Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MODULUS TLIF-O 7X10X25MM

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693363
Hospital Revenue Code	278
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$7,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

MODULUS TLIF-O 7X10X25MM

Facility

$32,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270693363
Hospital Revenue Code	278
Min. Negotiated Rate	$923.00
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,865.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Community & State	$1,027.00
Rate for Payer: Wellpoint Medicaid Managed Care	$923.00

MOLDABLE BONE MATRIX/2.5CC ALL

Facility

$4,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270704126
Hospital Revenue Code	278
Min. Negotiated Rate	$124.96
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,672.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$660.00
Rate for Payer: UnitedHealthcare Community & State	$139.04
Rate for Payer: Wellpoint Medicaid Managed Care	$124.96

MOLDABLE BONE MATRIX/2.5CC ALL

Facility

$4,400.00

Service Code	HCPCS C1763
Hospital Charge Code	270704126
Hospital Revenue Code	278
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$1,064.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.80
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

MOLD FEM CEMENT SPACER 60MM

Facility

$13,670.00

Hospital Charge Code	270677428
Hospital Revenue Code	272
Min. Negotiated Rate	$2,050.50
Max. Negotiated Rate	$2,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,050.50

MOLD FEM CEMENT SPACER 60MM

Facility

$13,670.00

Hospital Charge Code	270677428
Hospital Revenue Code	272
Min. Negotiated Rate	$388.23
Max. Negotiated Rate	$6,835.00
Rate for Payer: Aetna Commercial	$5,194.60
Rate for Payer: Aetna Medicare Advantage	$4,101.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,485.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,485.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,485.85
Rate for Payer: Cigna Commercial	$6,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,554.20
Rate for Payer: Oxford Commercial	$2,734.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,050.50
Rate for Payer: UnitedHealthcare Commercial	$2,734.00
Rate for Payer: UnitedHealthcare Community & State	$431.97
Rate for Payer: Wellpoint Medicaid Managed Care	$388.23

MOLD ID

Facility

$70.95

Service Code	HCPCS 87107
Hospital Charge Code	39900267
Hospital Revenue Code	309
Min. Negotiated Rate	$10.64
Max. Negotiated Rate	$10.64
Rate for Payer: Qualcare PPO/HMO/WC	$10.64

MOLD ID

Facility

$70.95

Service Code	HCPCS 87107
Hospital Charge Code	39900267
Hospital Revenue Code	309
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.07
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.44
Rate for Payer: Cigna Commercial	$35.48
Rate for Payer: Cigna Medicare Advantage	$10.32
Rate for Payer: Clover Medicare Advantage	$9.80
Rate for Payer: EmblemHealth Commercial	$30.96
Rate for Payer: Humana Medicare Advantage	$10.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.64
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.32
Rate for Payer: Wellcare Medicare Advantage	$10.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.01

MOLD TIB CEMENT SPACER 75MM

Facility

$6,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677431
Hospital Revenue Code	278
Min. Negotiated Rate	$183.89
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$2,460.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$204.61
Rate for Payer: Wellpoint Medicaid Managed Care	$183.89

MOLD TIB CEMENT SPACER 75MM

Facility

$6,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677431
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

MOLEC DIAG AMP SIGNAL EA SEQ

Facility

$118.00

Service Code	HCPCS 83908
Hospital Charge Code	38477141
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.35

MOLEC DIAG AMP SIGNAL EA SEQ

Facility

$118.00

Service Code	HCPCS 83908
Hospital Charge Code	38477141
Hospital Revenue Code	301
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

MOLEC DX MUTATION ID SEQ @ SEG

Facility

$118.00

Service Code	HCPCS 83904
Hospital Charge Code	38477140
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.35

MOLEC DX MUTATION ID SEQ @ SEG

Facility

$118.00

Service Code	HCPCS 83904
Hospital Charge Code	38477140
Hospital Revenue Code	301
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

MOLEC.DX REVERSE TRANS

Facility

$100.00

Service Code	HCPCS 83902
Hospital Charge Code	38472507
Hospital Revenue Code	301
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

MOLEC.DX REVERSE TRANS

Facility

$100.00

Service Code	HCPCS 83902
Hospital Charge Code	38472507
Hospital Revenue Code	301
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

MOLECULAR DIAG AMPLIFICATION

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38479468
Hospital Revenue Code	301
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

MOLECULAR DIAG AMPLIFICATION

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38479468
Hospital Revenue Code	301
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.18
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

MOLECULAR DIAG AMPLIFICATION 1

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473138
Hospital Revenue Code	301
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.18
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

MOLECULAR DIAG AMPLIFICATION 1

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473138
Hospital Revenue Code	301
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

MOLECULAR DIAG AMPLIFICATION 8

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473149
Hospital Revenue Code	301
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.18
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

MOLECULAR DIAG AMPLIFICATION 8

Facility

$293.00

Service Code	HCPCS 83898
Hospital Charge Code	38473149
Hospital Revenue Code	301
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

MOLECULAR DIAG INTERPRETATION

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38473145
Hospital Revenue Code	301
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

MOLECULAR DIAG INTERPRETATION

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38473145
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

MOLECULAR DIAG INTERPRETATION

Facility

$85.00

Hospital Charge Code	38479455
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

Know your out-of-pocket cost for care.

All Charges