Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RETRACTOR HOHMANN 6mmX160mm

Facility

$903.90

Hospital Charge Code	270638980
Hospital Revenue Code	272
Min. Negotiated Rate	$135.59
Max. Negotiated Rate	$135.59
Rate for Payer: Qualcare PPO/HMO/WC	$135.59

RETRACTOR HOHMANN 8mmX160mm

Facility

$903.90

Hospital Charge Code	270608595
Hospital Revenue Code	272
Min. Negotiated Rate	$135.59
Max. Negotiated Rate	$135.59
Rate for Payer: Qualcare PPO/HMO/WC	$135.59

RETRACTOR HOHMANN 8mmX160mm

Facility

$903.90

Hospital Charge Code	270608595
Hospital Revenue Code	272
Min. Negotiated Rate	$25.67
Max. Negotiated Rate	$451.95
Rate for Payer: Aetna Commercial	$343.48
Rate for Payer: Aetna Medicare Advantage	$271.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.49
Rate for Payer: Cigna Commercial	$451.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.01
Rate for Payer: Oxford Commercial	$180.78
Rate for Payer: Qualcare PPO/HMO/WC	$135.59
Rate for Payer: UnitedHealthcare Commercial	$180.78
Rate for Payer: UnitedHealthcare Community & State	$28.56
Rate for Payer: Wellpoint Medicaid Managed Care	$25.67

RETRACTOR INSTRUMENT

Facility

$25,500.00

Hospital Charge Code	270702925
Hospital Revenue Code	270
Min. Negotiated Rate	$3,825.00
Max. Negotiated Rate	$3,825.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00

RETRACTOR INSTRUMENT

Facility

$25,500.00

Hospital Charge Code	270702925
Hospital Revenue Code	270
Min. Negotiated Rate	$724.20
Max. Negotiated Rate	$12,750.00
Rate for Payer: Aetna Commercial	$9,690.00
Rate for Payer: Aetna Medicare Advantage	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,502.50
Rate for Payer: Cigna Commercial	$12,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,630.00
Rate for Payer: Oxford Commercial	$5,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00
Rate for Payer: UnitedHealthcare Commercial	$5,100.00
Rate for Payer: UnitedHealthcare Community & State	$805.80
Rate for Payer: Wellpoint Medicaid Managed Care	$724.20

RETRACTOR KIT LONE STAR DISP

Facility

$559.90

Hospital Charge Code	270677749
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$279.95
Rate for Payer: Aetna Commercial	$212.76
Rate for Payer: Aetna Medicare Advantage	$167.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.77
Rate for Payer: Cigna Commercial	$279.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.57
Rate for Payer: Oxford Commercial	$111.98
Rate for Payer: Qualcare PPO/HMO/WC	$83.98
Rate for Payer: UnitedHealthcare Commercial	$111.98
Rate for Payer: UnitedHealthcare Community & State	$17.69
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

RETRACTOR KIT LONE STAR DISP

Facility

$559.90

Hospital Charge Code	270677749
Hospital Revenue Code	272
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$83.98
Rate for Payer: Qualcare PPO/HMO/WC	$83.98

RETRACTOR LARGE HASSANS

Facility

$492.00

Hospital Charge Code	270665376
Hospital Revenue Code	272
Min. Negotiated Rate	$13.97
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna Commercial	$186.96
Rate for Payer: Aetna Medicare Advantage	$147.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.46
Rate for Payer: Cigna Commercial	$246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.92
Rate for Payer: Oxford Commercial	$98.40
Rate for Payer: Qualcare PPO/HMO/WC	$73.80
Rate for Payer: UnitedHealthcare Commercial	$98.40
Rate for Payer: UnitedHealthcare Community & State	$15.55
Rate for Payer: Wellpoint Medicaid Managed Care	$13.97

RETRACTOR LARGE HASSANS

Facility

$492.00

Hospital Charge Code	270665376
Hospital Revenue Code	272
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$73.80
Rate for Payer: Qualcare PPO/HMO/WC	$73.80

RETRACTOR LARGE HOHMAN

Facility

$1,096.95

Hospital Charge Code	270655528
Hospital Revenue Code	272
Min. Negotiated Rate	$31.15
Max. Negotiated Rate	$548.48
Rate for Payer: Aetna Commercial	$416.84
Rate for Payer: Aetna Medicare Advantage	$329.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.72
Rate for Payer: Cigna Commercial	$548.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.21
Rate for Payer: Oxford Commercial	$219.39
Rate for Payer: Qualcare PPO/HMO/WC	$164.54
Rate for Payer: UnitedHealthcare Commercial	$219.39
Rate for Payer: UnitedHealthcare Community & State	$34.66
Rate for Payer: Wellpoint Medicaid Managed Care	$31.15

RETRACTOR LARGE HOHMAN

Facility

$1,096.95

Hospital Charge Code	270655528
Hospital Revenue Code	272
Min. Negotiated Rate	$164.54
Max. Negotiated Rate	$164.54
Rate for Payer: Qualcare PPO/HMO/WC	$164.54

RETRACTOR LATROBE SOFT PALATE

Facility

$386.10

Hospital Charge Code	270684739
Hospital Revenue Code	272
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$193.05
Rate for Payer: Aetna Commercial	$146.72
Rate for Payer: Aetna Medicare Advantage	$115.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.46
Rate for Payer: Cigna Commercial	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.39
Rate for Payer: Oxford Commercial	$77.22
Rate for Payer: Qualcare PPO/HMO/WC	$57.91
Rate for Payer: UnitedHealthcare Commercial	$77.22
Rate for Payer: UnitedHealthcare Community & State	$12.20
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

