Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LG HYBRID GLENOID BASE 4MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687721
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

LG HYBRID GLENOID BASE 4MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687721
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

LGN CEMENT STEM 14MMX160MMSTRT

Facility

$12,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270686901
Hospital Revenue Code	278
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$6,405.00
Rate for Payer: Aetna Commercial	$4,867.80
Rate for Payer: Aetna Medicare Advantage	$3,843.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,266.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,266.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,562.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,266.55
Rate for Payer: Cigna Commercial	$6,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,100.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,921.50
Rate for Payer: UnitedHealthcare Community & State	$404.80
Rate for Payer: Wellpoint Medicaid Managed Care	$363.80

LGN CEMENT STEM 14MMX160MMSTRT

Facility

$12,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270686901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,921.50
Max. Negotiated Rate	$3,100.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,562.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,100.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,921.50

LGN OX CONSTRAINED FEM 5 RT

Facility

$63,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270686900
Hospital Revenue Code	278
Min. Negotiated Rate	$9,515.25
Max. Negotiated Rate	$15,351.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,687.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,351.27
Rate for Payer: Qualcare PPO/HMO/WC	$9,515.25

LGN OX CONSTRAINED FEM 5 RT

Facility

$63,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270686900
Hospital Revenue Code	278
Min. Negotiated Rate	$1,801.55
Max. Negotiated Rate	$31,717.50
Rate for Payer: Aetna Commercial	$24,105.30
Rate for Payer: Aetna Medicare Advantage	$19,030.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,175.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,175.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,175.92
Rate for Payer: Cigna Commercial	$31,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,351.27
Rate for Payer: Qualcare PPO/HMO/WC	$9,515.25
Rate for Payer: UnitedHealthcare Community & State	$2,004.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1,801.55

LGTIN/BAND ANGIOACCESS AV FSTL

Facility

$25,406.80

Service Code	HCPCS 37607
Hospital Charge Code	16000954
Hospital Revenue Code	360
Min. Negotiated Rate	$3,811.02
Max. Negotiated Rate	$3,811.02
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02

LGTIN/BAND ANGIOACCESS AV FSTL

Facility

$25,406.80

Service Code	HCPCS 37607
Hospital Charge Code	16000954
Hospital Revenue Code	360
Min. Negotiated Rate	$721.55
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,605.77
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$802.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$721.55

Facility

$192.85

Service Code	HCPCS 83002
Hospital Charge Code	39900415
Hospital Revenue Code	301
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.37
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.18
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: Cigna Medicare Advantage	$18.52
Rate for Payer: Clover Medicare Advantage	$17.59
Rate for Payer: EmblemHealth Commercial	$55.56
Rate for Payer: Humana Medicare Advantage	$19.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.52
Rate for Payer: Wellcare Medicare Advantage	$18.52
Rate for Payer: Wellpoint Medicaid Managed Care	$5.48

Facility

$192.85

Service Code	HCPCS 83002
Hospital Charge Code	39900415
Hospital Revenue Code	301
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$28.93
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

LH0 LV CORONARY SVG ANGIO

Facility

$12,026.00

Service Code	HCPCS 93459
Hospital Charge Code	366893459
Hospital Revenue Code	481
Min. Negotiated Rate	$1,803.90
Max. Negotiated Rate	$1,803.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,803.90

LH0 LV CORONARY SVG ANGIO

Facility

$12,026.00

Service Code	HCPCS 93459
Hospital Charge Code	366893459
Hospital Revenue Code	481
Min. Negotiated Rate	$341.54
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,126.76
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,803.90
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$380.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$341.54

L HRT ARTERY/VENTRICLE ANGIO

Facility

$25,737.16

Service Code	HCPCS 93458
Hospital Charge Code	5100666
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

L HRT ARTERY/VENTRICLE ANGIO

Facility

$25,737.16

Service Code	HCPCS 93458
Hospital Charge Code	5100666
Hospital Revenue Code	481
Min. Negotiated Rate	$730.94
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,691.66
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$813.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$730.94

L HRT ART/GRFT ANGIO

Facility

$25,737.16

Service Code	HCPCS 93459
Hospital Charge Code	5100667
Hospital Revenue Code	481
Min. Negotiated Rate	$730.94
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,691.66
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$813.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$730.94

L HRT ART/GRFT ANGIO

Facility

$25,737.16

Service Code	HCPCS 93459
Hospital Charge Code	5100667
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

L HRT CATH CHD NM/ABN NT CNJ

Facility

$25,737.16

Service Code	HCPCS 93595
Hospital Charge Code	411093595
Hospital Revenue Code	481
Min. Negotiated Rate	$730.94
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,691.66
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$813.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$730.94

L HRT CATH CHD NM/ABN NT CNJ

Facility

$25,737.16

Service Code	HCPCS 93595
Hospital Charge Code	411093595
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

L HRT CATH TRNSPTL PUNCTURE

Facility

$25,737.16

Service Code	HCPCS 93462
Hospital Charge Code	411093462
Hospital Revenue Code	481
Min. Negotiated Rate	$3,860.57
Max. Negotiated Rate	$3,860.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57

L HRT CATH TRNSPTL PUNCTURE

Facility

$25,737.16

Service Code	HCPCS 93462
Hospital Charge Code	411093462
Hospital Revenue Code	481
Min. Negotiated Rate	$730.94
Max. Negotiated Rate	$12,868.58
Rate for Payer: Aetna Commercial	$9,780.12
Rate for Payer: Aetna Medicare Advantage	$7,721.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,562.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,562.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,562.98
Rate for Payer: Cigna Commercial	$12,868.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,691.66
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,860.57
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$813.29
Rate for Payer: Wellpoint Medicaid Managed Care	$730.94

LIDOCAINE

Facility

$390.00

Service Code	HCPCS 80176
Hospital Charge Code	38473053
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIDOCAINE

Facility

$390.00

Service Code	HCPCS 80176
Hospital Charge Code	38473053
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.96
Rate for Payer: Aetna Medicare Advantage	$47.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.69
Rate for Payer: Clover Medicare Advantage	$13.96
Rate for Payer: EmblemHealth Commercial	$44.07
Rate for Payer: Humana Medicare Advantage	$15.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.69
Rate for Payer: Wellcare Medicare Advantage	$14.69
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LIDOCAINE 1% 50 ML SOL

Facility

$10.18

Service Code	NDC 409427602
Hospital Charge Code	60627570
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.09
Rate for Payer: Aetna Commercial	$3.87
Rate for Payer: Aetna Medicare Advantage	$3.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.60
Rate for Payer: Cigna Commercial	$5.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.65
Rate for Payer: Oxford Commercial	$2.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.53
Rate for Payer: UnitedHealthcare Commercial	$2.04
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

LIDOCAINE 1% 50 ML SOL

Facility

$10.18

Service Code	NDC 409427602
Hospital Charge Code	60627570
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.53

LIDOCAINE 1.5%EPI 1 2 INJ 5ML

Facility

$18.02

Service Code	NDC 409120901
Hospital Charge Code	606390202
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

Know your out-of-pocket cost for care.

All Charges