Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MIRTAZAPINE 30 MG TAB

Facility

$18.76

Service Code	NDC 51079008720
Hospital Charge Code	60628851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$9.38
Rate for Payer: Aetna Commercial	$7.13
Rate for Payer: Aetna Medicare Advantage	$5.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.78
Rate for Payer: Cigna Commercial	$9.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.88
Rate for Payer: Oxford Commercial	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.81
Rate for Payer: UnitedHealthcare Commercial	$3.75
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

MIRTAZAPINE ODT 15MG TAB

Facility

$15.81

Service Code	NDC 65862002106
Hospital Charge Code	606361034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$7.91
Rate for Payer: Aetna Commercial	$6.01
Rate for Payer: Aetna Medicare Advantage	$4.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.03
Rate for Payer: Cigna Commercial	$7.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.11
Rate for Payer: Oxford Commercial	$3.16
Rate for Payer: Qualcare PPO/HMO/WC	$2.37
Rate for Payer: UnitedHealthcare Commercial	$3.16
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

MIRTAZAPINE ODT 15MG TAB

Facility

$15.81

Service Code	NDC 65862002106
Hospital Charge Code	606361034
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.37

MIRUS CYGNUS SCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704631
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

MIRUS CYGNUS SCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704631
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

MIS CALCANEAL S7 HOLE PLATE

Facility

$8,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270700420
Hospital Revenue Code	278
Min. Negotiated Rate	$1,308.00
Max. Negotiated Rate	$2,110.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,110.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,308.00

MIS CALCANEAL S7 HOLE PLATE

Facility

$8,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270700420
Hospital Revenue Code	278
Min. Negotiated Rate	$247.65
Max. Negotiated Rate	$4,360.00
Rate for Payer: Aetna Commercial	$3,313.60
Rate for Payer: Aetna Medicare Advantage	$2,616.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,223.60
Rate for Payer: Cigna Commercial	$4,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,110.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,308.00
Rate for Payer: UnitedHealthcare Community & State	$275.55
Rate for Payer: Wellpoint Medicaid Managed Care	$247.65

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$61,661.03

Service Code	MSDRG 640
Min. Negotiated Rate	$18,774.99
Max. Negotiated Rate	$61,661.03
Rate for Payer: Aetna Commercial	$45,774.19
Rate for Payer: Aetna Medicare Advantage	$61,661.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,570.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,570.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,763.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,570.60
Rate for Payer: Cigna Commercial	$29,774.53
Rate for Payer: Cigna Medicare Advantage	$19,763.15
Rate for Payer: Clover Medicare Advantage	$18,774.99
Rate for Payer: EmblemHealth Commercial	$59,289.45
Rate for Payer: Humana Medicare Advantage	$20,356.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,763.15
Rate for Payer: Oxford Commercial	$23,533.27
Rate for Payer: UnitedHealthcare Commercial	$31,500.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,763.15
Rate for Payer: Wellcare Medicare Advantage	$19,763.15

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$44,050.75

Service Code	MSDRG 641
Min. Negotiated Rate	$13,412.89
Max. Negotiated Rate	$44,050.75
Rate for Payer: Aetna Commercial	$33,231.97
Rate for Payer: Aetna Medicare Advantage	$44,050.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,609.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,609.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,118.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,609.90
Rate for Payer: Cigna Commercial	$17,348.41
Rate for Payer: Cigna Medicare Advantage	$14,118.83
Rate for Payer: Clover Medicare Advantage	$13,412.89
Rate for Payer: EmblemHealth Commercial	$42,356.49
Rate for Payer: Humana Medicare Advantage	$14,542.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,118.83
Rate for Payer: Oxford Commercial	$13,711.88
Rate for Payer: UnitedHealthcare Commercial	$18,353.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,118.83
Rate for Payer: Wellcare Medicare Advantage	$14,118.83

