Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LRG BNE OSCLLTNG BLD 63.0X42MM

Facility

$35.00

Hospital Charge Code	270662588
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

LRG BNE OSCLLTNG BLD 63.0X49MM

Facility

$35.00

Hospital Charge Code	270662589
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

LRG BNE OSCLLTNG BLD 63.0X49MM

Facility

$35.00

Hospital Charge Code	270662589
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.10
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

LRG ROCKER SHOE - LNG

Facility

$8,167.40

Hospital Charge Code	270702829
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.11
Max. Negotiated Rate	$1,976.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,633.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,976.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,225.11

LRG ROCKER SHOE - LNG

Facility

$8,167.40

Hospital Charge Code	270702829
Hospital Revenue Code	278
Min. Negotiated Rate	$231.95
Max. Negotiated Rate	$4,083.70
Rate for Payer: Aetna Commercial	$3,103.61
Rate for Payer: Aetna Medicare Advantage	$2,450.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,082.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,082.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,633.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,082.69
Rate for Payer: Cigna Commercial	$4,083.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,976.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,225.11
Rate for Payer: UnitedHealthcare Community & State	$258.09
Rate for Payer: Wellpoint Medicaid Managed Care	$231.95

LSFMC DI RY 2ND & 3RD TMT PT

Facility

$8,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270701595
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.00
Max. Negotiated Rate	$2,023.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,023.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,254.00

LSFMC DI RY 2ND & 3RD TMT PT

Facility

$8,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270701595
Hospital Revenue Code	278
Min. Negotiated Rate	$237.42
Max. Negotiated Rate	$4,180.00
Rate for Payer: Aetna Commercial	$3,176.80
Rate for Payer: Aetna Medicare Advantage	$2,508.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,131.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,131.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,131.80
Rate for Payer: Cigna Commercial	$4,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,023.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,254.00
Rate for Payer: UnitedHealthcare Community & State	$264.18
Rate for Payer: Wellpoint Medicaid Managed Care	$237.42

L/S RATIO, AMNIOTIC FLUID

Facility

$437.00

Service Code	HCPCS 83661
Hospital Charge Code	38473110
Hospital Revenue Code	301
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$218.50
Rate for Payer: Aetna Commercial	$59.81
Rate for Payer: Aetna Medicare Advantage	$71.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.77
Rate for Payer: Cigna Commercial	$218.50
Rate for Payer: Cigna Medicare Advantage	$21.99
Rate for Payer: Clover Medicare Advantage	$20.89
Rate for Payer: EmblemHealth Commercial	$65.97
Rate for Payer: Humana Medicare Advantage	$22.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$65.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.99
Rate for Payer: Wellcare Medicare Advantage	$21.99
Rate for Payer: Wellpoint Medicaid Managed Care	$12.41

L/S RATIO, AMNIOTIC FLUID

Facility

$437.00

Service Code	HCPCS 83661
Hospital Charge Code	38473110
Hospital Revenue Code	301
Min. Negotiated Rate	$65.55
Max. Negotiated Rate	$65.55
Rate for Payer: Qualcare PPO/HMO/WC	$65.55

LS TIBIAL BEARING 22MM

Facility

$5,625.00

Hospital Charge Code	270678333
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

LS TIBIAL BEARING 22MM

Facility

$5,625.00

Hospital Charge Code	270678333
Hospital Revenue Code	278
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$177.75
Rate for Payer: Wellpoint Medicaid Managed Care	$159.75

LT PIPE STORZ FITTING THREADED

Facility

$2,920.05

Service Code	HCPCS C1713
Hospital Charge Code	270704143
Hospital Revenue Code	278
Min. Negotiated Rate	$82.93
Max. Negotiated Rate	$1,460.03
Rate for Payer: Aetna Commercial	$1,109.62
Rate for Payer: Aetna Medicare Advantage	$876.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$584.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$744.61
Rate for Payer: Cigna Commercial	$1,460.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.65
Rate for Payer: Qualcare PPO/HMO/WC	$438.01
Rate for Payer: UnitedHealthcare Community & State	$92.27
Rate for Payer: Wellpoint Medicaid Managed Care	$82.93

LT PIPE STORZ FITTING THREADED

Facility

$2,920.05

Service Code	HCPCS C1713
Hospital Charge Code	270704143
Hospital Revenue Code	278
Min. Negotiated Rate	$438.01
Max. Negotiated Rate	$706.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$584.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$706.65
Rate for Payer: Qualcare PPO/HMO/WC	$438.01

LUBRICANT EYE DROPS UD

Facility

$4.00

Service Code	NDC 23050601
Hospital Charge Code	60628083
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

LUBRICANT EYE DROPS UD

Facility

$4.00

Service Code	NDC 23050601
Hospital Charge Code	60628083
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LUBRICANT MIDAS REX

Facility

$31.00

Hospital Charge Code	270335561
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$15.50
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.06
Rate for Payer: Oxford Commercial	$6.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$6.20
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

LUBRICANT MIDAS REX

Facility

$31.00

Hospital Charge Code	270335561
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

LUBRICANT VIPERSLIDE 20ml

Facility

$400.00

Hospital Charge Code	270642016C
Hospital Revenue Code	272
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$12.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

LUBRICANT VIPERSLIDE 20ml

Facility

$400.00

Hospital Charge Code	270642016A
Hospital Revenue Code	272
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$12.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

LUBRICANT VIPERSLIDE 20ml

Facility

$400.00

Hospital Charge Code	270642016C
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

LUBRICANT VIPERSLIDE 20ml

Facility

$400.00

Hospital Charge Code	270642016A
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

LUBRIGLIDE COATED GUIDWIRE 3C

Facility

$213.10

Hospital Charge Code	270652682
Hospital Revenue Code	270
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$106.55
Rate for Payer: Aetna Commercial	$80.98
Rate for Payer: Aetna Medicare Advantage	$63.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.34
Rate for Payer: Cigna Commercial	$106.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.41
Rate for Payer: Oxford Commercial	$42.62
Rate for Payer: Qualcare PPO/HMO/WC	$31.96
Rate for Payer: UnitedHealthcare Commercial	$42.62
Rate for Payer: UnitedHealthcare Community & State	$6.73
Rate for Payer: Wellpoint Medicaid Managed Care	$6.05

LUBRIGLIDE COATED GUIDWIRE 3C

Facility

$213.10

Hospital Charge Code	270652682
Hospital Revenue Code	270
Min. Negotiated Rate	$31.96
Max. Negotiated Rate	$31.96
Rate for Payer: Qualcare PPO/HMO/WC	$31.96

LUBRI-GLIDE GUIDEWIRE MOVABLE

Facility

$303.00

Hospital Charge Code	270330754
Hospital Revenue Code	278
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$73.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.33
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

LUBRI-GLIDE GUIDEWIRE MOVABLE

Facility

$303.00

Hospital Charge Code	270330754
Hospital Revenue Code	278
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$115.14
Rate for Payer: Aetna Medicare Advantage	$90.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.27
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.33
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Community & State	$9.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

Know your out-of-pocket cost for care.

All Charges