RETRACTOR LATROBE SOFT PALATE

Facility

$386.10

Hospital Charge Code	270684739
Hospital Revenue Code	272
Min. Negotiated Rate	$57.91
Max. Negotiated Rate	$57.91
Rate for Payer: Qualcare PPO/HMO/WC	$57.91

RETRACTOR LONEST COLORECT DISP

Facility

$817.08

Hospital Charge Code	270695673
Hospital Revenue Code	272
Min. Negotiated Rate	$122.56
Max. Negotiated Rate	$122.56
Rate for Payer: Qualcare PPO/HMO/WC	$122.56

RETRACTOR LONEST COLORECT DISP

Facility

$817.08

Hospital Charge Code	270695673
Hospital Revenue Code	272
Min. Negotiated Rate	$23.21
Max. Negotiated Rate	$408.54
Rate for Payer: Aetna Commercial	$310.49
Rate for Payer: Aetna Medicare Advantage	$245.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.36
Rate for Payer: Cigna Commercial	$408.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.44
Rate for Payer: Oxford Commercial	$163.42
Rate for Payer: Qualcare PPO/HMO/WC	$122.56
Rate for Payer: UnitedHealthcare Commercial	$163.42
Rate for Payer: UnitedHealthcare Community & State	$25.82
Rate for Payer: Wellpoint Medicaid Managed Care	$23.21

RETRACTOR MOB ELAST MED 900515

Facility

$325.00

Hospital Charge Code	270633016
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

RETRACTOR MOB ELAST MED 900515

Facility

$325.00

Hospital Charge Code	270633016
Hospital Revenue Code	272
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.50
Rate for Payer: Oxford Commercial	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$65.00
Rate for Payer: UnitedHealthcare Community & State	$10.27
Rate for Payer: Wellpoint Medicaid Managed Care	$9.23

RETRACTOR MOBIUS 900-520

Facility

$620.00

Hospital Charge Code	270633148
Hospital Revenue Code	272
Min. Negotiated Rate	$17.61
Max. Negotiated Rate	$310.00
Rate for Payer: Aetna Commercial	$235.60
Rate for Payer: Aetna Medicare Advantage	$186.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.10
Rate for Payer: Cigna Commercial	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.20
Rate for Payer: Oxford Commercial	$124.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.59
Rate for Payer: Wellpoint Medicaid Managed Care	$17.61

RETRACTOR MOBIUS 900-520

Facility

$620.00

Hospital Charge Code	270633148
Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$93.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00

RETRACTOR RIGHT ANGLED 18MM

Facility

$1,005.00

Hospital Charge Code	270692073
Hospital Revenue Code	272
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$502.50
Rate for Payer: Aetna Commercial	$381.90
Rate for Payer: Aetna Medicare Advantage	$301.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.27
Rate for Payer: Cigna Commercial	$502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.30
Rate for Payer: Oxford Commercial	$201.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.75
Rate for Payer: UnitedHealthcare Commercial	$201.00
Rate for Payer: UnitedHealthcare Community & State	$31.76
Rate for Payer: Wellpoint Medicaid Managed Care	$28.54

RETRACTOR RIGHT ANGLED 18MM

Facility

$1,005.00

Hospital Charge Code	270692073
Hospital Revenue Code	272
Min. Negotiated Rate	$150.75
Max. Negotiated Rate	$150.75
Rate for Payer: Qualcare PPO/HMO/WC	$150.75

RETRACTOR RIGHT ANGLED 43MM

Facility

$1,105.00

Hospital Charge Code	270692074
Hospital Revenue Code	272
Min. Negotiated Rate	$31.38
Max. Negotiated Rate	$552.50
Rate for Payer: Aetna Commercial	$419.90
Rate for Payer: Aetna Medicare Advantage	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.77
Rate for Payer: Cigna Commercial	$552.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.30
Rate for Payer: Oxford Commercial	$221.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.75
Rate for Payer: UnitedHealthcare Commercial	$221.00
Rate for Payer: UnitedHealthcare Community & State	$34.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.38

RETRACTOR RIGHT ANGLED 43MM

Facility

$1,105.00

Hospital Charge Code	270692074
Hospital Revenue Code	272
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$165.75
Rate for Payer: Qualcare PPO/HMO/WC	$165.75

RETRACTOR RING 14.1 CM X 14.1C

Facility

$376.52

Hospital Charge Code	270679363
Hospital Revenue Code	272
Min. Negotiated Rate	$56.48
Max. Negotiated Rate	$56.48
Rate for Payer: Qualcare PPO/HMO/WC	$56.48

RETRACTOR RING 14.1 CM X 14.1C

Facility

$376.52

Hospital Charge Code	270679363
Hospital Revenue Code	272
Min. Negotiated Rate	$10.69
Max. Negotiated Rate	$188.26
Rate for Payer: Aetna Commercial	$143.08
Rate for Payer: Aetna Medicare Advantage	$112.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.01
Rate for Payer: Cigna Commercial	$188.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.90
Rate for Payer: Oxford Commercial	$75.30
Rate for Payer: Qualcare PPO/HMO/WC	$56.48
Rate for Payer: UnitedHealthcare Commercial	$75.30
Rate for Payer: UnitedHealthcare Community & State	$11.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.69

Know your out-of-pocket cost for care.

All Charges