Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RELOAD SMALL SIGNIA 30MM GRAY

Facility

$3,641.40

Hospital Charge Code	270692849
Hospital Revenue Code	272
Min. Negotiated Rate	$546.21
Max. Negotiated Rate	$546.21
Rate for Payer: Qualcare PPO/HMO/WC	$546.21

RELOAD SMALL SIGNIA 30MM WHITE

Facility

$3,695.41

Hospital Charge Code	270692848
Hospital Revenue Code	272
Min. Negotiated Rate	$104.95
Max. Negotiated Rate	$1,847.70
Rate for Payer: Aetna Commercial	$1,404.26
Rate for Payer: Aetna Medicare Advantage	$1,108.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$942.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$942.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$942.33
Rate for Payer: Cigna Commercial	$1,847.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$960.81
Rate for Payer: Oxford Commercial	$739.08
Rate for Payer: Qualcare PPO/HMO/WC	$554.31
Rate for Payer: UnitedHealthcare Commercial	$739.08
Rate for Payer: UnitedHealthcare Community & State	$116.77
Rate for Payer: Wellpoint Medicaid Managed Care	$104.95

RELOAD SMALL SIGNIA 30MM WHITE

Facility

$3,695.41

Hospital Charge Code	270692848
Hospital Revenue Code	272
Min. Negotiated Rate	$554.31
Max. Negotiated Rate	$554.31
Rate for Payer: Qualcare PPO/HMO/WC	$554.31

RELOAD SMALL SIGNIA 45MM WHITE

Facility

$3,896.66

Hospital Charge Code	270692850
Hospital Revenue Code	272
Min. Negotiated Rate	$110.67
Max. Negotiated Rate	$1,948.33
Rate for Payer: Aetna Commercial	$1,480.73
Rate for Payer: Aetna Medicare Advantage	$1,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$993.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$993.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$993.65
Rate for Payer: Cigna Commercial	$1,948.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,013.13
Rate for Payer: Oxford Commercial	$779.33
Rate for Payer: Qualcare PPO/HMO/WC	$584.50
Rate for Payer: UnitedHealthcare Commercial	$779.33
Rate for Payer: UnitedHealthcare Community & State	$123.13
Rate for Payer: Wellpoint Medicaid Managed Care	$110.67

RELOAD SMALL SIGNIA 45MM WHITE

Facility

$3,896.66

Hospital Charge Code	270692850
Hospital Revenue Code	272
Min. Negotiated Rate	$584.50
Max. Negotiated Rate	$584.50
Rate for Payer: Qualcare PPO/HMO/WC	$584.50

RELOAD STAPLER 30MM

Facility

$85.00

Hospital Charge Code	270338698
Hospital Revenue Code	272
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

RELOAD STAPLER 30MM

Facility

$85.00

Hospital Charge Code	270338698
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$17.00
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

RELOAD STAPLER 60MM

Facility

$87.00

Hospital Charge Code	270338700
Hospital Revenue Code	272
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Oxford Commercial	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$17.40
Rate for Payer: UnitedHealthcare Community & State	$2.75
Rate for Payer: Wellpoint Medicaid Managed Care	$2.47

RELOAD STAPLER 60MM

Facility

$87.00

Hospital Charge Code	270338700
Hospital Revenue Code	272
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

RELOAD STAPLER BLUE 45

Facility

$900.00

Hospital Charge Code	270666135
Hospital Revenue Code	270
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.00
Rate for Payer: Oxford Commercial	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.44
Rate for Payer: Wellpoint Medicaid Managed Care	$25.56

RELOAD STAPLER BLUE 45

Facility

$900.00

Hospital Charge Code	270666135
Hospital Revenue Code	270
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

RELOAD STAPLER GREEN 45

Facility

$900.00

Hospital Charge Code	270666136
Hospital Revenue Code	272
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.00
Rate for Payer: Oxford Commercial	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.44
Rate for Payer: Wellpoint Medicaid Managed Care	$25.56

RELOAD STAPLER GREEN 45

Facility

$900.00

Hospital Charge Code	270666136
Hospital Revenue Code	272
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

RELOAD STAPLER GREEN L 100M

Facility

$651.45

Hospital Charge Code	270697919
Hospital Revenue Code	272
Min. Negotiated Rate	$97.72
Max. Negotiated Rate	$97.72
Rate for Payer: Qualcare PPO/HMO/WC	$97.72

RELOAD STAPLER GREEN L 100M

Facility

$651.45

Hospital Charge Code	270697919
Hospital Revenue Code	272
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$325.73
Rate for Payer: Aetna Commercial	$247.55
Rate for Payer: Aetna Medicare Advantage	$195.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.12
Rate for Payer: Cigna Commercial	$325.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.38
Rate for Payer: Oxford Commercial	$130.29
Rate for Payer: Qualcare PPO/HMO/WC	$97.72
Rate for Payer: UnitedHealthcare Commercial	$130.29
Rate for Payer: UnitedHealthcare Community & State	$20.59
Rate for Payer: Wellpoint Medicaid Managed Care	$18.50

RELOAD SURE FORM 2.5 WHITE

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692195
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

RELOAD SURE FORM 2.5 WHITE

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692195
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

RELOAD SUREFORM BLACK 60X3.5 M

Facility

$13,800.00

Hospital Charge Code	270687012
Hospital Revenue Code	272
Min. Negotiated Rate	$391.92
Max. Negotiated Rate	$6,900.00
Rate for Payer: Aetna Commercial	$5,244.00
Rate for Payer: Aetna Medicare Advantage	$4,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,519.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,519.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,519.00
Rate for Payer: Cigna Commercial	$6,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,588.00
Rate for Payer: Oxford Commercial	$2,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,070.00
Rate for Payer: UnitedHealthcare Commercial	$2,760.00
Rate for Payer: UnitedHealthcare Community & State	$436.08
Rate for Payer: Wellpoint Medicaid Managed Care	$391.92

RELOAD SUREFORM BLACK 60X3.5 M

Facility

$13,800.00

Hospital Charge Code	270687012
Hospital Revenue Code	272
Min. Negotiated Rate	$2,070.00
Max. Negotiated Rate	$2,070.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,070.00

RELOAD SUREFORM BLUE 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687010
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD SUREFORM BLUE 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687010
Hospital Revenue Code	272
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

RELOAD SUREFORM GRN 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687011
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD SUREFORM GRN 60 X3.5 M

Facility

$1,150.00

Hospital Charge Code	270687011
Hospital Revenue Code	272
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

RELOAD SUREFORM WHITE 60 X2.5

Facility

$1,150.00

Hospital Charge Code	270687009
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

RELOAD SUREFORM WHITE 60 X2.5

Facility

$1,150.00

Hospital Charge Code	270687009
Hospital Revenue Code	272
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

Know your out-of-pocket cost for care.

All Charges