Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

KYPHON XPEDE BONE CEMENT

Facility

$828.50

Service Code	HCPCS C1765
Hospital Charge Code	270704148
Hospital Revenue Code	278
Min. Negotiated Rate	$124.28
Max. Negotiated Rate	$200.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.28

KYPHON XPEDE BONE CEMENT

Facility

$828.50

Service Code	HCPCS C1765
Hospital Charge Code	270704148
Hospital Revenue Code	278
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$414.25
Rate for Payer: Aetna Commercial	$314.83
Rate for Payer: Aetna Medicare Advantage	$248.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.27
Rate for Payer: Cigna Commercial	$414.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.28
Rate for Payer: UnitedHealthcare Community & State	$26.18
Rate for Payer: Wellpoint Medicaid Managed Care	$23.53

KYPHON X-STOP IPD IMP 14MM

Facility

$7,632.00

Hospital Charge Code	270335920
Hospital Revenue Code	278
Min. Negotiated Rate	$1,144.80
Max. Negotiated Rate	$1,846.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,526.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,846.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,144.80

KYPHON X-STOP IPD IMP 14MM

Facility

$7,632.00

Hospital Charge Code	270335920
Hospital Revenue Code	278
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$3,816.00
Rate for Payer: Aetna Commercial	$2,900.16
Rate for Payer: Aetna Medicare Advantage	$2,289.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,946.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,946.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,526.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,946.16
Rate for Payer: Cigna Commercial	$3,816.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,846.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,144.80
Rate for Payer: UnitedHealthcare Community & State	$241.17
Rate for Payer: Wellpoint Medicaid Managed Care	$216.75

KYPHOPLASTY BALLOONCATH10G15MM

Facility

$4,000.00

Hospital Charge Code	270699974
Hospital Revenue Code	272
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

KYPHOPLASTY BALLOONCATH10G15MM

Facility

$4,000.00

Hospital Charge Code	270699974
Hospital Revenue Code	272
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,040.00
Rate for Payer: Oxford Commercial	$800.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Commercial	$800.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

KYPHOPLASTY KIT G21

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695718
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$5,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50

KYPHOPLASTY KIT G21

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695718
Hospital Revenue Code	278
Min. Negotiated Rate	$603.50
Max. Negotiated Rate	$10,625.00
Rate for Payer: Aetna Commercial	$8,075.00
Rate for Payer: Aetna Medicare Advantage	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,418.75
Rate for Payer: Cigna Commercial	$10,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50
Rate for Payer: UnitedHealthcare Community & State	$671.50
Rate for Payer: Wellpoint Medicaid Managed Care	$603.50

KYPHX LATITUDE CURETTE A11B

Facility

$810.70

Hospital Charge Code	270633991
Hospital Revenue Code	272
Min. Negotiated Rate	$121.61
Max. Negotiated Rate	$121.61
Rate for Payer: Qualcare PPO/HMO/WC	$121.61

KYPHX LATITUDE CURETTE A11B

Facility

$810.70

Hospital Charge Code	270633991
Hospital Revenue Code	272
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$405.35
Rate for Payer: Aetna Commercial	$308.07
Rate for Payer: Aetna Medicare Advantage	$243.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.73
Rate for Payer: Cigna Commercial	$405.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.78
Rate for Payer: Oxford Commercial	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$121.61
Rate for Payer: UnitedHealthcare Commercial	$162.14
Rate for Payer: UnitedHealthcare Community & State	$25.62
Rate for Payer: Wellpoint Medicaid Managed Care	$23.02

L-0-SLIDE REVIEW

Facility

$680.00

Service Code	HCPCS 88321
Hospital Charge Code	3035064
Hospital Revenue Code	319
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$176.80
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$21.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$19.31

L-0-SLIDE REVIEW

Facility

$680.00

Service Code	HCPCS 88321
Hospital Charge Code	3035064
Hospital Revenue Code	319
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

