service Code	NDC 517037510
Hospital Charge Code	60627874
Hospital Revenue Code	250
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.04

INDIGO INJ 0.8%

Facility

$60.30

Service Code	NDC 517037510
Hospital Charge Code	60627874
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$30.15
Rate for Payer: Aetna Commercial	$22.91
Rate for Payer: Aetna Medicare Advantage	$18.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.38
Rate for Payer: Cigna Commercial	$30.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.68
Rate for Payer: Oxford Commercial	$12.06
Rate for Payer: Qualcare PPO/HMO/WC	$9.04
Rate for Payer: UnitedHealthcare Commercial	$12.06
Rate for Payer: UnitedHealthcare Community & State	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.71

INDIGO SYSTEM LIGHTING 7

Facility

$28,050.00

Service Code	HCPCS A4649
Hospital Charge Code	270693837S
Hospital Revenue Code	272
Min. Negotiated Rate	$796.62
Max. Negotiated Rate	$14,025.00
Rate for Payer: Aetna Commercial	$10,659.00
Rate for Payer: Aetna Medicare Advantage	$8,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,152.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,152.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,152.75
Rate for Payer: Cigna Commercial	$14,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,293.00
Rate for Payer: Oxford Commercial	$5,610.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,207.50
Rate for Payer: UnitedHealthcare Commercial	$5,610.00
Rate for Payer: UnitedHealthcare Community & State	$886.38
Rate for Payer: Wellpoint Medicaid Managed Care	$796.62

INDIGO SYSTEM LIGHTING 7

Facility

$28,050.00

Service Code	HCPCS A4649
Hospital Charge Code	270693837S
Hospital Revenue Code	272
Min. Negotiated Rate	$4,207.50
Max. Negotiated Rate	$4,207.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,207.50

INDIRECT COOMBS

Facility

$390.00

Service Code	HCPCS 86885
Hospital Charge Code	3100427
Hospital Revenue Code	300
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$15.56
Rate for Payer: Aetna Medicare Advantage	$18.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.75
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$5.72
Rate for Payer: Clover Medicare Advantage	$5.43
Rate for Payer: EmblemHealth Commercial	$17.16
Rate for Payer: Humana Medicare Advantage	$5.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.72
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	$4.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.72
Rate for Payer: Wellcare Medicare Advantage	$5.72
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

INDIRECT COOMBS

Facility

$390.00

Service Code	HCPCS 86885
Hospital Charge Code	3100427
Hospital Revenue Code	300
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