Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PSN REV FEM CMT CCR PLS SZ 3L

Facility

$727.20

Service Code	HCPCS C1776
Hospital Charge Code	270699862
Hospital Revenue Code	278
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna Commercial	$276.34
Rate for Payer: Aetna Medicare Advantage	$218.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.44
Rate for Payer: Cigna Commercial	$363.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: Qualcare PPO/HMO/WC	$109.08
Rate for Payer: UnitedHealthcare Community & State	$22.98
Rate for Payer: Wellpoint Medicaid Managed Care	$20.65

PSN REV FEM CMT CCR PLS SZ 3L

Facility

$727.20

Service Code	HCPCS C1776
Hospital Charge Code	270699862
Hospital Revenue Code	278
Min. Negotiated Rate	$109.08
Max. Negotiated Rate	$175.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: Qualcare PPO/HMO/WC	$109.08

PSN REV FEM CMT CCR PLS SZ7 L

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270691596
Hospital Revenue Code	278
Min. Negotiated Rate	$8,292.19
Max. Negotiated Rate	$13,378.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19

PSN REV FEM CMT CCR PLS SZ7 L

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270691596
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.99
Max. Negotiated Rate	$27,640.62
Rate for Payer: Aetna Commercial	$21,006.88
Rate for Payer: Aetna Medicare Advantage	$16,584.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,096.72
Rate for Payer: Cigna Commercial	$27,640.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19
Rate for Payer: UnitedHealthcare Community & State	$1,746.89
Rate for Payer: Wellpoint Medicaid Managed Care	$1,569.99

PSN REV FEM CMT CCR PL SZ 7 R

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270694282
Hospital Revenue Code	278
Min. Negotiated Rate	$8,292.19
Max. Negotiated Rate	$13,378.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19

PSN REV FEM CMT CCR PL SZ 7 R

Facility

$55,281.25

Service Code	HCPCS C1776
Hospital Charge Code	270694282
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.99
Max. Negotiated Rate	$27,640.62
Rate for Payer: Aetna Commercial	$21,006.88
Rate for Payer: Aetna Medicare Advantage	$16,584.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,056.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,096.72
Rate for Payer: Cigna Commercial	$27,640.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,378.06
Rate for Payer: Qualcare PPO/HMO/WC	$8,292.19
Rate for Payer: UnitedHealthcare Community & State	$1,746.89
Rate for Payer: Wellpoint Medicaid Managed Care	$1,569.99

PSN REV FEM CMT CCR STD SZ11 L

Facility

$51,656.25

Service Code	HCPCS C1776
Hospital Charge Code	270695148
Hospital Revenue Code	278
Min. Negotiated Rate	$7,748.44
Max. Negotiated Rate	$12,500.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,331.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,500.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,748.44

PSN REV FEM CMT CCR STD SZ11 L

Facility

$51,656.25

Service Code	HCPCS C1776
Hospital Charge Code	270695148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,467.04
Max. Negotiated Rate	$25,828.12
Rate for Payer: Aetna Commercial	$19,629.38
Rate for Payer: Aetna Medicare Advantage	$15,496.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,172.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,172.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,172.34
Rate for Payer: Cigna Commercial	$25,828.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,500.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,748.44
Rate for Payer: UnitedHealthcare Community & State	$1,632.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1,467.04

PSN REV FEM CMT CCR STD SZ 5

Facility

$44,040.00

Service Code	HCPCS C1776
Hospital Charge Code	270692736
Hospital Revenue Code	278
Min. Negotiated Rate	$6,606.00
Max. Negotiated Rate	$10,657.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,808.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,657.68
Rate for Payer: Qualcare PPO/HMO/WC	$6,606.00

PSN REV FEM CMT CCR STD SZ 5

Facility

$44,040.00

Service Code	HCPCS C1776
Hospital Charge Code	270692736
Hospital Revenue Code	278
Min. Negotiated Rate	$1,250.74
Max. Negotiated Rate	$22,020.00
Rate for Payer: Aetna Commercial	$16,735.20
Rate for Payer: Aetna Medicare Advantage	$13,212.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,230.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,230.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,230.20
Rate for Payer: Cigna Commercial	$22,020.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,657.68
Rate for Payer: Qualcare PPO/HMO/WC	$6,606.00
Rate for Payer: UnitedHealthcare Community & State	$1,391.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,250.74

PSN REV FEM CMT CCR STD SZ 5 L

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270696798
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR STD SZ 5 L

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270696798
Hospital Revenue Code	278
Min. Negotiated Rate	$1,511.31
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,681.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1,511.31

PSN REV FEM CMT CCR STD SZ7 LT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697666
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR STD SZ7 LT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,511.31
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,681.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1,511.31

PSN REV FEM CMT CCR STD SZ 9 L

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270690145
Hospital Revenue Code	278
Min. Negotiated Rate	$1,511.31
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,681.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1,511.31

PSN REV FEM CMT CCR STD SZ 9 L

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270690145
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR STD SZ9 LT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697462
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR STD SZ9 LT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697462
Hospital Revenue Code	278
Min. Negotiated Rate	$1,511.31
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,681.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1,511.31

PSN REV FEM CMT CCR SZ 7

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270698591
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

PSN REV FEM CMT CCR SZ 7

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270698591
Hospital Revenue Code	278
Min. Negotiated Rate	$1,511.31
Max. Negotiated Rate	$26,607.50
Rate for Payer: Aetna Commercial	$20,221.70
Rate for Payer: Aetna Medicare Advantage	$15,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,569.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,569.83
Rate for Payer: Cigna Commercial	$26,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25
Rate for Payer: UnitedHealthcare Community & State	$1,681.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1,511.31

PSN REV FEM DISTAL AUG SZ 5

Facility

$6,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270692737
Hospital Revenue Code	278
Min. Negotiated Rate	$193.40
Max. Negotiated Rate	$3,405.00
Rate for Payer: Aetna Commercial	$2,587.80
Rate for Payer: Aetna Medicare Advantage	$2,043.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,736.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,736.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,736.55
Rate for Payer: Cigna Commercial	$3,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.50
Rate for Payer: UnitedHealthcare Community & State	$215.20
Rate for Payer: Wellpoint Medicaid Managed Care	$193.40

PSN REV FEM DISTAL AUG SZ 5

Facility

$6,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270692737
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.50
Max. Negotiated Rate	$1,648.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.50

PSN REV FEM DISTAL AUG SZ9 5MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270696900
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.31
Max. Negotiated Rate	$1,991.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31

PSN REV FEM DISTAL AUG SZ9 5MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270696900
Hospital Revenue Code	278
Min. Negotiated Rate	$233.70
Max. Negotiated Rate	$4,114.38
Rate for Payer: Aetna Commercial	$3,126.93
Rate for Payer: Aetna Medicare Advantage	$2,468.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,098.33
Rate for Payer: Cigna Commercial	$4,114.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31
Rate for Payer: UnitedHealthcare Community & State	$260.03
Rate for Payer: Wellpoint Medicaid Managed Care	$233.70

PSN REV FEM DIST AUG SZ5 5MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270695260
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

Know your out-of-pocket cost for care.

All Charges