Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OBTRYX HALO SYSTEM

Facility

$3,206.00

Hospital Charge Code	270332608
Hospital Revenue Code	278
Min. Negotiated Rate	$91.05
Max. Negotiated Rate	$1,603.00
Rate for Payer: Aetna Commercial	$1,218.28
Rate for Payer: Aetna Medicare Advantage	$961.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$817.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$817.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$817.53
Rate for Payer: Cigna Commercial	$1,603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.85
Rate for Payer: Qualcare PPO/HMO/WC	$480.90
Rate for Payer: UnitedHealthcare Community & State	$101.31
Rate for Payer: Wellpoint Medicaid Managed Care	$91.05

OBTRYX HALO SYSTEM

Facility

$3,206.00

Hospital Charge Code	270332608
Hospital Revenue Code	278
Min. Negotiated Rate	$480.90
Max. Negotiated Rate	$775.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.85
Rate for Payer: Qualcare PPO/HMO/WC	$480.90

OBTURATOR BLADELESS 8MM

Facility

$125.00

Hospital Charge Code	270663999
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

OBTURATOR BLADELESS 8MM

Facility

$125.00

Hospital Charge Code	270663999
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

OBTURATOR PENCIL 4.0MM SHARP

Facility

$814.30

Hospital Charge Code	270688983
Hospital Revenue Code	272
Min. Negotiated Rate	$122.14
Max. Negotiated Rate	$122.14
Rate for Payer: Qualcare PPO/HMO/WC	$122.14

OBTURATOR PENCIL 4.0MM SHARP

Facility

$814.30

Hospital Charge Code	270688983
Hospital Revenue Code	272
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$407.15
Rate for Payer: Aetna Commercial	$309.43
Rate for Payer: Aetna Medicare Advantage	$244.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.65
Rate for Payer: Cigna Commercial	$407.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.72
Rate for Payer: Oxford Commercial	$162.86
Rate for Payer: Qualcare PPO/HMO/WC	$122.14
Rate for Payer: UnitedHealthcare Commercial	$162.86
Rate for Payer: UnitedHealthcare Community & State	$25.73
Rate for Payer: Wellpoint Medicaid Managed Care	$23.13

OBTURATOR PENCIL PKG

Facility

$587.10

Hospital Charge Code	270688258
Hospital Revenue Code	272
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$293.55
Rate for Payer: Aetna Commercial	$223.10
Rate for Payer: Aetna Medicare Advantage	$176.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.71
Rate for Payer: Cigna Commercial	$293.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.65
Rate for Payer: Oxford Commercial	$117.42
Rate for Payer: Qualcare PPO/HMO/WC	$88.06
Rate for Payer: UnitedHealthcare Commercial	$117.42
Rate for Payer: UnitedHealthcare Community & State	$18.55
Rate for Payer: Wellpoint Medicaid Managed Care	$16.67

OBTURATOR PENCIL PKG

Facility

$587.10

Hospital Charge Code	270688258
Hospital Revenue Code	272
Min. Negotiated Rate	$88.06
Max. Negotiated Rate	$88.06
Rate for Payer: Qualcare PPO/HMO/WC	$88.06

OBTURATOR XI 8MM BLADELESS XLN

Facility

$150.00

Service Code	HCPCS C1776
Hospital Charge Code	270678879
Hospital Revenue Code	278
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

OBTURATOR XI 8MM BLADELESS XLN

Facility

$150.00

Service Code	HCPCS C1776
Hospital Charge Code	270678879
Hospital Revenue Code	278
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

OBURATOR BLUNT 12 MM STAPLER

Facility

$3,900.00

Hospital Charge Code	270691092
Hospital Revenue Code	272
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,482.00
Rate for Payer: Aetna Medicare Advantage	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.50
Rate for Payer: Cigna Commercial	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,014.00
Rate for Payer: Oxford Commercial	$780.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Commercial	$780.00
Rate for Payer: UnitedHealthcare Community & State	$123.24
Rate for Payer: Wellpoint Medicaid Managed Care	$110.76

