Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PROCLAIM 6 ELITE

Facility

$120,940.00

Service Code	HCPCS C1767
Hospital Charge Code	270684306
Hospital Revenue Code	278
Min. Negotiated Rate	$3,434.70
Max. Negotiated Rate	$60,470.00
Rate for Payer: Aetna Commercial	$45,957.20
Rate for Payer: Aetna Medicare Advantage	$36,282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,839.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,839.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,839.70
Rate for Payer: Cigna Commercial	$60,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,267.48
Rate for Payer: Qualcare PPO/HMO/WC	$18,141.00
Rate for Payer: UnitedHealthcare Community & State	$3,821.70
Rate for Payer: Wellpoint Medicaid Managed Care	$3,434.70

PROCLAIM 6 ELITE

Facility

$120,940.00

Service Code	HCPCS C1767
Hospital Charge Code	270684306
Hospital Revenue Code	278
Min. Negotiated Rate	$18,141.00
Max. Negotiated Rate	$29,267.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,267.48
Rate for Payer: Qualcare PPO/HMO/WC	$18,141.00

PROC ONLY

Facility

$10,100.00

Hospital Charge Code	73190164
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

PROC ONLY

Facility

$10,100.00

Hospital Charge Code	73190164
Hospital Revenue Code	720
Min. Negotiated Rate	$286.84
Max. Negotiated Rate	$5,050.00
Rate for Payer: Aetna Commercial	$3,838.00
Rate for Payer: Aetna Medicare Advantage	$3,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,575.50
Rate for Payer: Cigna Commercial	$5,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,626.00
Rate for Payer: Oxford Commercial	$4,053.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$319.16
Rate for Payer: Wellpoint Medicaid Managed Care	$286.84

PROCTECTOMY,CPLT ABDOMINALOPNE

Facility

$22,891.20

Service Code	HCPCS 45110
Hospital Charge Code	1600000529
Hospital Revenue Code	360
Min. Negotiated Rate	$3,433.68
Max. Negotiated Rate	$3,433.68
Rate for Payer: Qualcare PPO/HMO/WC	$3,433.68

PROCTECTOMY,CPLT ABDOMINALOPNE

Facility

$22,891.20

Service Code	HCPCS 45110
Hospital Charge Code	1600000529
Hospital Revenue Code	360
Min. Negotiated Rate	$650.11
Max. Negotiated Rate	$11,445.60
Rate for Payer: Aetna Commercial	$8,698.66
Rate for Payer: Aetna Medicare Advantage	$6,867.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,837.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,837.26
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	$5,837.26
Rate for Payer: Cigna Commercial	$11,445.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,951.71
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,433.68
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$723.36
Rate for Payer: Wellpoint Medicaid Managed Care	$650.11

PROCTOSIGMOIDOSCOPY SDS

Facility

$3,489.62

Service Code	HCPCS 45300
Hospital Charge Code	16000485
Hospital Revenue Code	360
Min. Negotiated Rate	$523.44
Max. Negotiated Rate	$523.44
Rate for Payer: Qualcare PPO/HMO/WC	$523.44

PROCTOSIGMOIDOSCOPY SDS

Facility

$3,489.62

Service Code	HCPCS 45300
Hospital Charge Code	16000485
Hospital Revenue Code	360
Min. Negotiated Rate	$99.11
Max. Negotiated Rate	$4,007.70
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
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	$4,007.70
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.30
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$523.44
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$110.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$99.11

PRO-DENSE INJ 5CC

Facility

$17,292.00

Service Code	HCPCS C1713
Hospital Charge Code	270702616
Hospital Revenue Code	278
Min. Negotiated Rate	$2,593.80
Max. Negotiated Rate	$4,184.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,458.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,184.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,593.80

