Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RESTRATA MINIMATRIX 1000MG

Facility

$23,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270704827
Hospital Revenue Code	278
Min. Negotiated Rate	$665.98
Max. Negotiated Rate	$11,725.00
Rate for Payer: Aetna Commercial	$8,911.00
Rate for Payer: Aetna Medicare Advantage	$7,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,979.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,979.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,979.75
Rate for Payer: Cigna Commercial	$11,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,674.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.50
Rate for Payer: UnitedHealthcare Community & State	$741.02
Rate for Payer: Wellpoint Medicaid Managed Care	$665.98

RESTRATA MINIMATRIX 1000MG

Facility

$23,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270704827
Hospital Revenue Code	278
Min. Negotiated Rate	$3,517.50
Max. Negotiated Rate	$5,674.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,674.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.50

RESTRATA MINIMATRIX 500MG

Facility

$12,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704826
Hospital Revenue Code	278
Min. Negotiated Rate	$1,867.50
Max. Negotiated Rate	$3,012.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.50

RESTRATA MINIMATRIX 500MG

Facility

$12,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704826
Hospital Revenue Code	278
Min. Negotiated Rate	$353.58
Max. Negotiated Rate	$6,225.00
Rate for Payer: Aetna Commercial	$4,731.00
Rate for Payer: Aetna Medicare Advantage	$3,735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,174.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,174.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,174.75
Rate for Payer: Cigna Commercial	$6,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.50
Rate for Payer: UnitedHealthcare Community & State	$393.42
Rate for Payer: Wellpoint Medicaid Managed Care	$353.58

RESTRICTOR CEMENT 8-13MM

Facility

$475.00

Hospital Charge Code	270668557
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

RESTRICTOR CEMENT 8-13MM

Facility

$475.00

Hospital Charge Code	270668557
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

RESTRICTOR CEM SZ2 10.75MM FEM

Facility

$1,255.00

Service Code	HCPCS C1776
Hospital Charge Code	270697345
Hospital Revenue Code	278
Min. Negotiated Rate	$35.64
Max. Negotiated Rate	$627.50
Rate for Payer: Aetna Commercial	$476.90
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Community & State	$39.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.64

RESTRICTOR CEM SZ2 10.75MM FEM

Facility

$1,255.00

Service Code	HCPCS C1776
Hospital Charge Code	270697345
Hospital Revenue Code	278
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$303.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74115002
Hospital Revenue Code	341
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.22
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$336.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$302.59

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74117002
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$6,315.40

Service Code	HCPCS 78452
Hospital Charge Code	36540010
Hospital Revenue Code	341
Min. Negotiated Rate	$947.31
Max. Negotiated Rate	$947.31
Rate for Payer: Qualcare PPO/HMO/WC	$947.31

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	5307001
Hospital Revenue Code	341
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.22
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$336.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$302.59

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74115002
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	5307001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	94053001
Hospital Revenue Code	341
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.22
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$336.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$302.59

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74117002
Hospital Revenue Code	341
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.22
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$336.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$302.59

REST TEST

Facility

$6,315.40

Service Code	HCPCS 78452
Hospital Charge Code	36540010
Hospital Revenue Code	341
Min. Negotiated Rate	$179.36
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,642.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$947.31
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$199.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$179.36

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74116002
Hospital Revenue Code	341
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.22
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$336.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$302.59

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74116002
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	94053001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

RESURFACING PATELLA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677547
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

RESURFACING PATELLA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677547
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

RESUSCITATION PEDIATRIC/INFANT

Facility

$264.85

Hospital Charge Code	9501230
Hospital Revenue Code	270
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$39.73
Rate for Payer: Qualcare PPO/HMO/WC	$39.73

RESUSCITATION PEDIATRIC/INFANT

Facility

$264.85

Hospital Charge Code	9501230
Hospital Revenue Code	270
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$132.43
Rate for Payer: Aetna Commercial	$100.64
Rate for Payer: Aetna Medicare Advantage	$79.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.54
Rate for Payer: Cigna Commercial	$132.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.86
Rate for Payer: Oxford Commercial	$52.97
Rate for Payer: Qualcare PPO/HMO/WC	$39.73
Rate for Payer: UnitedHealthcare Commercial	$52.97
Rate for Payer: UnitedHealthcare Community & State	$8.37
Rate for Payer: Wellpoint Medicaid Managed Care	$7.52

RESUSCITATOR ADULT MANUAL

Facility

$193.00

Hospital Charge Code	270331414
Hospital Revenue Code	272
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

Know your out-of-pocket cost for care.

All Charges