Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 RIGHT 12MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687605
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 RIGHT 12MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687605
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 S3 12MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683109
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 S3 12MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683109
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 FOR ADM MDM 28/48MM 42E

Facility

$4,081.30

Service Code	HCPCS C1776
Hospital Charge Code	270646337
Hospital Revenue Code	278
Min. Negotiated Rate	$612.20
Max. Negotiated Rate	$987.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.67
Rate for Payer: Qualcare PPO/HMO/WC	$612.20

INSERT FOR ADM MDM 28/48MM 42E

Facility

$4,081.30

Service Code	HCPCS C1776
Hospital Charge Code	270646337
Hospital Revenue Code	278
Min. Negotiated Rate	$115.91
Max. Negotiated Rate	$2,040.65
Rate for Payer: Aetna Commercial	$1,550.89
Rate for Payer: Aetna Medicare Advantage	$1,224.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,040.73
Rate for Payer: Cigna Commercial	$2,040.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.67
Rate for Payer: Qualcare PPO/HMO/WC	$612.20
Rate for Payer: UnitedHealthcare Community & State	$128.97
Rate for Payer: Wellpoint Medicaid Managed Care	$115.91

INSERT FOR ADM/MDM 28/52MM 48f

Facility

$8,250.00

Hospital Charge Code	270684945
Hospital Revenue Code	272
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,145.00
Rate for Payer: Oxford Commercial	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Commercial	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

INSERT FOR ADM/MDM 28/52MM 48f

Facility

$8,250.00

Hospital Charge Code	270684945
Hospital Revenue Code	272
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INSERT FOR ADM/MDM 28/54MM 48G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

INSERT FOR ADM/MDM 28/54MM 48G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671849
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

INSERT FOR MDM LINER 22.2MM 36

Facility

$4,465.10

Service Code	HCPCS C1776
Hospital Charge Code	270682914
Hospital Revenue Code	278
Min. Negotiated Rate	$669.76
Max. Negotiated Rate	$1,080.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$893.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,080.55
Rate for Payer: Qualcare PPO/HMO/WC	$669.76

INSERT FOR MDM LINER 22.2MM 36

Facility

$4,465.10

Service Code	HCPCS C1776
Hospital Charge Code	270682914
Hospital Revenue Code	278
Min. Negotiated Rate	$126.81
Max. Negotiated Rate	$2,232.55
Rate for Payer: Aetna Commercial	$1,696.74
Rate for Payer: Aetna Medicare Advantage	$1,339.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,138.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$893.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,138.60
Rate for Payer: Cigna Commercial	$2,232.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,080.55
Rate for Payer: Qualcare PPO/HMO/WC	$669.76
Rate for Payer: UnitedHealthcare Community & State	$141.10
Rate for Payer: Wellpoint Medicaid Managed Care	$126.81

INSERT FOR MDM LINER 22.2MM 38

Facility

$4,055.65

Service Code	HCPCS C1776
Hospital Charge Code	270681379
Hospital Revenue Code	278
Min. Negotiated Rate	$608.35
Max. Negotiated Rate	$981.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$811.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$981.47
Rate for Payer: Qualcare PPO/HMO/WC	$608.35

INSERT FOR MDM LINER 22.2MM 38

Facility

$4,055.65

Service Code	HCPCS C1776
Hospital Charge Code	270681379
Hospital Revenue Code	278
Min. Negotiated Rate	$115.18
Max. Negotiated Rate	$2,027.83
Rate for Payer: Aetna Commercial	$1,541.15
Rate for Payer: Aetna Medicare Advantage	$1,216.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,034.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,034.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$811.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,034.19
Rate for Payer: Cigna Commercial	$2,027.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$981.47
Rate for Payer: Qualcare PPO/HMO/WC	$608.35
Rate for Payer: UnitedHealthcare Community & State	$128.16
Rate for Payer: Wellpoint Medicaid Managed Care	$115.18

INSERT HEPATIC SHUNT (TIPS)

Facility

$48,530.72

Service Code	HCPCS 37182
Hospital Charge Code	16000430
Hospital Revenue Code	360
Min. Negotiated Rate	$7,279.61
Max. Negotiated Rate	$7,279.61
Rate for Payer: Qualcare PPO/HMO/WC	$7,279.61

INSERT HEPATIC SHUNT (TIPS)

Facility

$48,530.72

Service Code	HCPCS 37182
Hospital Charge Code	16000430
Hospital Revenue Code	360
Min. Negotiated Rate	$1,378.27
Max. Negotiated Rate	$79,001.40
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$79,001.40
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,617.99
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,279.61
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,533.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1,378.27

INSERT HUMERAL FLEX SYS 36MM

Facility

$6,787.50

Service Code	HCPCS C1776
Hospital Charge Code	270698765
Hospital Revenue Code	278
Min. Negotiated Rate	$1,018.12
Max. Negotiated Rate	$1,642.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,642.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,018.12

INSERT HUMERAL FLEX SYS 36MM

Facility

$6,787.50

Service Code	HCPCS C1776
Hospital Charge Code	270698765
Hospital Revenue Code	278
Min. Negotiated Rate	$192.76
Max. Negotiated Rate	$3,393.75
Rate for Payer: Aetna Commercial	$2,579.25
Rate for Payer: Aetna Medicare Advantage	$2,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,730.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,730.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,730.81
Rate for Payer: Cigna Commercial	$3,393.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,642.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,018.12
Rate for Payer: UnitedHealthcare Community & State	$214.49
Rate for Payer: Wellpoint Medicaid Managed Care	$192.76

INSERT INTRA AORTIC BALLN PERC

Facility

$6,070.00

Service Code	HCPCS 33967
Hospital Charge Code	5100313
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

INSERT INTRA AORTIC BALLN PERC

Facility

$6,070.00

Service Code	HCPCS 33967
Hospital Charge Code	5100313
Hospital Revenue Code	480
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.20
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$191.81
Rate for Payer: Wellpoint Medicaid Managed Care	$172.39

INSERT INTRACRANIAL PRESSURE M

Facility

$9,489.90

Service Code	HCPCS 61107
Hospital Charge Code	83120005
Hospital Revenue Code	361
Min. Negotiated Rate	$269.51
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,606.16
Rate for Payer: Aetna Medicare Advantage	$2,846.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,419.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,419.92
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	$2,419.92
Rate for Payer: Cigna Commercial	$4,744.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,467.37
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$299.88
Rate for Payer: Wellpoint Medicaid Managed Care	$269.51

INSERT INTRACRANIAL PRESSURE M

Facility

$9,489.90

Service Code	HCPCS 61107
Hospital Charge Code	83120005
Hospital Revenue Code	361
Min. Negotiated Rate	$1,423.48
Max. Negotiated Rate	$1,423.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48

INSERTION CATHETER ARTERY

Facility

$959.80

Service Code	HCPCS 36620
Hospital Charge Code	1600000759
Hospital Revenue Code	360
Min. Negotiated Rate	$30.33
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$364.72
Rate for Payer: Aetna Medicare Advantage	$287.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.75
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	$244.75
Rate for Payer: Cigna Commercial	$479.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.55
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$143.97
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$30.33

INSERTION CATHETER ARTERY

Facility

$959.80

Service Code	HCPCS 36620
Hospital Charge Code	1600000759
Hospital Revenue Code	360
Min. Negotiated Rate	$143.97
Max. Negotiated Rate	$143.97
Rate for Payer: Qualcare PPO/HMO/WC	$143.97

Know your out-of-pocket cost for care.

All Charges