Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SELF CARE GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8988GPCN
Hospital Charge Code	84202050CN
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SELF CARE GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8988GPCN
Hospital Charge Code	84202050CN
Hospital Revenue Code	420
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SELF CENTERING BI POLAR HEAD

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270649219
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

SELF CENTERING BI POLAR HEAD

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270649219
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

SELF DRILL BIT 2.7 X 11 MM

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270690141
Hospital Revenue Code	278
Min. Negotiated Rate	$46.15
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$51.35
Rate for Payer: Wellpoint Medicaid Managed Care	$46.15

SELF DRILL BIT 2.7 X 11 MM

Facility

$1,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270690141
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

SELF DRILLING SCREW. 3.5X12MM

Facility

$2,500.00

Hospital Charge Code	270702106
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

SELF DRILLING SCREW. 3.5X12MM

Facility

$2,500.00

Hospital Charge Code	270702106
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

SELF DRILLING SCREW 3.5X15MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703995
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

SELF DRILLING SCREW 3.5X15MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703995
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

SELF DRILLING SCREW. 3.8X14MM

Facility

$2,500.00

Hospital Charge Code	270702107
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

SELF DRILLING SCREW. 3.8X14MM

Facility

$2,500.00

Hospital Charge Code	270702107
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

SELF DRILL SCREW 4.0 X 14MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270687501
Hospital Revenue Code	278
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

SELF DRILL SCREW 4.0 X 14MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270687501
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

SELF PUNCH KNOTLESS 2.6MM FIBE

Facility

$2,317.50

Service Code	HCPCS C1713
Hospital Charge Code	270704695
Hospital Revenue Code	278
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$1,158.75
Rate for Payer: Aetna Commercial	$880.65
Rate for Payer: Aetna Medicare Advantage	$695.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$590.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$590.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$590.96
Rate for Payer: Cigna Commercial	$1,158.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$560.84
Rate for Payer: Qualcare PPO/HMO/WC	$347.62
Rate for Payer: UnitedHealthcare Community & State	$73.23
Rate for Payer: Wellpoint Medicaid Managed Care	$65.82

SELF PUNCH KNOTLESS 2.6MM FIBE

Facility

$2,317.50

Service Code	HCPCS C1713
Hospital Charge Code	270704695
Hospital Revenue Code	278
Min. Negotiated Rate	$347.62
Max. Negotiated Rate	$560.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$463.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$560.84
Rate for Payer: Qualcare PPO/HMO/WC	$347.62

SELF SEAL CAP FOR GYNECOLOG

Facility

$49.40

Hospital Charge Code	270659399
Hospital Revenue Code	272
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$7.41
Rate for Payer: Qualcare PPO/HMO/WC	$7.41

SELF SEAL CAP FOR GYNECOLOG

Facility

$49.40

Hospital Charge Code	270659399
Hospital Revenue Code	272
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$18.77
Rate for Payer: Aetna Medicare Advantage	$14.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.60
Rate for Payer: Cigna Commercial	$24.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.84
Rate for Payer: Oxford Commercial	$9.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.41
Rate for Payer: UnitedHealthcare Commercial	$9.88
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

SELF TAP 16MM

Facility

$1,258.75

Service Code	HCPCS C1713
Hospital Charge Code	270689230
Hospital Revenue Code	278
Min. Negotiated Rate	$188.81
Max. Negotiated Rate	$304.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.62
Rate for Payer: Qualcare PPO/HMO/WC	$188.81

SELF TAP 16MM

Facility

$1,258.75

Service Code	HCPCS C1713
Hospital Charge Code	270689230
Hospital Revenue Code	278
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$629.38
Rate for Payer: Aetna Commercial	$478.32
Rate for Payer: Aetna Medicare Advantage	$377.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.98
Rate for Payer: Cigna Commercial	$629.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.62
Rate for Payer: Qualcare PPO/HMO/WC	$188.81
Rate for Payer: UnitedHealthcare Community & State	$39.78
Rate for Payer: Wellpoint Medicaid Managed Care	$35.75

SELF TAP SCREW 4X16MM

Facility

$875.00

Hospital Charge Code	270703079
Hospital Revenue Code	278
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

SELF TAP SCREW 4X16MM

Facility

$875.00

Hospital Charge Code	270703079
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

SEMEN ANALYSIS

Facility

$390.00

Service Code	HCPCS 89320
Hospital Charge Code	3004058
Hospital Revenue Code	300
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$33.48
Rate for Payer: Aetna Medicare Advantage	$39.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.65
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.31
Rate for Payer: Clover Medicare Advantage	$11.69
Rate for Payer: EmblemHealth Commercial	$36.93
Rate for Payer: Humana Medicare Advantage	$12.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.31
Rate for Payer: Wellcare Medicare Advantage	$12.31
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SEMEN ANALYSIS

Facility

$390.00

Service Code	HCPCS 89320
Hospital Charge Code	3004058
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SEMEN ANALYSIS, COMPLETE

Facility

$790.00

Service Code	HCPCS 89320
Hospital Charge Code	38473033
Hospital Revenue Code	309
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$33.48
Rate for Payer: Aetna Medicare Advantage	$39.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.65
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: Cigna Medicare Advantage	$12.31
Rate for Payer: Clover Medicare Advantage	$11.69
Rate for Payer: EmblemHealth Commercial	$36.93
Rate for Payer: Humana Medicare Advantage	$12.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.31
Rate for Payer: Wellcare Medicare Advantage	$12.31
Rate for Payer: Wellpoint Medicaid Managed Care	$22.44

Know your out-of-pocket cost for care.

All Charges