Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHELL FLAREHAWK 29MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270695593
Hospital Revenue Code	278
Min. Negotiated Rate	$560.90
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$624.10
Rate for Payer: Wellpoint Medicaid Managed Care	$560.90

SHELLFLAREHAWKLORDOT29MMTIH9

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270694806
Hospital Revenue Code	278
Min. Negotiated Rate	$538.89
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$599.61
Rate for Payer: Wellpoint Medicaid Managed Care	$538.89

SHELLFLAREHAWKLORDOT29MMTIH9

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270694806
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHELL FLAREHAWK LRD TI H9 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270692662
Hospital Revenue Code	278
Min. Negotiated Rate	$560.90
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$624.10
Rate for Payer: Wellpoint Medicaid Managed Care	$560.90

SHELL FLAREHAWK LRD TI H9 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270692662
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

SHELL FLAREHAWK TALL 25MM TIH9

Facility

$24,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697489
Hospital Revenue Code	278
Min. Negotiated Rate	$702.90
Max. Negotiated Rate	$12,375.00
Rate for Payer: Aetna Commercial	$9,405.00
Rate for Payer: Aetna Medicare Advantage	$7,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,311.25
Rate for Payer: Cigna Commercial	$12,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50
Rate for Payer: UnitedHealthcare Community & State	$782.10
Rate for Payer: Wellpoint Medicaid Managed Care	$702.90

SHELL FLAREHAWK TALL 25MM TIH9

Facility

$24,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697489
Hospital Revenue Code	278
Min. Negotiated Rate	$3,712.50
Max. Negotiated Rate	$5,989.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50

SHELLFLAREHAWKTALL29MMTIH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270697265
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHELLFLAREHAWKTALL29MMTIH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270697265
Hospital Revenue Code	278
Min. Negotiated Rate	$538.89
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$599.61
Rate for Payer: Wellpoint Medicaid Managed Care	$538.89

SHELL FLAREHAWK TI H9 25MM

Facility

$24,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696484
Hospital Revenue Code	278
Min. Negotiated Rate	$3,712.50
Max. Negotiated Rate	$5,989.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50

SHELL FLAREHAWK TI H9 25MM

Facility

$24,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696484
Hospital Revenue Code	278
Min. Negotiated Rate	$702.90
Max. Negotiated Rate	$12,375.00
Rate for Payer: Aetna Commercial	$9,405.00
Rate for Payer: Aetna Medicare Advantage	$7,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,311.25
Rate for Payer: Cigna Commercial	$12,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50
Rate for Payer: UnitedHealthcare Community & State	$782.10
Rate for Payer: Wellpoint Medicaid Managed Care	$702.90

SHELL FREEDOM CONSTR 36MM TAPE

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270692924
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.00
Max. Negotiated Rate	$1,916.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00

SHELL FREEDOM CONSTR 36MM TAPE

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270692924
Hospital Revenue Code	278
Min. Negotiated Rate	$224.93
Max. Negotiated Rate	$3,960.00
Rate for Payer: Aetna Commercial	$3,009.60
Rate for Payer: Aetna Medicare Advantage	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.60
Rate for Payer: Cigna Commercial	$3,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00
Rate for Payer: UnitedHealthcare Community & State	$250.27
Rate for Payer: Wellpoint Medicaid Managed Care	$224.93

SHELL G7 OSSEOTI 3H 48MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270694570
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL G7 OSSEOTI 3H 48MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270694570
Hospital Revenue Code	278
Min. Negotiated Rate	$446.45
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$496.75
Rate for Payer: Wellpoint Medicaid Managed Care	$446.45

SHELL G7 OSSEO TI 4H 58MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270693728
Hospital Revenue Code	278
Min. Negotiated Rate	$446.45
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$496.75
Rate for Payer: Wellpoint Medicaid Managed Care	$446.45

SHELL G7 OSSEO TI 4H 58MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270693728
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL G7 OSSEOTI 4HOLE 60MM G

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270694751
Hospital Revenue Code	278
Min. Negotiated Rate	$446.45
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$496.75
Rate for Payer: Wellpoint Medicaid Managed Care	$446.45

SHELL G7 OSSEOTI 4HOLE 60MM G

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270694751
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELLG7OSSEOTMULTIHOLE58MMG

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270693415
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.50
Max. Negotiated Rate	$4,595.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50

SHELLG7OSSEOTMULTIHOLE58MMG

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270693415
Hospital Revenue Code	278
Min. Negotiated Rate	$539.32
Max. Negotiated Rate	$9,495.00
Rate for Payer: Aetna Commercial	$7,216.20
Rate for Payer: Aetna Medicare Advantage	$5,697.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,842.45
Rate for Payer: Cigna Commercial	$9,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50
Rate for Payer: UnitedHealthcare Community & State	$600.08
Rate for Payer: Wellpoint Medicaid Managed Care	$539.32

SHELL GRIPTON 50MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL GRIPTON 50MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688139
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

SHELL GRIPTON 52MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688177
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

SHELL GRIPTON 52MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

Know your out-of-pocket cost for care.

All Charges