Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PACIFIC PLUS 5X40X180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683484S
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 5X40X180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683484S
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 5x60x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683485
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 5x60x180

Facility

$1,047.40

Service Code	HCPCS C1725
Hospital Charge Code	270683485
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 5x60x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683485N
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 5x60x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683485N
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 5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683486N
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 5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683486
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 5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683486
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 5x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683486N
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 6x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683488N
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 6x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683488
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 6x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683488
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 6x80x180

Facility

$1,140.00

Service Code	HCPCS C1725
Hospital Charge Code	270683488N
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

PACK ANTERIOR VITRECTOMY

Facility

$830.00

Hospital Charge Code	270653347
Hospital Revenue Code	270
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$124.50
Rate for Payer: Qualcare PPO/HMO/WC	$124.50

PACK ANTERIOR VITRECTOMY

Facility

$830.00

Hospital Charge Code	270653347
Hospital Revenue Code	270
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$415.00
Rate for Payer: Aetna Commercial	$315.40
Rate for Payer: Aetna Medicare Advantage	$249.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.65
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.80
Rate for Payer: Oxford Commercial	$166.00
Rate for Payer: Qualcare PPO/HMO/WC	$124.50
Rate for Payer: UnitedHealthcare Commercial	$166.00
Rate for Payer: UnitedHealthcare Community & State	$26.23
Rate for Payer: Wellpoint Medicaid Managed Care	$23.57

PACK AUTOGRAFT GRAFTLINK CONV

Facility

$3,400.00

Hospital Charge Code	270676748
Hospital Revenue Code	272
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$510.00
Rate for Payer: Qualcare PPO/HMO/WC	$510.00

PACK AUTOGRAFT GRAFTLINK CONV

Facility

$3,400.00

Hospital Charge Code	270676748
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

PACK A.V. FISTULA

Facility

$390.10

Hospital Charge Code	270653789
Hospital Revenue Code	270
Min. Negotiated Rate	$58.52
Max. Negotiated Rate	$58.52
Rate for Payer: Qualcare PPO/HMO/WC	$58.52

PACK A.V. FISTULA

Facility

$390.10

Hospital Charge Code	270653789
Hospital Revenue Code	270
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.05
Rate for Payer: Aetna Commercial	$148.24
Rate for Payer: Aetna Medicare Advantage	$117.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.48
Rate for Payer: Cigna Commercial	$195.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.43
Rate for Payer: Oxford Commercial	$78.02
Rate for Payer: Qualcare PPO/HMO/WC	$58.52
Rate for Payer: UnitedHealthcare Commercial	$78.02
Rate for Payer: UnitedHealthcare Community & State	$12.33
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PACK BREAST TRAY

Facility

$333.98

Hospital Charge Code	270671833
Hospital Revenue Code	272
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$50.10
Rate for Payer: Qualcare PPO/HMO/WC	$50.10

PACK BREAST TRAY

Facility

$333.98

Hospital Charge Code	270671833
Hospital Revenue Code	272
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$166.99
Rate for Payer: Aetna Commercial	$126.91
Rate for Payer: Aetna Medicare Advantage	$100.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.16
Rate for Payer: Cigna Commercial	$166.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.83
Rate for Payer: Oxford Commercial	$66.80
Rate for Payer: Qualcare PPO/HMO/WC	$50.10
Rate for Payer: UnitedHealthcare Commercial	$66.80
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

PACK BRONCHOSCOPY

Facility

$69.79

Hospital Charge Code	270653796
Hospital Revenue Code	272
Min. Negotiated Rate	$10.47
Max. Negotiated Rate	$10.47
Rate for Payer: Qualcare PPO/HMO/WC	$10.47

PACK BRONCHOSCOPY

Facility

$69.79

Hospital Charge Code	270653796
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$34.90
Rate for Payer: Aetna Commercial	$26.52
Rate for Payer: Aetna Medicare Advantage	$20.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.80
Rate for Payer: Cigna Commercial	$34.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Oxford Commercial	$13.96
Rate for Payer: Qualcare PPO/HMO/WC	$10.47
Rate for Payer: UnitedHealthcare Commercial	$13.96
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

PACK CATARACT ALCON

Facility

$1,487.50

Hospital Charge Code	270651590
Hospital Revenue Code	272
Min. Negotiated Rate	$42.24
Max. Negotiated Rate	$743.75
Rate for Payer: Aetna Commercial	$565.25
Rate for Payer: Aetna Medicare Advantage	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.31
Rate for Payer: Cigna Commercial	$743.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.75
Rate for Payer: Oxford Commercial	$297.50
Rate for Payer: Qualcare PPO/HMO/WC	$223.12
Rate for Payer: UnitedHealthcare Commercial	$297.50
Rate for Payer: UnitedHealthcare Community & State	$47.01
Rate for Payer: Wellpoint Medicaid Managed Care	$42.24

Know your out-of-pocket cost for care.

All Charges