Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SLEEVE FEM NCK BIOLOX TYP1 3MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695938
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 NECK ADJ STD V40

Facility

$9,195.00

Service Code	HCPCS C1776
Hospital Charge Code	270693840
Hospital Revenue Code	278
Min. Negotiated Rate	$261.14
Max. Negotiated Rate	$4,597.50
Rate for Payer: Aetna Commercial	$3,494.10
Rate for Payer: Aetna Medicare Advantage	$2,758.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,344.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,344.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,839.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,344.72
Rate for Payer: Cigna Commercial	$4,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,225.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,379.25
Rate for Payer: UnitedHealthcare Community & State	$290.56
Rate for Payer: Wellpoint Medicaid Managed Care	$261.14

SLEEVE FEM NECK ADJ STD V40

Facility

$9,195.00

Service Code	HCPCS C1776
Hospital Charge Code	270693840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,379.25
Max. Negotiated Rate	$2,225.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,839.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,225.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,379.25

SLEEVE HOLDING

Facility

$607.90

Hospital Charge Code	270686029
Hospital Revenue Code	272
Min. Negotiated Rate	$17.26
Max. Negotiated Rate	$303.95
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Aetna Medicare Advantage	$182.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.01
Rate for Payer: Cigna Commercial	$303.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.05
Rate for Payer: Oxford Commercial	$121.58
Rate for Payer: Qualcare PPO/HMO/WC	$91.19
Rate for Payer: UnitedHealthcare Commercial	$121.58
Rate for Payer: UnitedHealthcare Community & State	$19.21
Rate for Payer: Wellpoint Medicaid Managed Care	$17.26

SLEEVE HOLDING

Facility

$607.90

Hospital Charge Code	270686029
Hospital Revenue Code	272
Min. Negotiated Rate	$91.19
Max. Negotiated Rate	$91.19
Rate for Payer: Qualcare PPO/HMO/WC	$91.19

SLEEVE HOLDING NON STERILE

Facility

$1,923.00

Hospital Charge Code	270676258
Hospital Revenue Code	271
Min. Negotiated Rate	$288.45
Max. Negotiated Rate	$288.45
Rate for Payer: Qualcare PPO/HMO/WC	$288.45

SLEEVE HOLDING NON STERILE

Facility

$1,923.00

Hospital Charge Code	270676258
Hospital Revenue Code	271
Min. Negotiated Rate	$54.61
Max. Negotiated Rate	$961.50
Rate for Payer: Aetna Commercial	$730.74
Rate for Payer: Aetna Medicare Advantage	$576.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.37
Rate for Payer: Cigna Commercial	$961.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.98
Rate for Payer: Oxford Commercial	$384.60
Rate for Payer: Qualcare PPO/HMO/WC	$288.45
Rate for Payer: UnitedHealthcare Commercial	$384.60
Rate for Payer: UnitedHealthcare Community & State	$60.77
Rate for Payer: Wellpoint Medicaid Managed Care	$54.61

SLEEVE LAP FIXATION 5X100MM

Facility

$30.58

Service Code	HCPCS A4649
Hospital Charge Code	270642087
Hospital Revenue Code	272
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

SLEEVE LAP FIXATION 5X100MM

Facility

$30.58

Service Code	HCPCS A4649
Hospital Charge Code	270642087
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$15.29
Rate for Payer: Aetna Commercial	$11.62
Rate for Payer: Aetna Medicare Advantage	$9.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.80
Rate for Payer: Cigna Commercial	$15.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.95
Rate for Payer: Oxford Commercial	$6.12
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Commercial	$6.12
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

SLEEVE NECK ADJSMT C-TPR 0+

Facility

$926.25

Service Code	HCPCS C1776
Hospital Charge Code	270678037
Hospital Revenue Code	278
Min. Negotiated Rate	$138.94
Max. Negotiated Rate	$224.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.15
Rate for Payer: Qualcare PPO/HMO/WC	$138.94

SLEEVE NECK ADJSMT C-TPR 0+

Facility

$926.25

Service Code	HCPCS C1776
Hospital Charge Code	270678037
Hospital Revenue Code	278
Min. Negotiated Rate	$26.31
Max. Negotiated Rate	$463.12
Rate for Payer: Aetna Commercial	$351.98
Rate for Payer: Aetna Medicare Advantage	$277.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.19
Rate for Payer: Cigna Commercial	$463.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.15
Rate for Payer: Qualcare PPO/HMO/WC	$138.94
Rate for Payer: UnitedHealthcare Community & State	$29.27
Rate for Payer: Wellpoint Medicaid Managed Care	$26.31

