Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ROD 120MM

Facility

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270704434
Hospital Revenue Code	278
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) NJ Health	$230.00
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	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

ROD 120MM

Facility

$1,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270704434
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

ROD 150MM

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	270684455
Hospital Revenue Code	278
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) NJ Health	$65.00
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	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Community & State	$10.27
Rate for Payer: Wellpoint Medicaid Managed Care	$9.23

ROD 150MM

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	270684455
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

ROD 30MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688862
Hospital Revenue Code	278
Min. Negotiated Rate	$133.68
Max. Negotiated Rate	$215.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: Qualcare PPO/HMO/WC	$133.68

ROD 30MM

Facility

$891.20

Service Code	HCPCS C1713
Hospital Charge Code	270688862
Hospital Revenue Code	278
Min. Negotiated Rate	$25.31
Max. Negotiated Rate	$445.60
Rate for Payer: Aetna Commercial	$338.66
Rate for Payer: Aetna Medicare Advantage	$267.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.26
Rate for Payer: Cigna Commercial	$445.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.67
Rate for Payer: Qualcare PPO/HMO/WC	$133.68
Rate for Payer: UnitedHealthcare Community & State	$28.16
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

ROD 35 MM

Facility

$750.00

Hospital Charge Code	270703039
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

ROD 35 MM

Facility

$750.00

Hospital Charge Code	270703039
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

ROD 35MM

Facility

$1,075.00

Service Code	HCPCS C1713
Hospital Charge Code	270689970
Hospital Revenue Code	278
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$33.97
Rate for Payer: Wellpoint Medicaid Managed Care	$30.53

ROD 35MM

Facility

$1,075.00

Service Code	HCPCS C1713
Hospital Charge Code	270689970
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

ROD 35MM #11-3035

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705471
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD 35MM #11-3035

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705471
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

ROD 3.5x80MM

Facility

$1,820.00

Service Code	HCPCS C1713
Hospital Charge Code	270657226
Hospital Revenue Code	278
Min. Negotiated Rate	$51.69
Max. Negotiated Rate	$910.00
Rate for Payer: Aetna Commercial	$691.60
Rate for Payer: Aetna Medicare Advantage	$546.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$464.10
Rate for Payer: Cigna Commercial	$910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$440.44
Rate for Payer: Qualcare PPO/HMO/WC	$273.00
Rate for Payer: UnitedHealthcare Community & State	$57.51
Rate for Payer: Wellpoint Medicaid Managed Care	$51.69

ROD 3.5x80MM

Facility

$1,820.00

Service Code	HCPCS C1713
Hospital Charge Code	270657226
Hospital Revenue Code	278
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$440.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$364.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$440.44
Rate for Payer: Qualcare PPO/HMO/WC	$273.00

ROD 3.5X80MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699244
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD 3.5X80MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704795
Hospital Revenue Code	278
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) NJ Health	$180.00
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	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$28.44
Rate for Payer: Wellpoint Medicaid Managed Care	$25.56

ROD 3.5X80MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699244
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

ROD 3.5X80MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704795
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

ROD 3.5X90MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704793
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

ROD 3.5X90MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704793
Hospital Revenue Code	278
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) NJ Health	$180.00
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	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$28.44
Rate for Payer: Wellpoint Medicaid Managed Care	$25.56

ROD 40MM

Facility

$875.00

Hospital Charge Code	270703129
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

ROD 40MM

Facility

$940.00

Service Code	HCPCS C1713
Hospital Charge Code	270704013
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$227.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.48
Rate for Payer: Qualcare PPO/HMO/WC	$141.00

ROD 40MM

Facility

$940.00

Service Code	HCPCS C1713
Hospital Charge Code	270704013
Hospital Revenue Code	278
Min. Negotiated Rate	$26.70
Max. Negotiated Rate	$470.00
Rate for Payer: Aetna Commercial	$357.20
Rate for Payer: Aetna Medicare Advantage	$282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.70
Rate for Payer: Cigna Commercial	$470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.48
Rate for Payer: Qualcare PPO/HMO/WC	$141.00
Rate for Payer: UnitedHealthcare Community & State	$29.70
Rate for Payer: Wellpoint Medicaid Managed Care	$26.70

ROD 40MM

Facility

$2,377.45

Service Code	HCPCS C1713
Hospital Charge Code	270705423
Hospital Revenue Code	278
Min. Negotiated Rate	$67.52
Max. Negotiated Rate	$1,188.72
Rate for Payer: Aetna Commercial	$903.43
Rate for Payer: Aetna Medicare Advantage	$713.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$606.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$606.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$606.25
Rate for Payer: Cigna Commercial	$1,188.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$575.34
Rate for Payer: Qualcare PPO/HMO/WC	$356.62
Rate for Payer: UnitedHealthcare Community & State	$75.13
Rate for Payer: Wellpoint Medicaid Managed Care	$67.52

ROD 40MM

Facility

$2,377.45

Service Code	HCPCS C1713
Hospital Charge Code	270705423
Hospital Revenue Code	278
Min. Negotiated Rate	$356.62
Max. Negotiated Rate	$575.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$575.34
Rate for Payer: Qualcare PPO/HMO/WC	$356.62

Know your out-of-pocket cost for care.

All Charges