Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SLEEVE 5 X 100 STABILITY OPT

Facility

$90.00

Hospital Charge Code	270669196
Hospital Revenue Code	272
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

SLEEVE 5 X 100 STABILITY OPT

Facility

$90.00

Hospital Charge Code	270669196
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

SLEEVE ADAPTER FEMORAL 5MM

Facility

$2,015.00

Service Code	HCPCS C1776
Hospital Charge Code	270696296
Hospital Revenue Code	278
Min. Negotiated Rate	$57.23
Max. Negotiated Rate	$1,007.50
Rate for Payer: Aetna Commercial	$765.70
Rate for Payer: Aetna Medicare Advantage	$604.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$513.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$513.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$513.83
Rate for Payer: Cigna Commercial	$1,007.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.63
Rate for Payer: Qualcare PPO/HMO/WC	$302.25
Rate for Payer: UnitedHealthcare Community & State	$63.67
Rate for Payer: Wellpoint Medicaid Managed Care	$57.23

SLEEVE ADAPTER FEMORAL 5MM

Facility

$2,015.00

Service Code	HCPCS C1776
Hospital Charge Code	270696296
Hospital Revenue Code	278
Min. Negotiated Rate	$302.25
Max. Negotiated Rate	$487.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.63
Rate for Payer: Qualcare PPO/HMO/WC	$302.25

SLEEVE BIOLOX DELTA CERAMIC

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	270692214
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

SLEEVE BIOLOX DELTA CERAMIC

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	270692214
Hospital Revenue Code	278
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

SLEEVE BLOOD PRESSURE XL

Facility

$89.96

Hospital Charge Code	270655514
Hospital Revenue Code	270
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$13.49
Rate for Payer: Qualcare PPO/HMO/WC	$13.49

SLEEVE BLOOD PRESSURE XL

Facility

$89.96

Hospital Charge Code	270655514
Hospital Revenue Code	270
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$44.98
Rate for Payer: Aetna Commercial	$34.18
Rate for Payer: Aetna Medicare Advantage	$26.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.94
Rate for Payer: Cigna Commercial	$44.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.39
Rate for Payer: Oxford Commercial	$17.99
Rate for Payer: Qualcare PPO/HMO/WC	$13.49
Rate for Payer: UnitedHealthcare Commercial	$17.99
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.55

SLEEVE DBL DRILL 4.0/2.9MM

Facility

$1,239.10

Hospital Charge Code	270677605
Hospital Revenue Code	272
Min. Negotiated Rate	$35.19
Max. Negotiated Rate	$619.55
Rate for Payer: Aetna Commercial	$470.86
Rate for Payer: Aetna Medicare Advantage	$371.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.97
Rate for Payer: Cigna Commercial	$619.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.17
Rate for Payer: Oxford Commercial	$247.82
Rate for Payer: Qualcare PPO/HMO/WC	$185.87
Rate for Payer: UnitedHealthcare Commercial	$247.82
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$35.19

SLEEVE DBL DRILL 4.0/2.9MM

Facility

$1,239.10

Hospital Charge Code	270677605
Hospital Revenue Code	272
Min. Negotiated Rate	$185.87
Max. Negotiated Rate	$185.87
Rate for Payer: Qualcare PPO/HMO/WC	$185.87

SLEEVE DELTA BIOLOX NEUTRAL

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	270692220
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

SLEEVE DELTA BIOLOX NEUTRAL

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	270692220
Hospital Revenue Code	278
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

SLEEVE DRILL 4.0x2.5mm LONG

Facility

$513.00

Hospital Charge Code	270666876
Hospital Revenue Code	272
Min. Negotiated Rate	$76.95
Max. Negotiated Rate	$76.95
Rate for Payer: Qualcare PPO/HMO/WC	$76.95

