Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ORIOS XT 5CC

Facility

$4,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270704165
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

ORISE Gel

Facility

$425.00

Hospital Charge Code	270688072
Hospital Revenue Code	272
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

ORISE Gel

Facility

$425.00

Hospital Charge Code	270688072
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$70,023.81

Service Code	MSDRG 620
Min. Negotiated Rate	$21,321.35
Max. Negotiated Rate	$70,023.81
Rate for Payer: Aetna Commercial	$51,730.26
Rate for Payer: Aetna Medicare Advantage	$70,023.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44,882.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44,882.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,443.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44,882.10
Rate for Payer: Cigna Commercial	$35,675.49
Rate for Payer: Cigna Medicare Advantage	$22,443.53
Rate for Payer: Clover Medicare Advantage	$21,321.35
Rate for Payer: EmblemHealth Commercial	$67,330.59
Rate for Payer: Humana Medicare Advantage	$23,116.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,443.53
Rate for Payer: Oxford Commercial	$28,197.29
Rate for Payer: UnitedHealthcare Commercial	$37,743.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,443.53
Rate for Payer: Wellcare Medicare Advantage	$22,443.53

O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$110,687.93

Service Code	MSDRG 619
Min. Negotiated Rate	$33,703.06
Max. Negotiated Rate	$110,687.93
Rate for Payer: Aetna Commercial	$80,691.71
Rate for Payer: Aetna Medicare Advantage	$110,687.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72,033.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72,033.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35,476.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72,033.00
Rate for Payer: Cigna Commercial	$64,368.81
Rate for Payer: Cigna Medicare Advantage	$35,476.90
Rate for Payer: Clover Medicare Advantage	$33,703.06
Rate for Payer: EmblemHealth Commercial	$106,430.70
Rate for Payer: Humana Medicare Advantage	$36,541.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35,476.90
Rate for Payer: Oxford Commercial	$50,875.99
Rate for Payer: UnitedHealthcare Commercial	$68,099.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$35,476.90
Rate for Payer: Wellcare Medicare Advantage	$35,476.90

O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility

$67,120.34

Service Code	MSDRG 621
Min. Negotiated Rate	$20,437.28
Max. Negotiated Rate	$67,120.34
Rate for Payer: Aetna Commercial	$49,662.37
Rate for Payer: Aetna Medicare Advantage	$67,120.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42,111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42,111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,512.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42,111.60
Rate for Payer: Cigna Commercial	$33,626.76
Rate for Payer: Cigna Medicare Advantage	$21,512.93
Rate for Payer: Clover Medicare Advantage	$20,437.28
Rate for Payer: EmblemHealth Commercial	$64,538.79
Rate for Payer: Humana Medicare Advantage	$22,158.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,512.93
Rate for Payer: Oxford Commercial	$26,578.01
Rate for Payer: UnitedHealthcare Commercial	$35,575.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,512.93
Rate for Payer: Wellcare Medicare Advantage	$21,512.93

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$93,295.61

Service Code	MSDRG 940
Min. Negotiated Rate	$28,407.32
Max. Negotiated Rate	$93,295.61
Rate for Payer: Aetna Commercial	$68,304.73
Rate for Payer: Aetna Medicare Advantage	$93,295.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60,119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60,119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29,902.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60,119.85
Rate for Payer: Cigna Commercial	$52,096.51
Rate for Payer: Cigna Medicare Advantage	$29,902.44
Rate for Payer: Clover Medicare Advantage	$28,407.32
Rate for Payer: EmblemHealth Commercial	$89,707.32
Rate for Payer: Humana Medicare Advantage	$30,799.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29,902.44
Rate for Payer: Oxford Commercial	$41,176.18
Rate for Payer: UnitedHealthcare Commercial	$55,115.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$29,902.44
Rate for Payer: Wellcare Medicare Advantage	$29,902.44

