Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	7411211
Hospital Revenue Code	480
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
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	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	366893285
Hospital Revenue Code	480
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
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	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	7411211
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE EVAL PROGR

Facility

$152.00

Service Code	HCPCS 93285
Hospital Charge Code	366893285
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERROGATE

Facility

$152.00

Service Code	HCPCS 93291
Hospital Charge Code	366893291
Hospital Revenue Code	480
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
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	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

LLR DEVICE INTERROGATE

Facility

$152.00

Service Code	HCPCS 93291
Hospital Charge Code	366893291
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERROGATE

Facility

$152.00

Service Code	HCPCS 93291
Hospital Charge Code	7411213
Hospital Revenue Code	480
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
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	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

LLR DEVICE INTERROGATE

Facility

$152.00

Service Code	HCPCS 93291
Hospital Charge Code	7411213
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERRO REMOTE

Facility

$152.00

Service Code	HCPCS 93298
Hospital Charge Code	366893298
Hospital Revenue Code	480
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
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	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

LLR DEVICE INTERRO REMOTE

Facility

$152.00

Service Code	HCPCS 93298
Hospital Charge Code	366893298
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERRO REMOTE

Facility

$152.00

Service Code	HCPCS 93298
Hospital Charge Code	7411215
Hospital Revenue Code	480
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

LLR DEVICE INTERRO REMOTE

Facility

$152.00

Service Code	HCPCS 93298
Hospital Charge Code	7411215
Hospital Revenue Code	480
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
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	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

LMA UNIQUE STD SZ 2.5

Facility

$33.30

Hospital Charge Code	270669309
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$12.65
Rate for Payer: Aetna Medicare Advantage	$9.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.49
Rate for Payer: Cigna Commercial	$16.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.66
Rate for Payer: Oxford Commercial	$6.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.00
Rate for Payer: UnitedHealthcare Commercial	$6.66
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

LMA UNIQUE STD SZ 2.5

Facility

$33.30

Hospital Charge Code	270669309
Hospital Revenue Code	272
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.00

LNG ARM SPLNT SHLDR TO HN

Facility

$777.42

Service Code	HCPCS 29105
Hospital Charge Code	412329105
Hospital Revenue Code	361
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

LNG ARM SPLNT SHLDR TO HN

Facility

$777.42

Service Code	HCPCS 29105
Hospital Charge Code	412329105
Hospital Revenue Code	361
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.13
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.61
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$24.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$22.08

LNG LG SPLNT THGH TO TOES

Facility

$777.42

Service Code	HCPCS 29505
Hospital Charge Code	412329505
Hospital Revenue Code	361
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.13
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.61
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$24.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$22.08

LNG LG SPLNT THGH TO TOES

Facility

$777.42

Service Code	HCPCS 29505
Hospital Charge Code	412329505
Hospital Revenue Code	361
Min. Negotiated Rate	$116.61
Max. Negotiated Rate	$116.61
Rate for Payer: Qualcare PPO/HMO/WC	$116.61

LNR REST ADMMDM X3 INS 28/48E

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699503
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

LNR REST ADMMDM X3 INS 28/48E

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270699503
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

LOAD UNIT 55 2.5 WH TVR55

Facility

$266.90

Hospital Charge Code	270608734
Hospital Revenue Code	272
Min. Negotiated Rate	$40.03
Max. Negotiated Rate	$40.03
Rate for Payer: Qualcare PPO/HMO/WC	$40.03

LOAD UNIT 55 2.5 WH TVR55

Facility

$266.90

Hospital Charge Code	270608734
Hospital Revenue Code	272
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$133.45
Rate for Payer: Aetna Commercial	$101.42
Rate for Payer: Aetna Medicare Advantage	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.06
Rate for Payer: Cigna Commercial	$133.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.39
Rate for Payer: Oxford Commercial	$53.38
Rate for Payer: Qualcare PPO/HMO/WC	$40.03
Rate for Payer: UnitedHealthcare Commercial	$53.38
Rate for Payer: UnitedHealthcare Community & State	$8.43
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

LOAD UNIT ENDO GIA 30-2.5R

Facility

$683.60

Hospital Charge Code	270651833
Hospital Revenue Code	272
Min. Negotiated Rate	$19.41
Max. Negotiated Rate	$341.80
Rate for Payer: Aetna Commercial	$259.77
Rate for Payer: Aetna Medicare Advantage	$205.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.32
Rate for Payer: Cigna Commercial	$341.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.74
Rate for Payer: Oxford Commercial	$136.72
Rate for Payer: Qualcare PPO/HMO/WC	$102.54
Rate for Payer: UnitedHealthcare Commercial	$136.72
Rate for Payer: UnitedHealthcare Community & State	$21.60
Rate for Payer: Wellpoint Medicaid Managed Care	$19.41

LOAD UNIT ENDO GIA 30-2.5R

Facility

$683.60

Hospital Charge Code	270651833
Hospital Revenue Code	272
Min. Negotiated Rate	$102.54
Max. Negotiated Rate	$102.54
Rate for Payer: Qualcare PPO/HMO/WC	$102.54

LOAD UNIT ENDO GIA 45 2.5R

Facility

$781.22

Hospital Charge Code	270619587
Hospital Revenue Code	272
Min. Negotiated Rate	$22.19
Max. Negotiated Rate	$390.61
Rate for Payer: Aetna Commercial	$296.86
Rate for Payer: Aetna Medicare Advantage	$234.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.21
Rate for Payer: Cigna Commercial	$390.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.12
Rate for Payer: Oxford Commercial	$156.24
Rate for Payer: Qualcare PPO/HMO/WC	$117.18
Rate for Payer: UnitedHealthcare Commercial	$156.24
Rate for Payer: UnitedHealthcare Community & State	$24.69
Rate for Payer: Wellpoint Medicaid Managed Care	$22.19

Know your out-of-pocket cost for care.

All Charges