Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RX 4FR SPIROFLEX THROMBECTOMY

Facility

$10,225.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707O
Hospital Revenue Code	278
Min. Negotiated Rate	$290.39
Max. Negotiated Rate	$5,112.50
Rate for Payer: Aetna Commercial	$3,885.50
Rate for Payer: Aetna Medicare Advantage	$3,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,607.38
Rate for Payer: Cigna Commercial	$5,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75
Rate for Payer: UnitedHealthcare Community & State	$323.11
Rate for Payer: Wellpoint Medicaid Managed Care	$290.39

RX 4FR SPIROFLEX THROMBECTOMY

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707C
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

RX 4FR SPIROFLEX THROMBECTOMY

Facility

$10,225.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707O
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.75
Max. Negotiated Rate	$2,474.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,474.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.75

RX 4FR SPIROFLEX THROMBECTOMY

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

RYTHM EKG,INTERP.ONLY

Facility

$99.00

Service Code	HCPCS 93042
Hospital Charge Code	5780295
Hospital Revenue Code	730
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

RYTHM EKG,INTERP.ONLY

Facility

$99.00

Service Code	HCPCS 93042
Hospital Charge Code	5780295
Hospital Revenue Code	730
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$879.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.74
Rate for Payer: Oxford Commercial	$659.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$879.00
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

S3 K-WIRE 2.0X152MM (6IN) NS

Facility

$165.00

Hospital Charge Code	270664306
Hospital Revenue Code	272
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Qualcare PPO/HMO/WC	$24.75

S3 K-WIRE 2.0X152MM (6IN) NS

Facility

$165.00

Hospital Charge Code	270664306
Hospital Revenue Code	272
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$82.50
Rate for Payer: Aetna Commercial	$62.70
Rate for Payer: Aetna Medicare Advantage	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.08
Rate for Payer: Cigna Commercial	$82.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.90
Rate for Payer: Oxford Commercial	$33.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.75
Rate for Payer: UnitedHealthcare Commercial	$33.00
Rate for Payer: UnitedHealthcare Community & State	$5.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

SABER-C LOCKING PLATE

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705810
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SABER-C LOCKING PLATE

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705810
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

SABLE SPACER 12X30, 7-14MM 15D

Facility

$29,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704736
Hospital Revenue Code	278
Min. Negotiated Rate	$830.70
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$924.30
Rate for Payer: Wellpoint Medicaid Managed Care	$830.70

SABLE SPACER 12X30, 7-14MM 15D

Facility

$29,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704736
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

SACCHAROMYCES CEREVISIAE

Facility

$84.25

Service Code	HCPCS 86671
Hospital Charge Code	39900236
Hospital Revenue Code	302
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$33.32
Rate for Payer: Aetna Medicare Advantage	$39.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.44
Rate for Payer: Cigna Commercial	$42.12
Rate for Payer: Cigna Medicare Advantage	$12.25
Rate for Payer: Clover Medicare Advantage	$11.64
Rate for Payer: EmblemHealth Commercial	$36.75
Rate for Payer: Humana Medicare Advantage	$12.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.91
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.64
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.25
Rate for Payer: Wellcare Medicare Advantage	$12.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.39

SACCHAROMYCES CEREVISIAE

Facility

$84.25

Service Code	HCPCS 86671
Hospital Charge Code	39900236
Hospital Revenue Code	302
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$12.64
Rate for Payer: Qualcare PPO/HMO/WC	$12.64

SACCOMANNO CELL TRANS SYS

Facility

$20.00

Hospital Charge Code	270657259
Hospital Revenue Code	272
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SACCOMANNO CELL TRANS SYS

Facility

$20.00

Hospital Charge Code	270657259
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

SACRUM AND COCCYX

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	94061101
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SACRUM AND COCCYX

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	94061101
Hospital Revenue Code	320
Min. Negotiated Rate	$27.23
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

SACUBITRAL/VALSARTAN 97/103 MG

Facility

$46.03

Service Code	NDC 78069635
Hospital Charge Code	606390144
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

SACUBITRAL/VALSARTAN 97/103 MG

Facility

$46.03

Service Code	NDC 78069635
Hospital Charge Code	606390144
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$23.02
Rate for Payer: Aetna Commercial	$17.49
Rate for Payer: Aetna Medicare Advantage	$13.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.74
Rate for Payer: Cigna Commercial	$23.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.97
Rate for Payer: Oxford Commercial	$9.21
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.21
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

SACUBITRIL/VALSARTAN 24-26mg

Facility

$108.41

Service Code	NDC 78065920
Hospital Charge Code	606390104
Hospital Revenue Code	250
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$16.26
Rate for Payer: Qualcare PPO/HMO/WC	$16.26

SACUBITRIL/VALSARTAN 24-26mg

Facility

$108.41

Service Code	NDC 78065920
Hospital Charge Code	606390104
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$54.20
Rate for Payer: Aetna Commercial	$41.20
Rate for Payer: Aetna Medicare Advantage	$32.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.64
Rate for Payer: Cigna Commercial	$54.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.19
Rate for Payer: Oxford Commercial	$21.68
Rate for Payer: Qualcare PPO/HMO/WC	$16.26
Rate for Payer: UnitedHealthcare Commercial	$21.68
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: Wellpoint Medicaid Managed Care	$3.08

SACUBITRIL/VALSARTAN 49-51mg

Facility

$108.41

Service Code	NDC 78077720
Hospital Charge Code	606390105
Hospital Revenue Code	250
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$16.26
Rate for Payer: Qualcare PPO/HMO/WC	$16.26

SACUBITRIL/VALSARTAN 49-51mg

Facility

$108.41

Service Code	NDC 78077720
Hospital Charge Code	606390105
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$54.20
Rate for Payer: Aetna Commercial	$41.20
Rate for Payer: Aetna Medicare Advantage	$32.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.64
Rate for Payer: Cigna Commercial	$54.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.19
Rate for Payer: Oxford Commercial	$21.68
Rate for Payer: Qualcare PPO/HMO/WC	$16.26
Rate for Payer: UnitedHealthcare Commercial	$21.68
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: Wellpoint Medicaid Managed Care	$3.08

SAFEGUARD 24CM

Facility

$295.00

Hospital Charge Code	270657684
Hospital Revenue Code	270
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

Know your out-of-pocket cost for care.

All Charges