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$134,101.87

Service Code	MSDRG 939
Min. Negotiated Rate	$40,832.30
Max. Negotiated Rate	$134,101.87
Rate for Payer: Aetna Commercial	$97,367.41
Rate for Payer: Aetna Medicare Advantage	$134,101.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89,210.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89,210.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42,981.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89,210.10
Rate for Payer: Cigna Commercial	$80,890.15
Rate for Payer: Cigna Medicare Advantage	$42,981.37
Rate for Payer: Clover Medicare Advantage	$40,832.30
Rate for Payer: EmblemHealth Commercial	$128,944.11
Rate for Payer: Humana Medicare Advantage	$44,270.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42,981.37
Rate for Payer: Oxford Commercial	$63,934.17
Rate for Payer: UnitedHealthcare Commercial	$85,578.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$42,981.37
Rate for Payer: Wellcare Medicare Advantage	$42,981.37

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$83,526.86

Service Code	MSDRG 941
Min. Negotiated Rate	$25,432.86
Max. Negotiated Rate	$83,526.86
Rate for Payer: Aetna Commercial	$61,347.31
Rate for Payer: Aetna Medicare Advantage	$83,526.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,531.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,531.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,771.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,531.30
Rate for Payer: Cigna Commercial	$45,203.52
Rate for Payer: Cigna Medicare Advantage	$26,771.43
Rate for Payer: Clover Medicare Advantage	$25,432.86
Rate for Payer: EmblemHealth Commercial	$80,314.29
Rate for Payer: Humana Medicare Advantage	$27,574.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,771.43
Rate for Payer: Oxford Commercial	$35,728.07
Rate for Payer: UnitedHealthcare Commercial	$47,823.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,771.43
Rate for Payer: Wellcare Medicare Advantage	$26,771.43

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$141,570.56

Service Code	MSDRG 876
Min. Negotiated Rate	$43,106.42
Max. Negotiated Rate	$141,570.56
Rate for Payer: Aetna Commercial	$102,686.70
Rate for Payer: Aetna Medicare Advantage	$141,570.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103,339.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103,339.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$45,375.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103,339.65
Rate for Payer: Cigna Commercial	$86,160.22
Rate for Payer: Cigna Medicare Advantage	$45,375.18
Rate for Payer: Clover Medicare Advantage	$43,106.42
Rate for Payer: EmblemHealth Commercial	$136,125.54
Rate for Payer: Humana Medicare Advantage	$46,736.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$45,375.18
Rate for Payer: Oxford Commercial	$68,099.54
Rate for Payer: UnitedHealthcare Commercial	$91,153.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$45,375.18
Rate for Payer: Wellcare Medicare Advantage	$45,375.18

ORTHOCORD

Facility

$245.00

Hospital Charge Code	270663293
Hospital Revenue Code	272
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

ORTHOCORD

Facility

$245.00

Hospital Charge Code	270663293
Hospital Revenue Code	272
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.70
Rate for Payer: Oxford Commercial	$49.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$49.00
Rate for Payer: UnitedHealthcare Community & State	$7.74
Rate for Payer: Wellpoint Medicaid Managed Care	$6.96

ORTHOCORD #2 SUTURE 223105

Facility

$1,645.00

Hospital Charge Code	270634228
Hospital Revenue Code	272
Min. Negotiated Rate	$246.75
Max. Negotiated Rate	$246.75
Rate for Payer: Qualcare PPO/HMO/WC	$246.75

ORTHOCORD #2 SUTURE 223105

Facility

$1,645.00

Hospital Charge Code	270634228
Hospital Revenue Code	272
Min. Negotiated Rate	$46.72
Max. Negotiated Rate	$822.50
Rate for Payer: Aetna Commercial	$625.10
Rate for Payer: Aetna Medicare Advantage	$493.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$419.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$419.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$419.48
Rate for Payer: Cigna Commercial	$822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.70
Rate for Payer: Oxford Commercial	$329.00
Rate for Payer: Qualcare PPO/HMO/WC	$246.75
Rate for Payer: UnitedHealthcare Commercial	$329.00
Rate for Payer: UnitedHealthcare Community & State	$51.98
Rate for Payer: Wellpoint Medicaid Managed Care	$46.72