LAAROSCOPE PROC URETER

Facility

$21,530.28

Service Code	HCPCS 50949
Hospital Charge Code	1600000257
Hospital Revenue Code	360
Min. Negotiated Rate	$611.46
Max. Negotiated Rate	$26,053.61
Rate for Payer: Aetna Commercial	$19,535.72
Rate for Payer: Aetna Medicare Advantage	$23,270.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,053.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,053.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,182.25
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	$26,053.61
Rate for Payer: Cigna Commercial	$14,396.79
Rate for Payer: Cigna Medicare Advantage	$7,182.25
Rate for Payer: Clover Medicare Advantage	$6,823.14
Rate for Payer: EmblemHealth Commercial	$21,546.75
Rate for Payer: Humana Medicare Advantage	$7,397.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,182.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,597.87
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,229.54
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$680.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,182.25
Rate for Payer: Wellcare Medicare Advantage	$7,182.25
Rate for Payer: Wellpoint Medicaid Managed Care	$611.46

LAAROSCOPE PROC URETER

Facility

$21,530.28

Service Code	HCPCS 50949
Hospital Charge Code	1600000257
Hospital Revenue Code	360
Min. Negotiated Rate	$3,229.54
Max. Negotiated Rate	$3,229.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,229.54

LABETALOL 20MG/4ML

Facility

$10.52

Service Code	NDC 409233934
Hospital Charge Code	60630128
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.26
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: Aetna Medicare Advantage	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.68
Rate for Payer: Cigna Commercial	$5.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.74
Rate for Payer: Oxford Commercial	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$1.58
Rate for Payer: UnitedHealthcare Commercial	$2.10
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

LABETALOL 20MG/4ML

Facility

$10.52

Service Code	NDC 409233934
Hospital Charge Code	60630128
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$1.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.58

LABETALOL INJ 5MG/ML 20ML

Facility

$40.20

Service Code	NDC 409226720
Hospital Charge Code	6003214
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

LABETALOL INJ 5MG/ML 20ML

Facility

$40.20

Service Code	NDC 409226720
Hospital Charge Code	6003214
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.45
Rate for Payer: Oxford Commercial	$8.04
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

LABETALOL TAB 100MG

Facility

$4.00

Service Code	NDC 51079092820
Hospital Charge Code	60627635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LABETALOL TAB 100MG

Facility

$4.00

Service Code	NDC 51079092820
Hospital Charge Code	60627635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

LABETALOL TAB 200MG

Facility

$4.56

Service Code	NDC 51079092920
Hospital Charge Code	60627636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.28
Rate for Payer: Aetna Commercial	$1.73
Rate for Payer: Aetna Medicare Advantage	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.16
Rate for Payer: Cigna Commercial	$2.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.19
Rate for Payer: Oxford Commercial	$0.91
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.91
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

LABETALOL TAB 200MG

Facility

$4.56

Service Code	NDC 51079092920
Hospital Charge Code	60627636
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

LACERATION TRAY CUSTOM

Facility

$22.08

Hospital Charge Code	270659697
Hospital Revenue Code	272
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.31

LACERATION TRAY CUSTOM

Facility

$22.08

Hospital Charge Code	270659697
Hospital Revenue Code	272
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$11.04
Rate for Payer: Aetna Commercial	$8.39
Rate for Payer: Aetna Medicare Advantage	$6.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.63
Rate for Payer: Cigna Commercial	$11.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.74
Rate for Payer: Oxford Commercial	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$3.31
Rate for Payer: UnitedHealthcare Commercial	$4.42
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

LACER RIGHT MED 1799-006

Facility

$33.65

Hospital Charge Code	270301162
Hospital Revenue Code	270
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$12.79
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.75
Rate for Payer: Oxford Commercial	$6.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$6.73
Rate for Payer: UnitedHealthcare Community & State	$1.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

Know your out-of-pocket cost for care.

All Charges