Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OPTEFORM ALLOGRAFT 3x20MM

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270681387
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

OPTEFORM DISC 45MM

Facility

$8,437.50

Hospital Charge Code	270674125
Hospital Revenue Code	278
Min. Negotiated Rate	$239.62
Max. Negotiated Rate	$4,218.75
Rate for Payer: Aetna Commercial	$3,206.25
Rate for Payer: Aetna Medicare Advantage	$2,531.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,151.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,151.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,151.56
Rate for Payer: Cigna Commercial	$4,218.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.62
Rate for Payer: UnitedHealthcare Community & State	$266.62
Rate for Payer: Wellpoint Medicaid Managed Care	$239.62

OPTEFORM DISC 45MM

Facility

$8,437.50

Hospital Charge Code	270674125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.62
Max. Negotiated Rate	$2,041.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.62

OPTEMP CAUTERY

Facility

$255.00

Hospital Charge Code	270332557
Hospital Revenue Code	272
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$38.25
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

OPTEMP CAUTERY

Facility

$255.00

Hospital Charge Code	270332557
Hospital Revenue Code	272
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.30
Rate for Payer: Oxford Commercial	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.25
Rate for Payer: UnitedHealthcare Commercial	$51.00
Rate for Payer: UnitedHealthcare Community & State	$8.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.24

OPTICHAMBER

Facility

$45.22

Hospital Charge Code	270651553
Hospital Revenue Code	270
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$22.61
Rate for Payer: Aetna Commercial	$17.18
Rate for Payer: Aetna Medicare Advantage	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.53
Rate for Payer: Cigna Commercial	$22.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.76
Rate for Payer: Oxford Commercial	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$6.78
Rate for Payer: UnitedHealthcare Commercial	$9.04
Rate for Payer: UnitedHealthcare Community & State	$1.43
Rate for Payer: Wellpoint Medicaid Managed Care	$1.28

OPTICHAMBER

Facility

$45.22

Hospital Charge Code	270651553
Hospital Revenue Code	270
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$6.78
Rate for Payer: Qualcare PPO/HMO/WC	$6.78

OPTICROSS HD 5FR

Facility

$5,625.00

Hospital Charge Code	270703405
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

OPTICROSS HD 5FR

Facility

$5,625.00

Hospital Charge Code	270703405
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

OPTICROSS HD 6 FR

Facility

$5,625.00

Hospital Charge Code	270703406
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

OPTICROSS HD 6 FR

Facility

$5,625.00

Hospital Charge Code	270703406
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

OPTIFIX

Facility

$3,400.00

Hospital Charge Code	270685689
Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

OPTIFIX

Facility

$3,400.00

Hospital Charge Code	270685689
Hospital Revenue Code	272
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$1,700.00
Rate for Payer: Aetna Commercial	$1,292.00
Rate for Payer: Aetna Medicare Advantage	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$867.00
Rate for Payer: Cigna Commercial	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$884.00
Rate for Payer: Oxford Commercial	$680.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00
Rate for Payer: UnitedHealthcare Commercial	$680.00
Rate for Payer: UnitedHealthcare Community & State	$107.44
Rate for Payer: Wellpoint Medicaid Managed Care	$96.56

OPTI-FORM 14.7CC (602-05-75)

Facility

$4,221.00

Hospital Charge Code	270334767
Hospital Revenue Code	278
Min. Negotiated Rate	$633.15
Max. Negotiated Rate	$1,021.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$844.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,021.48
Rate for Payer: Qualcare PPO/HMO/WC	$633.15

OPTI-FORM 14.7CC (602-05-75)

Facility

$4,221.00

Hospital Charge Code	270334767
Hospital Revenue Code	278
Min. Negotiated Rate	$119.88
Max. Negotiated Rate	$2,110.50
Rate for Payer: Aetna Commercial	$1,603.98
Rate for Payer: Aetna Medicare Advantage	$1,266.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$844.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,076.36
Rate for Payer: Cigna Commercial	$2,110.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,021.48
Rate for Payer: Qualcare PPO/HMO/WC	$633.15
Rate for Payer: UnitedHealthcare Community & State	$133.38
Rate for Payer: Wellpoint Medicaid Managed Care	$119.88

OPTI-FORM 32CC (600-05-90)

Facility

$7,225.00

Hospital Charge Code	270334768
Hospital Revenue Code	278
Min. Negotiated Rate	$205.19
Max. Negotiated Rate	$3,612.50
Rate for Payer: Aetna Commercial	$2,745.50
Rate for Payer: Aetna Medicare Advantage	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,842.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,842.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,842.38
Rate for Payer: Cigna Commercial	$3,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,748.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,083.75
Rate for Payer: UnitedHealthcare Community & State	$228.31
Rate for Payer: Wellpoint Medicaid Managed Care	$205.19

OPTI-FORM 32CC (600-05-90)

Facility

$7,225.00

Hospital Charge Code	270334768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,083.75
Max. Negotiated Rate	$1,748.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,748.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,083.75

OPTIMUS X FIBER PLUS

Facility

$6,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270703776
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

OPTIMUS X FIBER PLUS

Facility

$6,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270703776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

OPTIMUS X FIBER PLUS 10CC

Facility

$11,625.00

Hospital Charge Code	270703477
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$2,813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

OPTIMUS X FIBER PLUS 10CC

Facility

$11,625.00

Hospital Charge Code	270703477
Hospital Revenue Code	278
Min. Negotiated Rate	$330.15
Max. Negotiated Rate	$5,812.50
Rate for Payer: Aetna Commercial	$4,417.50
Rate for Payer: Aetna Medicare Advantage	$3,487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,964.38
Rate for Payer: Cigna Commercial	$5,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75
Rate for Payer: UnitedHealthcare Community & State	$367.35
Rate for Payer: Wellpoint Medicaid Managed Care	$330.15

OPTISON PERFLUTREN PROTEIN A M

Facility

$376.27

Service Code	NDC 407270703
Hospital Charge Code	606390583
Hospital Revenue Code	250
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$188.13
Rate for Payer: Aetna Commercial	$142.98
Rate for Payer: Aetna Medicare Advantage	$112.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.95
Rate for Payer: Cigna Commercial	$188.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.83
Rate for Payer: Oxford Commercial	$75.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.44
Rate for Payer: UnitedHealthcare Commercial	$75.25
Rate for Payer: UnitedHealthcare Community & State	$11.89
Rate for Payer: Wellpoint Medicaid Managed Care	$10.69

OPTISON PERFLUTREN PROTEIN A M

Facility

$376.27

Service Code	NDC 407270703
Hospital Charge Code	606390583
Hospital Revenue Code	250
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$56.44

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626N
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

Optisphere Embolic Bds 100-300

Facility

$1,200.00

Hospital Charge Code	270686626N
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

Know your out-of-pocket cost for care.

All Charges