ORTHO GLASS SPLINTING SYSTEM

Facility

$471.25

Hospital Charge Code	270654391
Hospital Revenue Code	272
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$235.62
Rate for Payer: Aetna Commercial	$179.07
Rate for Payer: Aetna Medicare Advantage	$141.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.17
Rate for Payer: Cigna Commercial	$235.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.53
Rate for Payer: Oxford Commercial	$94.25
Rate for Payer: Qualcare PPO/HMO/WC	$70.69
Rate for Payer: UnitedHealthcare Commercial	$94.25
Rate for Payer: UnitedHealthcare Community & State	$14.89
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

ORTHO GLASS SPLINTING SYSTEM

Facility

$471.25

Hospital Charge Code	270654391
Hospital Revenue Code	272
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$70.69
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

ORTHO-PACK

Facility

$219.00

Hospital Charge Code	270330631
Hospital Revenue Code	272
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$109.50
Rate for Payer: Aetna Commercial	$83.22
Rate for Payer: Aetna Medicare Advantage	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.84
Rate for Payer: Cigna Commercial	$109.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.94
Rate for Payer: Oxford Commercial	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$32.85
Rate for Payer: UnitedHealthcare Commercial	$43.80
Rate for Payer: UnitedHealthcare Community & State	$6.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6.22

ORTHO-PACK

Facility

$219.00

Hospital Charge Code	270330631
Hospital Revenue Code	272
Min. Negotiated Rate	$32.85
Max. Negotiated Rate	$32.85
Rate for Payer: Qualcare PPO/HMO/WC	$32.85

ORTHOSIS TOWERS LONG TALL

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694371
Hospital Revenue Code	278
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.10
Rate for Payer: Qualcare PPO/HMO/WC	$382.50

ORTHOSIS TOWERS LONG TALL

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694371
Hospital Revenue Code	278
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$1,275.00
Rate for Payer: Aetna Commercial	$969.00
Rate for Payer: Aetna Medicare Advantage	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.25
Rate for Payer: Cigna Commercial	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.10
Rate for Payer: Qualcare PPO/HMO/WC	$382.50
Rate for Payer: UnitedHealthcare Community & State	$80.58
Rate for Payer: Wellpoint Medicaid Managed Care	$72.42

ORTHOSORB PIN LS 1.3MM KIT

Facility

$1,365.00

Service Code	HCPCS C1713
Hospital Charge Code	270601205
Hospital Revenue Code	278
Min. Negotiated Rate	$38.77
Max. Negotiated Rate	$682.50
Rate for Payer: Aetna Commercial	$518.70
Rate for Payer: Aetna Medicare Advantage	$409.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.07
Rate for Payer: Cigna Commercial	$682.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.33
Rate for Payer: Qualcare PPO/HMO/WC	$204.75
Rate for Payer: UnitedHealthcare Community & State	$43.13
Rate for Payer: Wellpoint Medicaid Managed Care	$38.77

ORTHOSORB PIN LS 1.3MM KIT

Facility

$1,365.00

Service Code	HCPCS C1713
Hospital Charge Code	270601205
Hospital Revenue Code	278
Min. Negotiated Rate	$204.75
Max. Negotiated Rate	$330.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.33
Rate for Payer: Qualcare PPO/HMO/WC	$204.75

ORTHO TAPE SCOTCH CAST 2- 4IN

Facility

$16.15

Hospital Charge Code	270652013
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$8.07
Rate for Payer: Aetna Commercial	$6.14
Rate for Payer: Aetna Medicare Advantage	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.12
Rate for Payer: Cigna Commercial	$8.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.20
Rate for Payer: Oxford Commercial	$3.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.42
Rate for Payer: UnitedHealthcare Commercial	$3.23
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

ORTHO TAPE SCOTCH CAST 2- 4IN

Facility

$16.15

Hospital Charge Code	270652013
Hospital Revenue Code	270
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$2.42

ORTHOTIC CHECKOUT EA 15 MINS

Facility

$299.00

Service Code	HCPCS 97763GP
Hospital Charge Code	1008370
Hospital Revenue Code	420
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$113.62
Rate for Payer: Aetna Medicare Advantage	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.74
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.45
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

Know your out-of-pocket cost for care.

All Charges