OBURATOR BLUNT 12 MM STAPLER

Facility

$3,900.00

Hospital Charge Code	270691092
Hospital Revenue Code	272
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

OB-US<14 WEEKS, ADDL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	83653035
Hospital Revenue Code	402
Min. Negotiated Rate	$31.72
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$424.46
Rate for Payer: Aetna Medicare Advantage	$335.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.83
Rate for Payer: Cigna Commercial	$558.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.42
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$35.30
Rate for Payer: Wellpoint Medicaid Managed Care	$31.72

OB-US<14 WEEKS, ADDL FETUS

Facility

$1,117.00

Service Code	HCPCS 76802
Hospital Charge Code	83653035
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

OB-US>14 WEEKS, ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	83653045
Hospital Revenue Code	402
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$211.20
Rate for Payer: Qualcare PPO/HMO/WC	$211.20

OB-US>14 WEEKS, ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	83653045
Hospital Revenue Code	402
Min. Negotiated Rate	$39.99
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$535.04
Rate for Payer: Aetna Medicare Advantage	$422.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$359.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$359.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$212.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$359.04
Rate for Payer: Cigna Commercial	$704.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.08
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$211.20
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$44.49
Rate for Payer: Wellpoint Medicaid Managed Care	$39.99

OB-US<14 WKS, SINGLE FETUS

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	83653030
Hospital Revenue Code	402
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$234.57
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

OB-US<14 WKS, SINGLE FETUS

Facility

$1,563.80

Service Code	HCPCS 76801
Hospital Charge Code	83653030
Hospital Revenue Code	402
Min. Negotiated Rate	$44.41
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.59
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$234.57
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$49.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$44.41

OB-US LIMITED MULTIPLE FETUS

Facility

$600.00

Service Code	HCPCS 76815
Hospital Charge Code	83653070
Hospital Revenue Code	402
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

OB-US LIMITED MULTIPLE FETUS

Facility

$600.00

Service Code	HCPCS 76815
Hospital Charge Code	83653070
Hospital Revenue Code	402
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	74308350
Hospital Revenue Code	402
Min. Negotiated Rate	$31.72
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.42
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$35.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$31.72

OB-US LIMITED MULTIPLE FETUS

Facility

$1,117.00

Service Code	HCPCS 76815
Hospital Charge Code	74308350
Hospital Revenue Code	402
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

OBV INP HSP HIGH SEVERITY

Facility

$666.42

Service Code	HCPCS 99236
Hospital Charge Code	87502350
Hospital Revenue Code	510
Min. Negotiated Rate	$99.96
Max. Negotiated Rate	$99.96
Rate for Payer: Qualcare PPO/HMO/WC	$99.96

OBV INP HSP HIGH SEVERITY

Facility

$666.42

Service Code	HCPCS 99236
Hospital Charge Code	87502350
Hospital Revenue Code	510
Min. Negotiated Rate	$18.93
Max. Negotiated Rate	$333.21
Rate for Payer: Aetna Commercial	$253.24
Rate for Payer: Aetna Medicare Advantage	$199.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.94
Rate for Payer: Cigna Commercial	$333.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.27
Rate for Payer: Qualcare PPO/HMO/WC	$99.96
Rate for Payer: UnitedHealthcare Community & State	$21.06
Rate for Payer: Wellpoint Medicaid Managed Care	$18.93

OBV INP HSP LOW SEVERITY

Facility

$412.93

Service Code	HCPCS 99234
Hospital Charge Code	87502345
Hospital Revenue Code	510
Min. Negotiated Rate	$61.94
Max. Negotiated Rate	$61.94
Rate for Payer: Qualcare PPO/HMO/WC	$61.94

Know your out-of-pocket cost for care.

All Charges