SLEEVE DRILL 4.0x2.5mm LONG

Facility

$513.00

Hospital Charge Code	270666876
Hospital Revenue Code	272
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Commercial	$194.94
Rate for Payer: Aetna Medicare Advantage	$153.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.81
Rate for Payer: Cigna Commercial	$256.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.38
Rate for Payer: Oxford Commercial	$102.60
Rate for Payer: Qualcare PPO/HMO/WC	$76.95
Rate for Payer: UnitedHealthcare Commercial	$102.60
Rate for Payer: UnitedHealthcare Community & State	$16.21
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

SLEEVE DRILL 4.0x2.5mm SHORT

Facility

$1,506.00

Hospital Charge Code	270666875
Hospital Revenue Code	272
Min. Negotiated Rate	$225.90
Max. Negotiated Rate	$225.90
Rate for Payer: Qualcare PPO/HMO/WC	$225.90

SLEEVE DRILL 4.0x2.5mm SHORT

Facility

$1,506.00

Hospital Charge Code	270666875
Hospital Revenue Code	272
Min. Negotiated Rate	$42.77
Max. Negotiated Rate	$753.00
Rate for Payer: Aetna Commercial	$572.28
Rate for Payer: Aetna Medicare Advantage	$451.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$384.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$384.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$384.03
Rate for Payer: Cigna Commercial	$753.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.56
Rate for Payer: Oxford Commercial	$301.20
Rate for Payer: Qualcare PPO/HMO/WC	$225.90
Rate for Payer: UnitedHealthcare Commercial	$301.20
Rate for Payer: UnitedHealthcare Community & State	$47.59
Rate for Payer: Wellpoint Medicaid Managed Care	$42.77

SLEEVE DRILL INSERT PARALL 2.0

Facility

$1,545.00

Hospital Charge Code	270666877
Hospital Revenue Code	272
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$772.50
Rate for Payer: Aetna Commercial	$587.10
Rate for Payer: Aetna Medicare Advantage	$463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.98
Rate for Payer: Cigna Commercial	$772.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.70
Rate for Payer: Oxford Commercial	$309.00
Rate for Payer: Qualcare PPO/HMO/WC	$231.75
Rate for Payer: UnitedHealthcare Commercial	$309.00
Rate for Payer: UnitedHealthcare Community & State	$48.82
Rate for Payer: Wellpoint Medicaid Managed Care	$43.88

SLEEVE DRILL INSERT PARALL 2.0

Facility

$1,545.00

Hospital Charge Code	270666877
Hospital Revenue Code	272
Min. Negotiated Rate	$231.75
Max. Negotiated Rate	$231.75
Rate for Payer: Qualcare PPO/HMO/WC	$231.75

SLEEVE DRILL MEAS 8163-01-005

Facility

$850.00

Hospital Charge Code	270658917
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

SLEEVE DRILL MEAS 8163-01-005

Facility

$850.00

Hospital Charge Code	270658917
Hospital Revenue Code	272
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

SLEEVE FEM ADAPTER 0MM NECK

Facility

$547.05

Service Code	HCPCS C1776
Hospital Charge Code	270697131
Hospital Revenue Code	278
Min. Negotiated Rate	$82.06
Max. Negotiated Rate	$132.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.39
Rate for Payer: Qualcare PPO/HMO/WC	$82.06

SLEEVE FEM ADAPTER 0MM NECK

Facility

$547.05

Service Code	HCPCS C1776
Hospital Charge Code	270697131
Hospital Revenue Code	278
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$273.52
Rate for Payer: Aetna Commercial	$207.88
Rate for Payer: Aetna Medicare Advantage	$164.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.50
Rate for Payer: Cigna Commercial	$273.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.39
Rate for Payer: Qualcare PPO/HMO/WC	$82.06
Rate for Payer: UnitedHealthcare Community & State	$17.29
Rate for Payer: Wellpoint Medicaid Managed Care	$15.54

SLEEVE FEM HD BIOLOX OPT1 TPR

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694752
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

SLEEVE FEM HD BIOLOX OPT1 TPR

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694752
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

SLEEVE FEM NCK BIOLOX TYP1 3MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695938
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

Know your out-of-pocket cost for care.

All Charges