SLEEVE PROTECTIVE

Facility

$422.50

Hospital Charge Code	270677297
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$211.25
Rate for Payer: Aetna Commercial	$160.55
Rate for Payer: Aetna Medicare Advantage	$126.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.74
Rate for Payer: Cigna Commercial	$211.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.85
Rate for Payer: Oxford Commercial	$84.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.38
Rate for Payer: UnitedHealthcare Commercial	$84.50
Rate for Payer: UnitedHealthcare Community & State	$13.35
Rate for Payer: Wellpoint Medicaid Managed Care	$12.00

SLEEVE PROTECTIVE

Facility

$422.50

Hospital Charge Code	270677297
Hospital Revenue Code	272
Min. Negotiated Rate	$63.38
Max. Negotiated Rate	$63.38
Rate for Payer: Qualcare PPO/HMO/WC	$63.38

SLEEVE PROTECTIVE TM ANKLE

Facility

$390.00

Hospital Charge Code	270695538
Hospital Revenue Code	272
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SLEEVE PROTECTIVE TM ANKLE

Facility

$390.00

Hospital Charge Code	270695538
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SLEEVE RESORB F/4.0mm SCREW

Facility

$816.00

Hospital Charge Code	270662828
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$197.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

SLEEVE RESORB F/4.0mm SCREW

Facility

$816.00

Hospital Charge Code	270662828
Hospital Revenue Code	278
Min. Negotiated Rate	$23.17
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$310.08
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$23.17

SLEEVE SCD CALF LG 14IN BULK

Facility

$165.61

Hospital Charge Code	270654148
Hospital Revenue Code	270
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$82.81
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: Aetna Medicare Advantage	$49.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.23
Rate for Payer: Cigna Commercial	$82.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.06
Rate for Payer: Oxford Commercial	$33.12
Rate for Payer: Qualcare PPO/HMO/WC	$24.84
Rate for Payer: UnitedHealthcare Commercial	$33.12
Rate for Payer: UnitedHealthcare Community & State	$5.23
Rate for Payer: Wellpoint Medicaid Managed Care	$4.70

SLEEVE SCD CALF LG 14IN BULK

Facility

$165.61

Hospital Charge Code	270654148
Hospital Revenue Code	270
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$24.84
Rate for Payer: Qualcare PPO/HMO/WC	$24.84

SLEEVE SEQUEN COMP LG 5480

Facility

$502.45

Hospital Charge Code	270604156
Hospital Revenue Code	270
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$251.22
Rate for Payer: Aetna Commercial	$190.93
Rate for Payer: Aetna Medicare Advantage	$150.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.12
Rate for Payer: Cigna Commercial	$251.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.64
Rate for Payer: Oxford Commercial	$100.49
Rate for Payer: Qualcare PPO/HMO/WC	$75.37
Rate for Payer: UnitedHealthcare Commercial	$100.49
Rate for Payer: UnitedHealthcare Community & State	$15.88
Rate for Payer: Wellpoint Medicaid Managed Care	$14.27

SLEEVE SEQUEN COMP LG 5480

Facility

$502.45

Hospital Charge Code	270604156
Hospital Revenue Code	270
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$75.37
Rate for Payer: Qualcare PPO/HMO/WC	$75.37

SLEEVE SEQUEN COMP MED

Facility

$414.45

Hospital Charge Code	270604157
Hospital Revenue Code	270
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.76
Rate for Payer: Oxford Commercial	$82.89
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$82.89
Rate for Payer: UnitedHealthcare Community & State	$13.10
Rate for Payer: Wellpoint Medicaid Managed Care	$11.77

SLEEVE SEQUEN COMP MED

Facility

$414.45

Hospital Charge Code	270604157
Hospital Revenue Code	270
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

SLEEVES SCD KNEE 3583005480

Facility

$36.93

Hospital Charge Code	270301510
Hospital Revenue Code	270
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$18.46
Rate for Payer: Aetna Commercial	$14.03
Rate for Payer: Aetna Medicare Advantage	$11.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.42
Rate for Payer: Cigna Commercial	$18.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$7.39
Rate for Payer: Qualcare PPO/HMO/WC	$5.54
Rate for Payer: UnitedHealthcare Commercial	$7.39
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

SLEEVES SCD KNEE 3583005480

Facility

$36.93

Hospital Charge Code	270301510
Hospital Revenue Code	270
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$5.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.54

Know your out-of-pocket cost for care.

All Charges