Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INTERLOCK 12MM X 30CM

Facility

$2,499.00

Hospital Charge Code	270662972
Hospital Revenue Code	278
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$604.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.76
Rate for Payer: Qualcare PPO/HMO/WC	$374.85

INTERLOCK 18MM X50CM

Facility

$4,777.50

Hospital Charge Code	270680002
Hospital Revenue Code	278
Min. Negotiated Rate	$716.62
Max. Negotiated Rate	$1,156.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62

INTERLOCK 18MM X50CM

Facility

$4,777.50

Hospital Charge Code	270680002
Hospital Revenue Code	278
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,815.45
Rate for Payer: Aetna Medicare Advantage	$1,433.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.26
Rate for Payer: Cigna Commercial	$2,388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62
Rate for Payer: UnitedHealthcare Community & State	$150.97
Rate for Payer: Wellpoint Medicaid Managed Care	$135.68

INTERLOCK 20MM X50CM

Facility

$4,777.50

Hospital Charge Code	270679996
Hospital Revenue Code	278
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,815.45
Rate for Payer: Aetna Medicare Advantage	$1,433.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.26
Rate for Payer: Cigna Commercial	$2,388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62
Rate for Payer: UnitedHealthcare Community & State	$150.97
Rate for Payer: Wellpoint Medicaid Managed Care	$135.68

INTERLOCK 20MM X50CM

Facility

$4,777.50

Hospital Charge Code	270679996
Hospital Revenue Code	278
Min. Negotiated Rate	$716.62
Max. Negotiated Rate	$1,156.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62

INTERLOCK 22MM X30CM

Facility

$4,777.50

Hospital Charge Code	270679995
Hospital Revenue Code	278
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,815.45
Rate for Payer: Aetna Medicare Advantage	$1,433.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.26
Rate for Payer: Cigna Commercial	$2,388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62
Rate for Payer: UnitedHealthcare Community & State	$150.97
Rate for Payer: Wellpoint Medicaid Managed Care	$135.68

INTERLOCK 22MM X30CM

Facility

$4,777.50

Hospital Charge Code	270679995
Hospital Revenue Code	278
Min. Negotiated Rate	$716.62
Max. Negotiated Rate	$1,156.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62

Interlock 2D 4mm x 8cm

Facility

$2,572.50

Hospital Charge Code	270679431
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

Interlock 2D 4mm x 8cm

Facility

$2,572.50

Hospital Charge Code	270679431
Hospital Revenue Code	272
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$668.85
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$81.29
Rate for Payer: Wellpoint Medicaid Managed Care	$73.06

INTERLOCK 8MM X 20CM

Facility

$2,499.00

Hospital Charge Code	270662971
Hospital Revenue Code	278
Min. Negotiated Rate	$70.97
Max. Negotiated Rate	$1,249.50
Rate for Payer: Aetna Commercial	$949.62
Rate for Payer: Aetna Medicare Advantage	$749.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.25
Rate for Payer: Cigna Commercial	$1,249.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.76
Rate for Payer: Qualcare PPO/HMO/WC	$374.85
Rate for Payer: UnitedHealthcare Community & State	$78.97
Rate for Payer: Wellpoint Medicaid Managed Care	$70.97

INTERLOCK 8MM X 20CM

Facility

$2,499.00

Hospital Charge Code	270662971
Hospital Revenue Code	278
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$604.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.76
Rate for Payer: Qualcare PPO/HMO/WC	$374.85

INTERLOCK OCCLUSION SYS

Facility

$2,000.00

Hospital Charge Code	7412025
Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

INTERLOCK OCCLUSION SYS

Facility

$2,000.00

Hospital Charge Code	2680390
Hospital Revenue Code	272
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

INTERLOCK OCCLUSION SYS

Facility

$2,000.00

Hospital Charge Code	2680390
Hospital Revenue Code	272
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$400.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

INTERLOCK OCCLUSION SYS

Facility

$2,000.00

Hospital Charge Code	7412025
Hospital Revenue Code	272
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$520.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$400.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

INTERLOCK OCLUSION SYSTEM 10 M

Facility

$2,697.50

Hospital Charge Code	270679435
Hospital Revenue Code	272
Min. Negotiated Rate	$76.61
Max. Negotiated Rate	$1,348.75
Rate for Payer: Aetna Commercial	$1,025.05
Rate for Payer: Aetna Medicare Advantage	$809.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.86
Rate for Payer: Cigna Commercial	$1,348.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$701.35
Rate for Payer: Oxford Commercial	$539.50
Rate for Payer: Qualcare PPO/HMO/WC	$404.62
Rate for Payer: UnitedHealthcare Commercial	$539.50
Rate for Payer: UnitedHealthcare Community & State	$85.24
Rate for Payer: Wellpoint Medicaid Managed Care	$76.61

INTERLOCK OCLUSION SYSTEM 10 M

Facility

$2,697.50

Hospital Charge Code	270679435
Hospital Revenue Code	272
Min. Negotiated Rate	$404.62
Max. Negotiated Rate	$404.62
Rate for Payer: Qualcare PPO/HMO/WC	$404.62

INTERLOCK OCLUSION SYSTEM 3MM

Facility

$2,572.50

Hospital Charge Code	270679430
Hospital Revenue Code	272
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$668.85
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$81.29
Rate for Payer: Wellpoint Medicaid Managed Care	$73.06

INTERLOCK OCLUSION SYSTEM 3MM

Facility

$2,572.50

Hospital Charge Code	270679430
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

INTERLOCK OCLUSION SYSTEM 3MM

Facility

$2,572.50

Hospital Charge Code	270679430O
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

INTERLOCK OCLUSION SYSTEM 3MM

Facility

$2,572.50

Hospital Charge Code	270679430O
Hospital Revenue Code	272
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$668.85
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$81.29
Rate for Payer: Wellpoint Medicaid Managed Care	$73.06

INTERLOCK OCLUSION SYSTEM 5 MM

Facility

$2,572.50

Hospital Charge Code	270679432
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

INTERLOCK OCLUSION SYSTEM 5 MM

Facility

$2,572.50

Hospital Charge Code	270679432
Hospital Revenue Code	272
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$668.85
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$81.29
Rate for Payer: Wellpoint Medicaid Managed Care	$73.06

INTERLOCK OCLUSION SYSTEM 6 MM

Facility

$2,572.50

Hospital Charge Code	270679433
Hospital Revenue Code	272
Min. Negotiated Rate	$385.88
Max. Negotiated Rate	$385.88
Rate for Payer: Qualcare PPO/HMO/WC	$385.88

INTERLOCK OCLUSION SYSTEM 6 MM

Facility

$2,572.50

Hospital Charge Code	270679433
Hospital Revenue Code	272
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$977.55
Rate for Payer: Aetna Medicare Advantage	$771.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.99
Rate for Payer: Cigna Commercial	$1,286.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$668.85
Rate for Payer: Oxford Commercial	$514.50
Rate for Payer: Qualcare PPO/HMO/WC	$385.88
Rate for Payer: UnitedHealthcare Commercial	$514.50
Rate for Payer: UnitedHealthcare Community & State	$81.29
Rate for Payer: Wellpoint Medicaid Managed Care	$73.06

Know your out-of-pocket cost for care.

All Charges