Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RETRIEVER NET ROTH 2.5mm 230cm

Facility

$500.00

Hospital Charge Code	270684082
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

RETRIEVER SUTURE HEWSON 10.1L

Facility

$324.00

Hospital Charge Code	270644147
Hospital Revenue Code	272
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

RETRIEVER SUTURE HEWSON 10.1L

Facility

$324.00

Hospital Charge Code	270644147
Hospital Revenue Code	272
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Oxford Commercial	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$64.80
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

RETRIVAL SNARE SPYGLASS

Facility

$2,145.00

Hospital Charge Code	270684733
Hospital Revenue Code	272
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$321.75
Rate for Payer: Qualcare PPO/HMO/WC	$321.75

RETRIVAL SNARE SPYGLASS

Facility

$2,145.00

Hospital Charge Code	270684733
Hospital Revenue Code	272
Min. Negotiated Rate	$60.92
Max. Negotiated Rate	$1,072.50
Rate for Payer: Aetna Commercial	$815.10
Rate for Payer: Aetna Medicare Advantage	$643.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$546.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$546.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$546.98
Rate for Payer: Cigna Commercial	$1,072.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$557.70
Rate for Payer: Oxford Commercial	$429.00
Rate for Payer: Qualcare PPO/HMO/WC	$321.75
Rate for Payer: UnitedHealthcare Commercial	$429.00
Rate for Payer: UnitedHealthcare Community & State	$67.78
Rate for Payer: Wellpoint Medicaid Managed Care	$60.92

RETROBULBAR NEEDLE 25G.

Facility

$48.00

Hospital Charge Code	270331702
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

RETROBULBAR NEEDLE 25G.

Facility

$48.00

Hospital Charge Code	270331702
Hospital Revenue Code	272
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

RETROGRADE PYELOGRAM

Facility

$2,469.00

Service Code	HCPCS 74420
Hospital Charge Code	1600000439
Hospital Revenue Code	360
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,503.49
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$414.47
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.94
Rate for Payer: Qualcare PPO/HMO/WC	$370.35
Rate for Payer: UnitedHealthcare Community & State	$78.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$70.12

RETROGRADE PYELOGRAM

Facility

$2,469.00

Service Code	HCPCS 74420
Hospital Charge Code	1600000439
Hospital Revenue Code	360
Min. Negotiated Rate	$370.35
Max. Negotiated Rate	$370.35
Rate for Payer: Qualcare PPO/HMO/WC	$370.35

RETRO INJ URETHRA

Facility

$988.84

Service Code	HCPCS 51610
Hospital Charge Code	16000996
Hospital Revenue Code	360
Min. Negotiated Rate	$28.08
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$375.76
Rate for Payer: Aetna Medicare Advantage	$296.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.15
Rate for Payer: Cigna Commercial	$494.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.10
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$148.33
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$31.25
Rate for Payer: Wellpoint Medicaid Managed Care	$28.08

RETRO INJ URETHRA

Facility

$988.84

Service Code	HCPCS 51610
Hospital Charge Code	16000996
Hospital Revenue Code	360
Min. Negotiated Rate	$148.33
Max. Negotiated Rate	$148.33
Rate for Payer: Qualcare PPO/HMO/WC	$148.33

RETROPERITONEUM/RENAL

Facility

$6,700.00

Service Code	HCPCS 76770
Hospital Charge Code	94061167
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

RETROPERITONEUM/RENAL

Facility

$6,700.00

Service Code	HCPCS 76770
Hospital Charge Code	94061167
Hospital Revenue Code	402
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

RETROVIR/10MG/1ML

Facility

$4.00

Service Code	NDC 65862004824
Hospital Charge Code	60633821
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

RETROVIR/10MG/1ML

Facility

$4.00

Service Code	NDC 65862004824
Hospital Charge Code	60633821
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

REV BODY STD AND REV BODY SCRE

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704898
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

REV BODY STD AND REV BODY SCRE

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704898
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

REV. CURVED SPLIT CANNULA

Facility

$487.00

Hospital Charge Code	270339438
Hospital Revenue Code	272
Min. Negotiated Rate	$13.83
Max. Negotiated Rate	$243.50
Rate for Payer: Aetna Commercial	$185.06
Rate for Payer: Aetna Medicare Advantage	$146.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.19
Rate for Payer: Cigna Commercial	$243.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.62
Rate for Payer: Oxford Commercial	$97.40
Rate for Payer: Qualcare PPO/HMO/WC	$73.05
Rate for Payer: UnitedHealthcare Commercial	$97.40
Rate for Payer: UnitedHealthcare Community & State	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$13.83

REV. CURVED SPLIT CANNULA

Facility

$487.00

Hospital Charge Code	270339438
Hospital Revenue Code	272
Min. Negotiated Rate	$73.05
Max. Negotiated Rate	$73.05
Rate for Payer: Qualcare PPO/HMO/WC	$73.05

REVERSE BODY

Facility

$14,852.50

Service Code	HCPCS C1776
Hospital Charge Code	270689174
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$3,594.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY

Facility

$14,852.50

Service Code	HCPCS C1776
Hospital Charge Code	270689174
Hospital Revenue Code	278
Min. Negotiated Rate	$421.81
Max. Negotiated Rate	$7,426.25
Rate for Payer: Aetna Commercial	$5,643.95
Rate for Payer: Aetna Medicare Advantage	$4,455.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,787.39
Rate for Payer: Cigna Commercial	$7,426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88
Rate for Payer: UnitedHealthcare Community & State	$469.34
Rate for Payer: Wellpoint Medicaid Managed Care	$421.81

REVERSE BODY SCREW

Facility

$14,852.50

Service Code	HCPCS C1713
Hospital Charge Code	270688867
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.88
Max. Negotiated Rate	$3,594.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88

REVERSE BODY SCREW

Facility

$14,852.50

Service Code	HCPCS C1713
Hospital Charge Code	270688867
Hospital Revenue Code	278
Min. Negotiated Rate	$421.81
Max. Negotiated Rate	$7,426.25
Rate for Payer: Aetna Commercial	$5,643.95
Rate for Payer: Aetna Medicare Advantage	$4,455.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,787.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,787.39
Rate for Payer: Cigna Commercial	$7,426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,594.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.88
Rate for Payer: UnitedHealthcare Community & State	$469.34
Rate for Payer: Wellpoint Medicaid Managed Care	$421.81

REVERSE BODY SCREW AND STD

Facility

$7,711.30

Service Code	HCPCS C1776
Hospital Charge Code	270691400
Hospital Revenue Code	278
Min. Negotiated Rate	$1,156.69
Max. Negotiated Rate	$1,866.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,542.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,866.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,156.69

REVERSE BODY SCREW AND STD

Facility

$7,711.30

Service Code	HCPCS C1776
Hospital Charge Code	270691400
Hospital Revenue Code	278
Min. Negotiated Rate	$219.00
Max. Negotiated Rate	$3,855.65
Rate for Payer: Aetna Commercial	$2,930.29
Rate for Payer: Aetna Medicare Advantage	$2,313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,966.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,966.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,542.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,966.38
Rate for Payer: Cigna Commercial	$3,855.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,866.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,156.69
Rate for Payer: UnitedHealthcare Community & State	$243.68
Rate for Payer: Wellpoint Medicaid Managed Care	$219.00

Know your out-of-pocket cost for care.

All Charges