Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

Pacific Plus 3x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683474
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 3x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683474N
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 3x150x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683475
Hospital Revenue Code	278
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$33.10
Rate for Payer: Wellpoint Medicaid Managed Care	$29.75

Pacific Plus 3x150x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683475N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 3x150x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683475N
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 3x150x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683475
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Pacific Plus 3x40x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683471
Hospital Revenue Code	278
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$33.10
Rate for Payer: Wellpoint Medicaid Managed Care	$29.75

Pacific Plus 3x40x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683471
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Pacific Plus 3x40x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683471N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 3x40x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683471N
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 3x60x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683472N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 3x60x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683472N
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 3x60x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683472
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 3x60x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683472
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 3x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683473
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 3x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683473N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 3x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683473
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 3x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683473N
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

PACIFIC PLUS 3X80X180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683473S
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

PACIFIC PLUS 3X80X180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683473S
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 4x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683482N
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

Pacific Plus 4x120x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683482
Hospital Revenue Code	278
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$33.10
Rate for Payer: Wellpoint Medicaid Managed Care	$29.75

Pacific Plus 4x120x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683482
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Pacific Plus 4x120x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683482N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

Pacific Plus 4x40x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683479
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

Know your out-of-pocket cost for care.

All Charges