Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INNERBODY 15X13X7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704157
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

INNERBODY 15X13X7MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704157
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

IN.PACT Admiral 4x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684953
Hospital Revenue Code	278
Min. Negotiated Rate	$304.59
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$338.91
Rate for Payer: Wellpoint Medicaid Managed Care	$304.59

IN.PACT Admiral 4x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684953
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 4x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684953N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 4x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684953N
Hospital Revenue Code	278
Min. Negotiated Rate	$304.59
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$338.91
Rate for Payer: Wellpoint Medicaid Managed Care	$304.59

IN.PACT Admiral 4x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684954
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 4x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684954N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 4x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684954
Hospital Revenue Code	278
Min. Negotiated Rate	$335.12
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$372.88
Rate for Payer: Wellpoint Medicaid Managed Care	$335.12

IN.PACT Admiral 4x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684954N
Hospital Revenue Code	278
Min. Negotiated Rate	$335.12
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$372.88
Rate for Payer: Wellpoint Medicaid Managed Care	$335.12

IN.PACT Admiral 5x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684955N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 5x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684955
Hospital Revenue Code	278
Min. Negotiated Rate	$304.59
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$338.91
Rate for Payer: Wellpoint Medicaid Managed Care	$304.59

IN.PACT Admiral 5x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684955N
Hospital Revenue Code	278
Min. Negotiated Rate	$304.59
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$338.91
Rate for Payer: Wellpoint Medicaid Managed Care	$304.59

IN.PACT Admiral 5x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684955
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 5x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684956
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 5x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684956N
Hospital Revenue Code	278
Min. Negotiated Rate	$335.12
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$372.88
Rate for Payer: Wellpoint Medicaid Managed Care	$335.12

IN.PACT Admiral 5x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684956N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 5x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684956
Hospital Revenue Code	278
Min. Negotiated Rate	$335.12
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$372.88
Rate for Payer: Wellpoint Medicaid Managed Care	$335.12

IN.PACT Admiral 6x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 6x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957N
Hospital Revenue Code	278
Min. Negotiated Rate	$304.59
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$338.91
Rate for Payer: Wellpoint Medicaid Managed Care	$304.59

IN.PACT Admiral 6x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT Admiral 6x200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957
Hospital Revenue Code	278
Min. Negotiated Rate	$304.59
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$338.91
Rate for Payer: Wellpoint Medicaid Managed Care	$304.59

IN.PACT ADMIRAL 6X200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,608.75
Max. Negotiated Rate	$2,595.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75

IN.PACT ADMIRAL 6X200

Facility

$10,725.00

Service Code	HCPCS C2623
Hospital Charge Code	270684957S
Hospital Revenue Code	278
Min. Negotiated Rate	$304.59
Max. Negotiated Rate	$5,362.50
Rate for Payer: Aetna Commercial	$4,075.50
Rate for Payer: Aetna Medicare Advantage	$3,217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,734.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,734.88
Rate for Payer: Cigna Commercial	$5,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,595.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,608.75
Rate for Payer: UnitedHealthcare Community & State	$338.91
Rate for Payer: Wellpoint Medicaid Managed Care	$304.59

IN.PACT Admiral 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

Know your out-of-pocket cost for care.

All Charges