Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AVANCE NERVE GRAFT

Facility

$10,625.00

Service Code	HCPCS C1768
Hospital Charge Code	270664250
Hospital Revenue Code	278
Min. Negotiated Rate	$301.75
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$335.75
Rate for Payer: Wellpoint Medicaid Managed Care	$301.75

AVEENO BATH

Facility

$4.00

Service Code	NDC 8137003662
Hospital Charge Code	60634467
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AVEENO BATH

Facility

$4.00

Service Code	NDC 8137003662
Hospital Charge Code	60634467
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

AVENIR CMPL HA HO COL SZ 6

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270699206
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

AVENIR CMPL HA HO COL SZ 6

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270699206
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

AVENIR CMPL HA HO COL SZ 7

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270695087
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

AVENIR CMPL HA HO COL SZ 7

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270695087
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

AVENIR CMPL HA STD COL SZ 0

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270694919
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

AVENIR CMPL HA STD COL SZ 0

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270694919
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

AVENIR CMPL HA VAR COL SZ 5

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270694800
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

AVENIR CMPL HA VAR COL SZ 5

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270694800
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

AVERNIR CMPL HA VAR COL SZ 2

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270699679
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

AVERNIR CMPL HA VAR COL SZ 2

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270699679
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

AVERNIR CMPL HIP STD COL SZ 6

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270695047
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.13
Max. Negotiated Rate	$3,578.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13

AVERNIR CMPL HIP STD COL SZ 6

Facility

$14,787.55

Service Code	HCPCS C1776
Hospital Charge Code	270695047
Hospital Revenue Code	278
Min. Negotiated Rate	$419.97
Max. Negotiated Rate	$7,393.77
Rate for Payer: Aetna Commercial	$5,619.27
Rate for Payer: Aetna Medicare Advantage	$4,436.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,770.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,957.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,770.83
Rate for Payer: Cigna Commercial	$7,393.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,578.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,218.13
Rate for Payer: UnitedHealthcare Community & State	$467.29
Rate for Payer: Wellpoint Medicaid Managed Care	$419.97

AV FUSE UPPR ARM BASILIC

Facility

$38,857.60

Service Code	HCPCS 36819
Hospital Charge Code	1800000822
Hospital Revenue Code	360
Min. Negotiated Rate	$1,103.56
Max. Negotiated Rate	$23,980.53
Rate for Payer: Aetna Commercial	$17,981.27
Rate for Payer: Aetna Medicare Advantage	$21,418.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,980.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,980.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,610.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,980.53
Rate for Payer: Cigna Commercial	$13,251.23
Rate for Payer: Cigna Medicare Advantage	$6,610.76
Rate for Payer: Clover Medicare Advantage	$6,280.22
Rate for Payer: EmblemHealth Commercial	$19,832.28
Rate for Payer: Humana Medicare Advantage	$6,809.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,610.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,102.98
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,828.64
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,227.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,610.76
Rate for Payer: Wellcare Medicare Advantage	$6,610.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1,103.56

AV FUSE UPPR ARM BASILIC

Facility

$38,857.60

Service Code	HCPCS 36819
Hospital Charge Code	1800000822
Hospital Revenue Code	360
Min. Negotiated Rate	$5,828.64
Max. Negotiated Rate	$5,828.64
Rate for Payer: Qualcare PPO/HMO/WC	$5,828.64

AV FUSION FOREARM VEIN

Facility

$31,830.40

Service Code	HCPCS 36280
Hospital Charge Code	1600000645
Hospital Revenue Code	360
Min. Negotiated Rate	$903.98
Max. Negotiated Rate	$15,915.20
Rate for Payer: Aetna Commercial	$12,095.55
Rate for Payer: Aetna Medicare Advantage	$9,549.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,116.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,116.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,116.75
Rate for Payer: Cigna Commercial	$15,915.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,275.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,774.56
Rate for Payer: UnitedHealthcare Community & State	$1,005.84
Rate for Payer: Wellpoint Medicaid Managed Care	$903.98

AV FUSION FOREARM VEIN

Facility

$31,830.40

Service Code	HCPCS 36280
Hospital Charge Code	1600000645
Hospital Revenue Code	360
Min. Negotiated Rate	$4,774.56
Max. Negotiated Rate	$4,774.56
Rate for Payer: Qualcare PPO/HMO/WC	$4,774.56

AVIATOR BALLOON 6X20

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270631631S
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

AVIATOR BALLOON 6X20

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270631631S
Hospital Revenue Code	278
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

AVISTA MRI 74CM 8 CON LEAD KIT

Facility

$12,500.00

Service Code	HCPCS C1778
Hospital Charge Code	270702948
Hospital Revenue Code	278
Min. Negotiated Rate	$355.00
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$395.00
Rate for Payer: Wellpoint Medicaid Managed Care	$355.00

AVISTA MRI 74CM 8 CON LEAD KIT

Facility

$12,500.00

Service Code	HCPCS C1778
Hospital Charge Code	270702948
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

AVITENE ENDOSCOPIC 1010150

Facility

$693.00

Hospital Charge Code	270608018
Hospital Revenue Code	272
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$346.50
Rate for Payer: Aetna Commercial	$263.34
Rate for Payer: Aetna Medicare Advantage	$207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.72
Rate for Payer: Cigna Commercial	$346.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.18
Rate for Payer: Oxford Commercial	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$103.95
Rate for Payer: UnitedHealthcare Commercial	$138.60
Rate for Payer: UnitedHealthcare Community & State	$21.90
Rate for Payer: Wellpoint Medicaid Managed Care	$19.68

AVITENE ENDOSCOPIC 1010150

Facility

$693.00

Hospital Charge Code	270608018
Hospital Revenue Code	272
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$103.95
Rate for Payer: Qualcare PPO/HMO/WC	$103.95

Know your out-of-pocket cost for care.

All Charges