Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

REFOBACIN BC R 1X40 US

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270682262
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

REFOBACIN BC R 1X40 US

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270682262
Hospital Revenue Code	278
Min. Negotiated Rate	$90.88
Max. Negotiated Rate	$1,600.00
Rate for Payer: Aetna Commercial	$1,216.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00
Rate for Payer: UnitedHealthcare Community & State	$101.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.88

REFORM SCREW 8.5X40MM

Facility

$2,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270704778
Hospital Revenue Code	278
Min. Negotiated Rate	$62.48
Max. Negotiated Rate	$1,100.00
Rate for Payer: Aetna Commercial	$836.00
Rate for Payer: Aetna Medicare Advantage	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.00
Rate for Payer: Cigna Commercial	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: Qualcare PPO/HMO/WC	$330.00
Rate for Payer: UnitedHealthcare Community & State	$69.52
Rate for Payer: Wellpoint Medicaid Managed Care	$62.48

REFORM SCREW 8.5X40MM

Facility

$2,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270704778
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$532.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: Qualcare PPO/HMO/WC	$330.00

REFORM TI EXTENDED TAB TULIP

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695750
Hospital Revenue Code	278
Min. Negotiated Rate	$191.42
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$212.98
Rate for Payer: Wellpoint Medicaid Managed Care	$191.42

REFORM TI EXTENDED TAB TULIP

Facility

$6,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270695750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

REFORM TI MOD TOWER TULIP

Facility

$6,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270696179
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

REFORM TI MOD TOWER TULIP

Facility

$6,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270696179
Hospital Revenue Code	278
Min. Negotiated Rate	$174.38
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$194.02
Rate for Payer: Wellpoint Medicaid Managed Care	$174.38

REG

Facility

$11.75

Hospital Charge Code	270648986
Hospital Revenue Code	271
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.88
Rate for Payer: Aetna Commercial	$4.46
Rate for Payer: Aetna Medicare Advantage	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.00
Rate for Payer: Cigna Commercial	$5.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.06
Rate for Payer: Oxford Commercial	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.76
Rate for Payer: UnitedHealthcare Commercial	$2.35
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

REG

Facility

$11.75

Hospital Charge Code	270648986
Hospital Revenue Code	271
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.76

REGADENOSON 0.4 MG/5 ML INJ

Facility

$1,761.03

Service Code	HCPCS J2785
Hospital Charge Code	60630057
Hospital Revenue Code	636
Min. Negotiated Rate	$50.01
Max. Negotiated Rate	$880.51
Rate for Payer: Aetna Commercial	$669.19
Rate for Payer: Aetna Medicare Advantage	$528.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$449.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$449.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$449.06
Rate for Payer: Cigna Commercial	$880.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$426.17
Rate for Payer: Qualcare PPO/HMO/WC	$264.15
Rate for Payer: UnitedHealthcare Community & State	$55.65
Rate for Payer: Wellpoint Medicaid Managed Care	$50.01

REGADENOSON 0.4 MG/5 ML INJ

Facility

$1,761.03

Service Code	HCPCS J2785
Hospital Charge Code	60630057
Hospital Revenue Code	636
Min. Negotiated Rate	$264.15
Max. Negotiated Rate	$426.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$426.17
Rate for Payer: Qualcare PPO/HMO/WC	$264.15

REGATTA IMPLANT 18X14X45MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693949
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

REGATTA IMPLANT 18X14X45MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693949
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

REGATTA IMPLANT 23X12X50MM

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693185
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

REGATTA IMPLANT 23X12X50MM

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693185
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

REGATTA IMP LAT 23X12X50MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694405
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

REGATTA IMP LAT 23X12X50MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694405
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

REGATTA IMP LAT 23X14X50MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694224
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

REGATTA IMP LAT 23X14X50MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270694224
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

REGATTA LATERAL 18X12X60MM 10D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693182
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

REGATTA LATERAL 18X12X60MM 10D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693182
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

REGATTA LATERAL 23X12X60MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693184
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

REGATTA LATERAL 23X12X60MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693184
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

REGATTA LATERAL 23X14X50MM 15D

Facility

$29,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270693183
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

Know your out-of-pocket cost for care.

All Charges