Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PERI LOCKING SCREW 3.5MM X 44M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684874
Hospital Revenue Code	278
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$198.55
Rate for Payer: Aetna Medicare Advantage	$156.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.24
Rate for Payer: Cigna Commercial	$261.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

PERI LOCKING SCREW 3.5MM X 44M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684874
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$126.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38

PERI LOCKING SCREW 3.5MM X 50M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684875
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$126.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38

PERI LOCKING SCREW 3.5MM X 50M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684875
Hospital Revenue Code	278
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$198.55
Rate for Payer: Aetna Medicare Advantage	$156.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.24
Rate for Payer: Cigna Commercial	$261.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

PERI LOCKING SCREW 3.5MM X 54M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684876
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$126.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38

PERI LOCKING SCREW 3.5MM X 54M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684876
Hospital Revenue Code	278
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$198.55
Rate for Payer: Aetna Medicare Advantage	$156.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.24
Rate for Payer: Cigna Commercial	$261.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

PERI LOCKING SCREW 3.5MM X 58M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684877
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$126.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38

PERI LOCKING SCREW 3.5MM X 58M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684877
Hospital Revenue Code	278
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$198.55
Rate for Payer: Aetna Medicare Advantage	$156.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.24
Rate for Payer: Cigna Commercial	$261.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

PERI LOCKING SCREW 3.5MM X 60M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684878
Hospital Revenue Code	278
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$198.55
Rate for Payer: Aetna Medicare Advantage	$156.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.24
Rate for Payer: Cigna Commercial	$261.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

PERI LOCKING SCREW 3.5MM X 60M

Facility

$522.50

Service Code	HCPCS C1713
Hospital Charge Code	270684878
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$126.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: Qualcare PPO/HMO/WC	$78.38

PERI LOCKING SCREW 3.5.MM X 65

Facility

$577.50

Service Code	HCPCS C1713
Hospital Charge Code	270684879
Hospital Revenue Code	278
Min. Negotiated Rate	$86.62
Max. Negotiated Rate	$139.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.62

PERI LOCKING SCREW 3.5.MM X 65

Facility

$577.50

Service Code	HCPCS C1713
Hospital Charge Code	270684879
Hospital Revenue Code	278
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$288.75
Rate for Payer: Aetna Commercial	$219.45
Rate for Payer: Aetna Medicare Advantage	$173.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.26
Rate for Payer: Cigna Commercial	$288.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.62
Rate for Payer: UnitedHealthcare Community & State	$18.25
Rate for Payer: Wellpoint Medicaid Managed Care	$16.40

PERI LOCKING SCREW 3.5MM X 80M

Facility

$577.50

Service Code	HCPCS C1713
Hospital Charge Code	270684880
Hospital Revenue Code	278
Min. Negotiated Rate	$86.62
Max. Negotiated Rate	$139.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.62

PERI LOCKING SCREW 3.5MM X 80M

Facility

$577.50

Service Code	HCPCS C1713
Hospital Charge Code	270684880
Hospital Revenue Code	278
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$288.75
Rate for Payer: Aetna Commercial	$219.45
Rate for Payer: Aetna Medicare Advantage	$173.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.26
Rate for Payer: Cigna Commercial	$288.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.75
Rate for Payer: Qualcare PPO/HMO/WC	$86.62
Rate for Payer: UnitedHealthcare Community & State	$18.25
Rate for Payer: Wellpoint Medicaid Managed Care	$16.40

PERINEAL PAD SUPINE

Facility

$425.00

Hospital Charge Code	270670483
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

PERINEAL PAD SUPINE

Facility

$425.00

Hospital Charge Code	270670483
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

PERI NON STRESS TEST

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	74308045
Hospital Revenue Code	920
Min. Negotiated Rate	$284.76
Max. Negotiated Rate	$284.76
Rate for Payer: Qualcare PPO/HMO/WC	$284.76

PERI NON STRESS TEST

Facility

$1,898.40

Service Code	HCPCS 59025
Hospital Charge Code	74308045
Hospital Revenue Code	920
Min. Negotiated Rate	$53.91
Max. Negotiated Rate	$2,301.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.58
Rate for Payer: Oxford Commercial	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.76
Rate for Payer: UnitedHealthcare Commercial	$2,301.00
Rate for Payer: UnitedHealthcare Community & State	$59.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$53.91

PERI OBSERVATION PER HOUR

Facility

$151.00

Service Code	HCPCS 99235
Hospital Charge Code	74308320
Hospital Revenue Code	762
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$22.65
Rate for Payer: Qualcare PPO/HMO/WC	$22.65

PERI OBSERVATION PER HOUR

Facility

$151.00

Service Code	HCPCS 99235
Hospital Charge Code	74308320
Hospital Revenue Code	762
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$10,618.00
Rate for Payer: Aetna Commercial	$57.38
Rate for Payer: Aetna Medicare Advantage	$45.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.51
Rate for Payer: Cigna Commercial	$75.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.26
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.65
Rate for Payer: UnitedHealthcare Commercial	$10,618.00
Rate for Payer: UnitedHealthcare Community & State	$4.77
Rate for Payer: Wellpoint Medicaid Managed Care	$50.00

PERI OB/US<14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76802
Hospital Charge Code	74308100
Hospital Revenue Code	402
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

PERI OB/US<14 WKS ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76802
Hospital Charge Code	74308100
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI OB/US>/=14 WKS ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	74308110
Hospital Revenue Code	402
Min. Negotiated Rate	$39.99
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$535.04
Rate for Payer: Aetna Medicare Advantage	$422.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$359.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$359.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$212.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$359.04
Rate for Payer: Cigna Commercial	$704.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.08
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$211.20
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$44.49
Rate for Payer: Wellpoint Medicaid Managed Care	$39.99

PERI OB/US>/=14 WKS ADDL FETUS

Facility

$1,408.00

Service Code	HCPCS 76810
Hospital Charge Code	74308110
Hospital Revenue Code	402
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$211.20
Rate for Payer: Qualcare PPO/HMO/WC	$211.20

PERI OB/US<14 WKS SINGLE FETUS

Facility

$6,700.00

Service Code	HCPCS 76801
Hospital Charge Code	74308095
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

Know your out-of-pocket cost for care.

All Charges