Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHIM 9MM X3MM FH7 FLAREHAWK

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692115
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

SHIM 9X12X25MM.

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703683
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

SHIM 9X12X25MM.

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703683
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHIM FLAREHAWK 10MMX25MM 6D

Facility

$23,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696485
Hospital Revenue Code	278
Min. Negotiated Rate	$3,596.25
Max. Negotiated Rate	$5,801.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,801.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25

SHIM FLAREHAWK 10MMX25MM 6D

Facility

$23,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696485
Hospital Revenue Code	278
Min. Negotiated Rate	$680.89
Max. Negotiated Rate	$11,987.50
Rate for Payer: Aetna Commercial	$9,110.50
Rate for Payer: Aetna Medicare Advantage	$7,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,113.62
Rate for Payer: Cigna Commercial	$11,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,801.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25
Rate for Payer: UnitedHealthcare Community & State	$757.61
Rate for Payer: Wellpoint Medicaid Managed Care	$680.89

SHIM FLAREHAWK 10X29MM 6D

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270695592
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

SHIM FLAREHAWK 10X29MM 6D

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270695592
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

SHIM FLAREHAWK 12X25MM0D FH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696184
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

SHIM FLAREHAWK 12X25MM0D FH11

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696184
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

SHIM FLAREHAWK 14MMX23MM 0DEG

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692663
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

SHIM FLAREHAWK 14MMX23MM 0DEG

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270692663
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

SHIM FLAREHAWK 14MMX25MM 6D

Facility

$23,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696483
Hospital Revenue Code	278
Min. Negotiated Rate	$3,596.25
Max. Negotiated Rate	$5,801.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,801.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25

SHIM FLAREHAWK 14MMX25MM 6D

Facility

$23,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270696483
Hospital Revenue Code	278
Min. Negotiated Rate	$680.89
Max. Negotiated Rate	$11,987.50
Rate for Payer: Aetna Commercial	$9,110.50
Rate for Payer: Aetna Medicare Advantage	$7,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,113.62
Rate for Payer: Cigna Commercial	$11,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,801.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25
Rate for Payer: UnitedHealthcare Community & State	$757.61
Rate for Payer: Wellpoint Medicaid Managed Care	$680.89

SHIM FLAREHAWK 14MMX29MM

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270693444
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

SHIM FLAREHAWK 14MMX29MM

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270693444
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

SHIM FLAREHAWK 14MMX29MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696846
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

SHIM FLAREHAWK 14MMX29MM 0D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696846
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

SHIM FLAREHAWK 14MMX29MM 6D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694807
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

SHIM FLAREHAWK 14MMX29MM 6D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270694807
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

SHIM FLAREHAWK 14X25MM 6D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697853
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

SHIM FLAREHAWK 14X25MM 6D

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270697853
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

SHIM SPLIT , 12X25MM 9DEG

Facility

$10,000.00

Hospital Charge Code	270702896
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHIM SPLIT , 12X25MM 9DEG

Facility

$10,000.00

Hospital Charge Code	270702896
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

SHIRLEY SUMP DRAIN

Facility

$66.00

Hospital Charge Code	270332574
Hospital Revenue Code	278
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

SHIRLEY SUMP DRAIN

Facility

$66.00

Hospital Charge Code	270332574
Hospital Revenue Code	278
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$15.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

Know your out-of-pocket cost for care.

All Charges