Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SET RADIATION TX FIELD-GL

Facility

$1,370.00

Service Code	HCPCS 77280
Hospital Charge Code	85000385
Hospital Revenue Code	333
Min. Negotiated Rate	$38.91
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$434.33
Rate for Payer: Aetna Medicare Advantage	$517.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$579.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$579.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$159.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$579.24
Rate for Payer: Cigna Commercial	$320.09
Rate for Payer: Cigna Medicare Advantage	$111.78
Rate for Payer: Clover Medicare Advantage	$151.70
Rate for Payer: EmblemHealth Commercial	$479.04
Rate for Payer: Humana Medicare Advantage	$164.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$159.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.20
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$205.50
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$43.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.68
Rate for Payer: Wellcare Medicare Advantage	$159.68
Rate for Payer: Wellpoint Medicaid Managed Care	$38.91

SET RADIATION TX FIELD-GL

Facility

$5,502.00

Service Code	HCPCS 77295
Hospital Charge Code	85000430
Hospital Revenue Code	333
Min. Negotiated Rate	$156.26
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$4,472.71
Rate for Payer: Aetna Medicare Advantage	$5,327.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,964.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,964.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,644.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,964.99
Rate for Payer: Cigna Commercial	$3,296.16
Rate for Payer: Cigna Medicare Advantage	$1,151.07
Rate for Payer: Clover Medicare Advantage	$1,562.16
Rate for Payer: EmblemHealth Commercial	$4,933.14
Rate for Payer: Humana Medicare Advantage	$1,693.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,644.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,430.52
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.30
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$173.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,644.38
Rate for Payer: Wellcare Medicare Advantage	$1,644.38
Rate for Payer: Wellpoint Medicaid Managed Care	$156.26

SET RADIATION TX FIELD-GL

Facility

$5,502.00

Service Code	HCPCS 77295
Hospital Charge Code	85000430
Hospital Revenue Code	333
Min. Negotiated Rate	$825.30
Max. Negotiated Rate	$825.30
Rate for Payer: Qualcare PPO/HMO/WC	$825.30

SET RADIATION TX FIELD-GL

Facility

$1,833.00

Service Code	HCPCS 77285
Hospital Charge Code	85000400
Hospital Revenue Code	333
Min. Negotiated Rate	$274.95
Max. Negotiated Rate	$274.95
Rate for Payer: Qualcare PPO/HMO/WC	$274.95

SET RENAL DILATOR 8F 30Fx35cm

Facility

$2,101.35

Service Code	HCPCS C1894
Hospital Charge Code	270627868
Hospital Revenue Code	278
Min. Negotiated Rate	$315.20
Max. Negotiated Rate	$508.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.53
Rate for Payer: Qualcare PPO/HMO/WC	$315.20

SET RENAL DILATOR 8F 30Fx35cm

Facility

$2,101.35

Service Code	HCPCS C1894
Hospital Charge Code	270627868
Hospital Revenue Code	278
Min. Negotiated Rate	$59.68
Max. Negotiated Rate	$1,050.67
Rate for Payer: Aetna Commercial	$798.51
Rate for Payer: Aetna Medicare Advantage	$630.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.84
Rate for Payer: Cigna Commercial	$1,050.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.53
Rate for Payer: Qualcare PPO/HMO/WC	$315.20
Rate for Payer: UnitedHealthcare Community & State	$66.40
Rate for Payer: Wellpoint Medicaid Managed Care	$59.68

SET SCREW

Facility

$2,900.00

Hospital Charge Code	270662645
Hospital Revenue Code	278
Min. Negotiated Rate	$435.00
Max. Negotiated Rate	$701.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$701.80
Rate for Payer: Qualcare PPO/HMO/WC	$435.00

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681776
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704448
Hospital Revenue Code	278
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$8.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.81

SET SCREW

Facility

$275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704448
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

SET SCREW

Facility

$2,900.00

Hospital Charge Code	270662645
Hospital Revenue Code	278
Min. Negotiated Rate	$82.36
Max. Negotiated Rate	$1,450.00
Rate for Payer: Aetna Commercial	$1,102.00
Rate for Payer: Aetna Medicare Advantage	$870.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$739.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$739.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$739.50
Rate for Payer: Cigna Commercial	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$701.80
Rate for Payer: Qualcare PPO/HMO/WC	$435.00
Rate for Payer: UnitedHealthcare Community & State	$91.64
Rate for Payer: Wellpoint Medicaid Managed Care	$82.36

SET SCREW

Facility

$625.00

Hospital Charge Code	270701731
Hospital Revenue Code	270
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681776
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

SET SCREW

Facility

$625.00

Hospital Charge Code	270701731
Hospital Revenue Code	270
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

SET SCREW

Facility

$2,845.00

Hospital Charge Code	270702579
Hospital Revenue Code	278
Min. Negotiated Rate	$80.80
Max. Negotiated Rate	$1,422.50
Rate for Payer: Aetna Commercial	$1,081.10
Rate for Payer: Aetna Medicare Advantage	$853.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.48
Rate for Payer: Cigna Commercial	$1,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: Qualcare PPO/HMO/WC	$426.75
Rate for Payer: UnitedHealthcare Community & State	$89.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.80

SET SCREW

Facility

$2,845.00

Hospital Charge Code	270702579
Hospital Revenue Code	278
Min. Negotiated Rate	$426.75
Max. Negotiated Rate	$688.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.49
Rate for Payer: Qualcare PPO/HMO/WC	$426.75

SET SCREW #11-4001

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705470
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SET SCREW #11-4001

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705470
Hospital Revenue Code	278
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) NJ Health	$100.00
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	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

SET SCREW EVEREST POLYAXIAL

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270670411
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

SET SCREW EVEREST POLYAXIAL

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270670411
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SET SCREW LATERAL PLATE NEXXT

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693626
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

SET SCREW LATERAL PLATE NEXXT

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693626
Hospital Revenue Code	278
Min. Negotiated Rate	$41.89
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$46.61
Rate for Payer: Wellpoint Medicaid Managed Care	$41.89

SET SCREW PEDICLE 4.15X9MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693617
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

SET SCREW PEDICLE 4.15X9MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693617
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

SET SCREWS

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705515
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

Know your out-of-pocket cost for care.

All Charges