Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IRRIGATOR SHOWEHEAD SET TIP

Facility

$628.45

Hospital Charge Code	270657856
Hospital Revenue Code	270
Min. Negotiated Rate	$94.27
Max. Negotiated Rate	$94.27
Rate for Payer: Qualcare PPO/HMO/WC	$94.27

IRRIGATOR SIMPULSE

Facility

$475.00

Hospital Charge Code	270335141
Hospital Revenue Code	272
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.50
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

IRRIGATOR SIMPULSE

Facility

$475.00

Hospital Charge Code	270335141
Hospital Revenue Code	272
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

IRRIGATOR SUCTION

Facility

$453.65

Hospital Charge Code	270600334
Hospital Revenue Code	270
Min. Negotiated Rate	$68.05
Max. Negotiated Rate	$68.05
Rate for Payer: Qualcare PPO/HMO/WC	$68.05

IRRIGATOR SUCTION

Facility

$453.65

Hospital Charge Code	270600334
Hospital Revenue Code	270
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$226.82
Rate for Payer: Aetna Commercial	$172.39
Rate for Payer: Aetna Medicare Advantage	$136.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.68
Rate for Payer: Cigna Commercial	$226.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.95
Rate for Payer: Oxford Commercial	$90.73
Rate for Payer: Qualcare PPO/HMO/WC	$68.05
Rate for Payer: UnitedHealthcare Commercial	$90.73
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

IRRIG CORPOR CAVERN F PRIAPISM

Facility

$833.00

Service Code	HCPCS 54220
Hospital Charge Code	5770001
Hospital Revenue Code	450
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$1,076.75
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,076.75
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

IRRIG CORPOR CAVERN F PRIAPISM

Facility

$833.00

Service Code	HCPCS 54220
Hospital Charge Code	5770001
Hospital Revenue Code	450
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRRIG. CYSTOTOME 25G FORMED

Facility

$36.00

Hospital Charge Code	270331571
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

IRRIG. CYSTOTOME 25G FORMED

Facility

$36.00

Hospital Charge Code	270331571
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

IRRIG OF DRUG DELIVERY SYSTEM

Facility

$152.00

Service Code	HCPCS 96523
Hospital Charge Code	3401160
Hospital Revenue Code	335
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

IRRIG OF DRUG DELIVERY SYSTEM

Facility

$152.00

Service Code	HCPCS 96523
Hospital Charge Code	3401160
Hospital Revenue Code	335
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$49.06
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.52
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$4.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

IRRISEPT CLEANSNG & DEBRID SYS

Facility

$316.50

Hospital Charge Code	270680866
Hospital Revenue Code	272
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$158.25
Rate for Payer: Aetna Commercial	$120.27
Rate for Payer: Aetna Medicare Advantage	$94.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.71
Rate for Payer: Cigna Commercial	$158.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.29
Rate for Payer: Oxford Commercial	$63.30
Rate for Payer: Qualcare PPO/HMO/WC	$47.48
Rate for Payer: UnitedHealthcare Commercial	$63.30
Rate for Payer: UnitedHealthcare Community & State	$10.00
Rate for Payer: Wellpoint Medicaid Managed Care	$8.99

IRRISEPT CLEANSNG & DEBRID SYS

Facility

$316.50

Hospital Charge Code	270680866
Hospital Revenue Code	272
Min. Negotiated Rate	$47.48
Max. Negotiated Rate	$47.48
Rate for Payer: Qualcare PPO/HMO/WC	$47.48

IRR NOZZLE F/05.001.063 F/PEN

Facility

$833.00

Hospital Charge Code	270674693
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/05.001.063 F/PEN

Facility

$833.00

Hospital Charge Code	270674693
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

IRR NOZZLE F/05.001.177

Facility

$784.00

Hospital Charge Code	270674706
Hospital Revenue Code	272
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$392.00
Rate for Payer: Aetna Commercial	$297.92
Rate for Payer: Aetna Medicare Advantage	$235.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.92
Rate for Payer: Cigna Commercial	$392.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.84
Rate for Payer: Oxford Commercial	$156.80
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Commercial	$156.80
Rate for Payer: UnitedHealthcare Community & State	$24.77
Rate for Payer: Wellpoint Medicaid Managed Care	$22.27

IRR NOZZLE F/05.001.177

Facility

$784.00

Hospital Charge Code	270674706
Hospital Revenue Code	272
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$117.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

IRR NOZZLE F/ EPD RECIP ATTACH

Facility

$833.00

Hospital Charge Code	270674697
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/ EPD RECIP ATTACH

Facility

$833.00

Hospital Charge Code	270674697
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

IRR NOZZLE F/ EPD SAG ATTACH

Facility

$833.00

Hospital Charge Code	270674164
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

IRR NOZZLE F/ EPD SAG ATTACH

Facility

$833.00

Hospital Charge Code	270674164
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/HEX DRILL ATTACH

Facility

$833.00

Hospital Charge Code	270674699
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE F/HEX DRILL ATTACH

Facility

$833.00

Hospital Charge Code	270674699
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

IRR NOZZLE-LONG F/E- PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674696
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE-LONG F/E- PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674696
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

Know your out-of-pocket cost for care.

All Charges