MIS CURVED PRE-BENT ROD

Facility

$1,200.00

Hospital Charge Code	270703020
Hospital Revenue Code	278
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$37.92
Rate for Payer: Wellpoint Medicaid Managed Care	$34.08

MIS CURVED PRE-BENT ROD

Facility

$1,200.00

Hospital Charge Code	270703020
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

MIS HEADED SCREW 33MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681305
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

MIS HEADED SCREW 33MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681305
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Community & State	$13.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

MIS HEADED SCREW 48MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681304
Hospital Revenue Code	278
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Community & State	$13.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

MIS HEADED SCREW 48MM

Facility

$420.00

Service Code	HCPCS C1713
Hospital Charge Code	270681304
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$101.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.64
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

MIS MTP S-PLATE L

Facility

$7,750.00

Hospital Charge Code	270703226
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

MIS MTP S-PLATE L

Facility

$7,750.00

Hospital Charge Code	270703226
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

MIS SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705054
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

MIS SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705054
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

MIS STERILE INSTR

Facility

$1,300.50

Hospital Charge Code	270702611
Hospital Revenue Code	270
Min. Negotiated Rate	$36.93
Max. Negotiated Rate	$650.25
Rate for Payer: Aetna Commercial	$494.19
Rate for Payer: Aetna Medicare Advantage	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.63
Rate for Payer: Cigna Commercial	$650.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.13
Rate for Payer: Oxford Commercial	$260.10
Rate for Payer: Qualcare PPO/HMO/WC	$195.07
Rate for Payer: UnitedHealthcare Commercial	$260.10
Rate for Payer: UnitedHealthcare Community & State	$41.10
Rate for Payer: Wellpoint Medicaid Managed Care	$36.93

MIS STERILE INSTR

Facility

$1,300.50

Hospital Charge Code	270702611
Hospital Revenue Code	270
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$195.07
Rate for Payer: Qualcare PPO/HMO/WC	$195.07

MIS STERILE INSTRUMENT PACK W

Facility

$3,942.00

Hospital Charge Code	270703557
Hospital Revenue Code	272
Min. Negotiated Rate	$591.30
Max. Negotiated Rate	$591.30
Rate for Payer: Qualcare PPO/HMO/WC	$591.30

MIS STERILE INSTRUMENT PACK W

Facility

$3,942.00

Hospital Charge Code	270703557
Hospital Revenue Code	272
Min. Negotiated Rate	$111.95
Max. Negotiated Rate	$1,971.00
Rate for Payer: Aetna Commercial	$1,497.96
Rate for Payer: Aetna Medicare Advantage	$1,182.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.21
Rate for Payer: Cigna Commercial	$1,971.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.92
Rate for Payer: Oxford Commercial	$788.40
Rate for Payer: Qualcare PPO/HMO/WC	$591.30
Rate for Payer: UnitedHealthcare Commercial	$788.40
Rate for Payer: UnitedHealthcare Community & State	$124.57
Rate for Payer: Wellpoint Medicaid Managed Care	$111.95

MIS STER INST PACK W/BLD MICA

Facility

$1,300.50

Service Code	HCPCS C1713
Hospital Charge Code	270702621
Hospital Revenue Code	278
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$314.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.72
Rate for Payer: Qualcare PPO/HMO/WC	$195.07

MIS STER INST PACK W/BLD MICA

Facility

$1,300.50

Service Code	HCPCS C1713
Hospital Charge Code	270702621
Hospital Revenue Code	278
Min. Negotiated Rate	$36.93
Max. Negotiated Rate	$650.25
Rate for Payer: Aetna Commercial	$494.19
Rate for Payer: Aetna Medicare Advantage	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.63
Rate for Payer: Cigna Commercial	$650.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.72
Rate for Payer: Qualcare PPO/HMO/WC	$195.07
Rate for Payer: UnitedHealthcare Community & State	$41.10
Rate for Payer: Wellpoint Medicaid Managed Care	$36.93

Know your out-of-pocket cost for care.

All Charges