Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCROTOPLASTY

Facility

$20,308.55

Service Code	HCPCS 55175
Hospital Charge Code	1600000791
Hospital Revenue Code	360
Min. Negotiated Rate	$576.76
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,280.22
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,046.28
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$641.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$576.76

SCROTOPLASTY; COMPLICATED

Facility

$18,835.12

Service Code	HCPCS 55180
Hospital Charge Code	160000203
Hospital Revenue Code	360
Min. Negotiated Rate	$534.92
Max. Negotiated Rate	$23,107.03
Rate for Payer: Aetna Commercial	$17,326.29
Rate for Payer: Aetna Medicare Advantage	$20,638.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,107.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,107.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6,369.96
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	$23,107.03
Rate for Payer: Cigna Commercial	$12,768.54
Rate for Payer: Cigna Medicare Advantage	$6,369.96
Rate for Payer: Clover Medicare Advantage	$6,051.46
Rate for Payer: EmblemHealth Commercial	$19,109.88
Rate for Payer: Humana Medicare Advantage	$6,561.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6,369.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,897.13
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,825.27
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$595.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$6,369.96
Rate for Payer: Wellcare Medicare Advantage	$6,369.96
Rate for Payer: Wellpoint Medicaid Managed Care	$534.92

SCROTOPLASTY; COMPLICATED

Facility

$18,835.12

Service Code	HCPCS 55180
Hospital Charge Code	160000203
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.27
Max. Negotiated Rate	$2,825.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,825.27

SCRW 2.7x10MM LOCK 53-27610E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647785
Hospital Revenue Code	278
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$154.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.94

SCRW 2.7x10MM LOCK 53-27610E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647785
Hospital Revenue Code	278
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$319.80
Rate for Payer: Aetna Commercial	$243.05
Rate for Payer: Aetna Medicare Advantage	$191.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.10
Rate for Payer: Cigna Commercial	$319.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.94
Rate for Payer: UnitedHealthcare Community & State	$20.21
Rate for Payer: Wellpoint Medicaid Managed Care	$18.16

SCRW 2.7x12MM LOCK 53-27612E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647784
Hospital Revenue Code	278
Min. Negotiated Rate	$95.94
Max. Negotiated Rate	$154.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.94

SCRW 2.7x12MM LOCK 53-27612E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647784
Hospital Revenue Code	278
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$319.80
Rate for Payer: Aetna Commercial	$243.05
Rate for Payer: Aetna Medicare Advantage	$191.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.10
Rate for Payer: Cigna Commercial	$319.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.94
Rate for Payer: UnitedHealthcare Community & State	$20.21
Rate for Payer: Wellpoint Medicaid Managed Care	$18.16

SCRW 2.7x14 NON-LOCK 53-27214E

Facility

$17,580.00

Service Code	HCPCS C1713
Hospital Charge Code	270647783
Hospital Revenue Code	278
Min. Negotiated Rate	$499.27
Max. Negotiated Rate	$8,790.00
Rate for Payer: Aetna Commercial	$6,680.40
Rate for Payer: Aetna Medicare Advantage	$5,274.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,482.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,482.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,482.90
Rate for Payer: Cigna Commercial	$8,790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,254.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,637.00
Rate for Payer: UnitedHealthcare Community & State	$555.53
Rate for Payer: Wellpoint Medicaid Managed Care	$499.27

SCRW 2.7x14 NON-LOCK 53-27214E

Facility

$17,580.00

Service Code	HCPCS C1713
Hospital Charge Code	270647783
Hospital Revenue Code	278
Min. Negotiated Rate	$2,637.00
Max. Negotiated Rate	$4,254.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,254.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,637.00

SCRW 2.7x16MM LOCK 53-27616E

Facility

$497.50

Service Code	HCPCS C1713
Hospital Charge Code	270647781
Hospital Revenue Code	278
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$120.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.39
Rate for Payer: Qualcare PPO/HMO/WC	$74.62

SCRW 2.7x16MM LOCK 53-27616E

Facility

$497.50

Service Code	HCPCS C1713
Hospital Charge Code	270647781
Hospital Revenue Code	278
Min. Negotiated Rate	$14.13
Max. Negotiated Rate	$248.75
Rate for Payer: Aetna Commercial	$189.05
Rate for Payer: Aetna Medicare Advantage	$149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.86
Rate for Payer: Cigna Commercial	$248.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.39
Rate for Payer: Qualcare PPO/HMO/WC	$74.62
Rate for Payer: UnitedHealthcare Community & State	$15.72
Rate for Payer: Wellpoint Medicaid Managed Care	$14.13

SCRW 2.7x18MM LOCK 53-27618E

Facility

$995.00

Service Code	HCPCS C1713
Hospital Charge Code	270647780
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

SCRW 2.7x18MM LOCK 53-27618E

Facility

$995.00

Service Code	HCPCS C1713
Hospital Charge Code	270647780
Hospital Revenue Code	278
Min. Negotiated Rate	$28.26
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$378.10
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25
Rate for Payer: UnitedHealthcare Community & State	$31.44
Rate for Payer: Wellpoint Medicaid Managed Care	$28.26

SCRW 2.7x20MM LOCK 53-27620E

Facility

$2,110.00

Hospital Charge Code	270647782
Hospital Revenue Code	278
Min. Negotiated Rate	$316.50
Max. Negotiated Rate	$510.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.62
Rate for Payer: Qualcare PPO/HMO/WC	$316.50

SCRW 2.7x20MM LOCK 53-27620E

Facility

$2,110.00

Hospital Charge Code	270647782
Hospital Revenue Code	278
Min. Negotiated Rate	$59.92
Max. Negotiated Rate	$1,055.00
Rate for Payer: Aetna Commercial	$801.80
Rate for Payer: Aetna Medicare Advantage	$633.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$538.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$538.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$538.05
Rate for Payer: Cigna Commercial	$1,055.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.62
Rate for Payer: Qualcare PPO/HMO/WC	$316.50
Rate for Payer: UnitedHealthcare Community & State	$66.68
Rate for Payer: Wellpoint Medicaid Managed Care	$59.92

SCRW 2.7x26 NON-LOCK 53-27226E

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270647779
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SCRW 2.7x26 NON-LOCK 53-27226E

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270647779
Hospital Revenue Code	278
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

SCRW 3.5x16 LPNLCK 1312-18-016

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661582
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x16 LPNLCK 1312-18-016

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661582
Hospital Revenue Code	278
Min. Negotiated Rate	$10.51
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.51

SCRW 3.5x18 LPNLCK 1312-18-018

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661583
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x18 LPNLCK 1312-18-018

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661583
Hospital Revenue Code	278
Min. Negotiated Rate	$10.51
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: Wellpoint Medicaid Managed Care	$10.51

SCRW 3.5x24 LP NLCK1312-18-024

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658896
Hospital Revenue Code	278
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

SCRW 3.5x24 LP NLCK1312-18-024

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658896
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x34 LP NLCK1312-18-034

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658895
Hospital Revenue Code	278
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

SCRW 3.5x34 LP NLCK1312-18-034

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658895
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

Know your out-of-pocket cost for care.

All Charges