Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OVERDRILL FOR 3.5 SCREW AO FIT

Facility

$930.00

Hospital Charge Code	270660365
Hospital Revenue Code	272
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Qualcare PPO/HMO/WC	$139.50

OVERDRILL FOR 3.5 SCREW AO FIT

Facility

$930.00

Hospital Charge Code	270660365
Hospital Revenue Code	272
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$465.00
Rate for Payer: Aetna Commercial	$353.40
Rate for Payer: Aetna Medicare Advantage	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.15
Rate for Payer: Cigna Commercial	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.80
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.50
Rate for Payer: UnitedHealthcare Commercial	$186.00
Rate for Payer: UnitedHealthcare Community & State	$29.39
Rate for Payer: Wellpoint Medicaid Managed Care	$26.41

OVERDRILL TC 2.0/2.5

Facility

$880.00

Hospital Charge Code	270669820
Hospital Revenue Code	272
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

OVERDRILL TC 2.0/2.5

Facility

$880.00

Hospital Charge Code	270669820
Hospital Revenue Code	272
Min. Negotiated Rate	$24.99
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.80
Rate for Payer: Oxford Commercial	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Commercial	$176.00
Rate for Payer: UnitedHealthcare Community & State	$27.81
Rate for Payer: Wellpoint Medicaid Managed Care	$24.99

OVERTUBE GUARDUS 10.0x11.7mm

Facility

$775.00

Hospital Charge Code	270640965
Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

OVERTUBE GUARDUS 10.0x11.7mm

Facility

$775.00

Hospital Charge Code	270640965
Hospital Revenue Code	272
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.50
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$155.00
Rate for Payer: UnitedHealthcare Community & State	$24.49
Rate for Payer: Wellpoint Medicaid Managed Care	$22.01

OVERTUBE GUARDUS 50CM

Facility

$930.00

Hospital Charge Code	270678796
Hospital Revenue Code	272
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$465.00
Rate for Payer: Aetna Commercial	$353.40
Rate for Payer: Aetna Medicare Advantage	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.15
Rate for Payer: Cigna Commercial	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.80
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.50
Rate for Payer: UnitedHealthcare Commercial	$186.00
Rate for Payer: UnitedHealthcare Community & State	$29.39
Rate for Payer: Wellpoint Medicaid Managed Care	$26.41

OVERTUBE GUARDUS 50CM

Facility

$930.00

Hospital Charge Code	270678796
Hospital Revenue Code	272
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Qualcare PPO/HMO/WC	$139.50

OVERTUBE GUARDUS 8.6x10mm

Facility

$525.00

Hospital Charge Code	270636439
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

OVERTUBE GUARDUS 8.6x10mm

Facility

$525.00

Hospital Charge Code	270636439
Hospital Revenue Code	272
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Commercial	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

OVERTUBE GUARDUS 8.6x10mm

Facility

$975.00

Hospital Charge Code	270642702
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

OVERTUBE GUARDUS 8.6x10mm

Facility

$975.00

Hospital Charge Code	270642702
Hospital Revenue Code	272
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$30.81
Rate for Payer: Wellpoint Medicaid Managed Care	$27.69

OVERTUBE GUARDUS 8.6X10MM

Facility

$219.95

Hospital Charge Code	2706427002
Hospital Revenue Code	272
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$109.97
Rate for Payer: Aetna Commercial	$83.58
Rate for Payer: Aetna Medicare Advantage	$65.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.09
Rate for Payer: Cigna Commercial	$109.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.19
Rate for Payer: Oxford Commercial	$43.99
Rate for Payer: Qualcare PPO/HMO/WC	$32.99
Rate for Payer: UnitedHealthcare Commercial	$43.99
Rate for Payer: UnitedHealthcare Community & State	$6.95
Rate for Payer: Wellpoint Medicaid Managed Care	$6.25

OVERTUBE GUARDUS 8.6X10MM

Facility

$219.95

Hospital Charge Code	2706427002
Hospital Revenue Code	272
Min. Negotiated Rate	$32.99
Max. Negotiated Rate	$32.99
Rate for Payer: Qualcare PPO/HMO/WC	$32.99

OV-ESTABLISHED-BRIEF

Facility

$318.00

Service Code	HCPCS 99211
Hospital Charge Code	83653180
Hospital Revenue Code	514
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$47.70

OV-ESTABLISHED-BRIEF

Facility

$318.00

Service Code	HCPCS 99211
Hospital Charge Code	83653180
Hospital Revenue Code	514
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$120.84
Rate for Payer: Aetna Medicare Advantage	$95.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.09
Rate for Payer: Cigna Commercial	$159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.68
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Community & State	$10.05
Rate for Payer: Wellpoint Medicaid Managed Care	$9.03

OV-ESTABLISHED-COMPREHENSIVE

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	83653220
Hospital Revenue Code	514
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

OV-ESTABLISHED-COMPREHENSIVE

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	83653220
Hospital Revenue Code	514
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

OV-ESTABLISHED-EXTENDED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	83653195
Hospital Revenue Code	514
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$26.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.54

OV-ESTABLISHED-EXTENDED

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	83653195
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	83653190
Hospital Revenue Code	514
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.35
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$20.70
Rate for Payer: Wellpoint Medicaid Managed Care	$18.61

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	83653190
Hospital Revenue Code	514
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	74308305
Hospital Revenue Code	514
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.35
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$20.70
Rate for Payer: Wellpoint Medicaid Managed Care	$18.61

OV-ESTABLISHED-INTERMEDIATE

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	74308305
Hospital Revenue Code	514
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

OV ESTAB PT EXPAND PROB FOCUS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84506120
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

Know your out-of-pocket cost for care.

All Charges