PRO-DENSE INJ 5CC

Facility

$17,292.00

Service Code	HCPCS C1713
Hospital Charge Code	270702616
Hospital Revenue Code	278
Min. Negotiated Rate	$491.09
Max. Negotiated Rate	$8,646.00
Rate for Payer: Aetna Commercial	$6,570.96
Rate for Payer: Aetna Medicare Advantage	$5,187.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,409.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,409.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,458.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,409.46
Rate for Payer: Cigna Commercial	$8,646.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,184.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,593.80
Rate for Payer: UnitedHealthcare Community & State	$546.43
Rate for Payer: Wellpoint Medicaid Managed Care	$491.09

PRO-DENSE INJECTABLE

Facility

$23,040.00

Service Code	HCPCS C1713
Hospital Charge Code	270667309
Hospital Revenue Code	278
Min. Negotiated Rate	$3,456.00
Max. Negotiated Rate	$5,575.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,608.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,575.68
Rate for Payer: Qualcare PPO/HMO/WC	$3,456.00

PRO-DENSE INJECTABLE

Facility

$23,040.00

Service Code	HCPCS C1713
Hospital Charge Code	270667309
Hospital Revenue Code	278
Min. Negotiated Rate	$654.34
Max. Negotiated Rate	$11,520.00
Rate for Payer: Aetna Commercial	$8,755.20
Rate for Payer: Aetna Medicare Advantage	$6,912.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,875.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,875.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,608.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,875.20
Rate for Payer: Cigna Commercial	$11,520.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,575.68
Rate for Payer: Qualcare PPO/HMO/WC	$3,456.00
Rate for Payer: UnitedHealthcare Community & State	$728.06
Rate for Payer: Wellpoint Medicaid Managed Care	$654.34

PRODISC-C DEEP IMPL LG 6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692629
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C DEEP IMPL LG 6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692629
Hospital Revenue Code	278
Min. Negotiated Rate	$844.90
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$940.10
Rate for Payer: Wellpoint Medicaid Managed Care	$844.90

PRODISC-C IMPL MED .5MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692980
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C IMPL MED .5MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692980
Hospital Revenue Code	278
Min. Negotiated Rate	$844.90
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$940.10
Rate for Payer: Wellpoint Medicaid Managed Care	$844.90

PRODISC-C INTER PROS LARGE 6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693729
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C INTER PROS LARGE 6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270693729
Hospital Revenue Code	278
Min. Negotiated Rate	$844.90
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$940.10
Rate for Payer: Wellpoint Medicaid Managed Care	$844.90

PRODISC-C INTERV DISC PROS MOD

Facility

$29,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270693191
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C INTERV DISC PROS MOD

Facility

$29,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270693191
Hospital Revenue Code	278
Min. Negotiated Rate	$844.90
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$940.10
Rate for Payer: Wellpoint Medicaid Managed Care	$844.90

PRODISC-C L 17X14MMX5MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697230
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC-C L 17X14MMX5MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697230
Hospital Revenue Code	278
Min. Negotiated Rate	$844.90
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$940.10
Rate for Payer: Wellpoint Medicaid Managed Care	$844.90

PRODISC-C MOLYB 12X15X6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694331
Hospital Revenue Code	278
Min. Negotiated Rate	$844.90
Max. Negotiated Rate	$14,875.00
Rate for Payer: Aetna Commercial	$11,305.00
Rate for Payer: Aetna Medicare Advantage	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,586.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,586.25
Rate for Payer: Cigna Commercial	$14,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50
Rate for Payer: UnitedHealthcare Community & State	$940.10
Rate for Payer: Wellpoint Medicaid Managed Care	$844.90

PRODISC-C MOLYB 12X15X6MM

Facility

$29,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694331
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

PRODISC C VIVO 15X14MM H6MM

Facility

$29,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704586
Hospital Revenue Code	278
Min. Negotiated Rate	$4,462.50
Max. Negotiated Rate	$7,199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,199.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,462.50

Know your out-of-pocket cost for care.

All Charges