Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INSERT DRUG IMPLANT DEVICE

Facility

$716.00

Service Code	HCPCS 11981
Hospital Charge Code	87502620
Hospital Revenue Code	761
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.16
Rate for Payer: Oxford Commercial	$143.20
Rate for Payer: Qualcare PPO/HMO/WC	$107.40
Rate for Payer: UnitedHealthcare Commercial	$143.20
Rate for Payer: UnitedHealthcare Community & State	$22.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$361.89
Rate for Payer: Wellpoint Medicaid Managed Care	$20.33

INSERT DRUG IMPLANT DEVICE

Facility

$716.00

Service Code	HCPCS 11981
Hospital Charge Code	87502620
Hospital Revenue Code	761
Min. Negotiated Rate	$107.40
Max. Negotiated Rate	$107.40
Rate for Payer: Qualcare PPO/HMO/WC	$107.40

INSERT DUAL PM LEADS

Facility

$15,108.00

Service Code	HCPCS 33217
Hospital Charge Code	366833217
Hospital Revenue Code	480
Min. Negotiated Rate	$270.60
Max. Negotiated Rate	$35,663.33
Rate for Payer: Aetna Commercial	$26,741.35
Rate for Payer: Aetna Medicare Advantage	$31,853.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,663.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,663.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,831.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$270.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,663.33
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: Cigna Medicare Advantage	$9,831.38
Rate for Payer: Clover Medicare Advantage	$9,339.81
Rate for Payer: EmblemHealth Commercial	$29,494.14
Rate for Payer: Humana Medicare Advantage	$10,126.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,831.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,928.08
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,266.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$477.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,831.38
Rate for Payer: Wellcare Medicare Advantage	$9,831.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,899.11
Rate for Payer: Wellpoint Medicaid Managed Care	$429.07

INSERT DUAL PM LEADS

Facility

$15,108.00

Service Code	HCPCS 33217
Hospital Charge Code	366833217
Hospital Revenue Code	480
Min. Negotiated Rate	$2,266.20
Max. Negotiated Rate	$2,266.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,266.20

INSERTER CRUCIFORM 2.4mm

Facility

$2,208.00

Hospital Charge Code	270656614
Hospital Revenue Code	272
Min. Negotiated Rate	$331.20
Max. Negotiated Rate	$331.20
Rate for Payer: Qualcare PPO/HMO/WC	$331.20

INSERTER CRUCIFORM 2.4mm

Facility

$2,208.00

Hospital Charge Code	270656614
Hospital Revenue Code	272
Min. Negotiated Rate	$62.71
Max. Negotiated Rate	$1,104.00
Rate for Payer: Aetna Commercial	$839.04
Rate for Payer: Aetna Medicare Advantage	$662.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.04
Rate for Payer: Cigna Commercial	$1,104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.08
Rate for Payer: Oxford Commercial	$441.60
Rate for Payer: Qualcare PPO/HMO/WC	$331.20
Rate for Payer: UnitedHealthcare Commercial	$441.60
Rate for Payer: UnitedHealthcare Community & State	$69.77
Rate for Payer: Wellpoint Medicaid Managed Care	$62.71

INSERTER HELICAL BLADE

Facility

$5,473.00

Hospital Charge Code	270688249
Hospital Revenue Code	272
Min. Negotiated Rate	$155.43
Max. Negotiated Rate	$2,736.50
Rate for Payer: Aetna Commercial	$2,079.74
Rate for Payer: Aetna Medicare Advantage	$1,641.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,395.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,395.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,395.62
Rate for Payer: Cigna Commercial	$2,736.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.98
Rate for Payer: Oxford Commercial	$1,094.60
Rate for Payer: Qualcare PPO/HMO/WC	$820.95
Rate for Payer: UnitedHealthcare Commercial	$1,094.60
Rate for Payer: UnitedHealthcare Community & State	$172.95
Rate for Payer: Wellpoint Medicaid Managed Care	$155.43

INSERTER HELICAL BLADE

Facility

$5,473.00

Hospital Charge Code	270688249
Hospital Revenue Code	272
Min. Negotiated Rate	$820.95
Max. Negotiated Rate	$820.95
Rate for Payer: Qualcare PPO/HMO/WC	$820.95

INSERTER TIP DEEP LARGE 6MM

Facility

$1,725.00

Hospital Charge Code	270692630
Hospital Revenue Code	272
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$258.75
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

INSERTER TIP DEEP LARGE 6MM

Facility

$1,725.00

Hospital Charge Code	270692630
Hospital Revenue Code	272
Min. Negotiated Rate	$48.99
Max. Negotiated Rate	$862.50
Rate for Payer: Aetna Commercial	$655.50
Rate for Payer: Aetna Medicare Advantage	$517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.88
Rate for Payer: Cigna Commercial	$862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.50
Rate for Payer: Oxford Commercial	$345.00
Rate for Payer: Qualcare PPO/HMO/WC	$258.75
Rate for Payer: UnitedHealthcare Commercial	$345.00
Rate for Payer: UnitedHealthcare Community & State	$54.51
Rate for Payer: Wellpoint Medicaid Managed Care	$48.99

INSERTER TIP L/LD H 5MM

Facility

$1,725.00

Hospital Charge Code	270697229
Hospital Revenue Code	272
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$258.75
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

INSERTER TIP L/LD H 5MM

Facility

$1,725.00

Hospital Charge Code	270697229
Hospital Revenue Code	272
Min. Negotiated Rate	$48.99
Max. Negotiated Rate	$862.50
Rate for Payer: Aetna Commercial	$655.50
Rate for Payer: Aetna Medicare Advantage	$517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.88
Rate for Payer: Cigna Commercial	$862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.50
Rate for Payer: Oxford Commercial	$345.00
Rate for Payer: Qualcare PPO/HMO/WC	$258.75
Rate for Payer: UnitedHealthcare Commercial	$345.00
Rate for Payer: UnitedHealthcare Community & State	$54.51
Rate for Payer: Wellpoint Medicaid Managed Care	$48.99

INSERTER TIP MED

Facility

$1,725.00

Hospital Charge Code	270693682
Hospital Revenue Code	272
Min. Negotiated Rate	$48.99
Max. Negotiated Rate	$862.50
Rate for Payer: Aetna Commercial	$655.50
Rate for Payer: Aetna Medicare Advantage	$517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.88
Rate for Payer: Cigna Commercial	$862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.50
Rate for Payer: Oxford Commercial	$345.00
Rate for Payer: Qualcare PPO/HMO/WC	$258.75
Rate for Payer: UnitedHealthcare Commercial	$345.00
Rate for Payer: UnitedHealthcare Community & State	$54.51
Rate for Payer: Wellpoint Medicaid Managed Care	$48.99

INSERTER TIP MED

Facility

$1,725.00

Hospital Charge Code	270693682
Hospital Revenue Code	272
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$258.75
Rate for Payer: Qualcare PPO/HMO/WC	$258.75

INSERT FEMUR SZ 3 RIGHT 12MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678167
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

INSERT FEMUR SZ 3 RIGHT 12MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678167
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

INSERT FLEX LEFT 14MM S3

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681758
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

INSERT FLEX LEFT 14MM S3

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681758
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

INSERT FLEX SPHERE 10MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678630
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT FLEX SPHERE 10MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678630
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE 12MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681366
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT FLEX SPHERE 12MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681366
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE LEFT 12MM S

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683574
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

INSERT FLEX SPHERE LEFT 12MM S

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683574
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT FLEX SPHERE R 17MM S5

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270684546
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

Know your out-of-pocket cost for care.

All Charges