Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SET SCREWS

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705515
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

SET SCREWS

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703859
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 SCREWS

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703859
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 SUTURE DISP

Facility

$28.17

Hospital Charge Code	270600744
Hospital Revenue Code	272
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.23

SET SUTURE DISP

Facility

$28.17

Hospital Charge Code	270600744
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.09
Rate for Payer: Aetna Commercial	$10.70
Rate for Payer: Aetna Medicare Advantage	$8.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.18
Rate for Payer: Cigna Commercial	$14.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.32
Rate for Payer: Oxford Commercial	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.23
Rate for Payer: UnitedHealthcare Commercial	$5.63
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.64
Rate for Payer: Aetna Commercial	$2.01
Rate for Payer: Aetna Medicare Advantage	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.37
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.64
Rate for Payer: Aetna Commercial	$2.01
Rate for Payer: Aetna Medicare Advantage	$1.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.37
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SET SUTURE REMOVAL

Facility

$5.28

Hospital Charge Code	270302266W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

SET THROMBECTOMY XVG ULTRA

Facility

$10,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270645568C
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

SET THROMBECTOMY XVG ULTRA

Facility

$10,225.00

Service Code	HCPCS C1714
Hospital Charge Code	270645568C
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

SEVELAMER 400 MG TAB

Facility

$21.37

Service Code	NDC 58468002001
Hospital Charge Code	60629367
Hospital Revenue Code	251
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$10.69
Rate for Payer: Aetna Commercial	$8.12
Rate for Payer: Aetna Medicare Advantage	$6.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.45
Rate for Payer: Cigna Commercial	$10.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.56
Rate for Payer: Oxford Commercial	$4.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Commercial	$4.27
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

SEVELAMER 400 MG TAB

Facility

$21.37

Service Code	NDC 58468002001
Hospital Charge Code	60629367
Hospital Revenue Code	251
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

SEVOFLURANE - INH LIQ

Facility

$1,511.52

Service Code	NDC 74445651
Hospital Charge Code	60629265
Hospital Revenue Code	250
Min. Negotiated Rate	$226.73
Max. Negotiated Rate	$226.73
Rate for Payer: Qualcare PPO/HMO/WC	$226.73

SEVOFLURANE - INH LIQ

Facility

$1,511.52

Service Code	NDC 74445651
Hospital Charge Code	60629265
Hospital Revenue Code	250
Min. Negotiated Rate	$42.93
Max. Negotiated Rate	$755.76
Rate for Payer: Aetna Commercial	$574.38
Rate for Payer: Aetna Medicare Advantage	$453.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$385.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$385.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$385.44
Rate for Payer: Cigna Commercial	$755.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.00
Rate for Payer: Oxford Commercial	$302.30
Rate for Payer: Qualcare PPO/HMO/WC	$226.73
Rate for Payer: UnitedHealthcare Commercial	$302.30
Rate for Payer: UnitedHealthcare Community & State	$47.76
Rate for Payer: Wellpoint Medicaid Managed Care	$42.93

SEX HORMONE BINDING GLOBU

Facility

$390.00

Service Code	HCPCS 84270
Hospital Charge Code	39900132
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SEX HORMONE BINDING GLOBU

Facility

$390.00

Service Code	HCPCS 84270
Hospital Charge Code	39900132
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$59.11
Rate for Payer: Aetna Medicare Advantage	$70.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.83
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$21.73
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.73
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	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Medicare Advantage	$21.73
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SEX HORMONE BINDING GLOBULIN

Facility

$153.00

Service Code	HCPCS 84270
Hospital Charge Code	38477170
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$59.11
Rate for Payer: Aetna Medicare Advantage	$70.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.83
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: Cigna Medicare Advantage	$21.73
Rate for Payer: Clover Medicare Advantage	$20.64
Rate for Payer: EmblemHealth Commercial	$65.19
Rate for Payer: Humana Medicare Advantage	$22.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.73
Rate for Payer: Wellcare Medicare Advantage	$21.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

SEX HORMONE BINDING GLOBULIN

Facility

$153.00

Service Code	HCPCS 84270
Hospital Charge Code	38477170
Hospital Revenue Code	301
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

SFT NON BRDED MKLSSON 5FRX80CM

Facility

$510.00

Hospital Charge Code	270663267
Hospital Revenue Code	278
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.05
Rate for Payer: Cigna Commercial	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: Qualcare PPO/HMO/WC	$76.50
Rate for Payer: UnitedHealthcare Community & State	$16.12
Rate for Payer: Wellpoint Medicaid Managed Care	$14.48

SFT NON BRDED MKLSSON 5FRX80CM

Facility

$510.00

Hospital Charge Code	270663267
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

SFT TISS BX - NECK/THORAX

Facility

$13,615.50

Service Code	HCPCS 21550
Hospital Charge Code	16000798
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

SFT TISS BX - NECK/THORAX

Facility

$13,615.50

Service Code	HCPCS 21550
Hospital Charge Code	16000798
Hospital Revenue Code	360
Min. Negotiated Rate	$386.68
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,540.03
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$430.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$386.68

SGL NBI BRACHIAL PLEXUS

Facility

$4,204.50

Service Code	HCPCS 64415
Hospital Charge Code	16000237
Hospital Revenue Code	360
Min. Negotiated Rate	$119.41
Max. Negotiated Rate	$3,811.70
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,811.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,811.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,811.70
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,093.17
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.67
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$132.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellpoint Medicaid Managed Care	$119.41

SGL NBI BRACHIAL PLEXUS

Facility

$4,204.50

Service Code	HCPCS 64415
Hospital Charge Code	16000237
Hospital Revenue Code	360
Min. Negotiated Rate	$630.67
Max. Negotiated Rate	$630.67
Rate for Payer: Qualcare PPO/HMO/WC	$630.67

Know your out-of-pocket cost for care.

All Charges