Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SOFRADIM MESH PCO-2015 8X6

Facility

$1,227.00

Hospital Charge Code	270338747
Hospital Revenue Code	278
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$613.50
Rate for Payer: Aetna Commercial	$466.26
Rate for Payer: Aetna Medicare Advantage	$368.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$245.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.88
Rate for Payer: Cigna Commercial	$613.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.93
Rate for Payer: Qualcare PPO/HMO/WC	$184.05
Rate for Payer: UnitedHealthcare Community & State	$38.77
Rate for Payer: Wellpoint Medicaid Managed Care	$34.85

SOFRADIM MESH PCO-2520 10X8

Facility

$1,560.00

Hospital Charge Code	270338748
Hospital Revenue Code	278
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$377.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.52
Rate for Payer: Qualcare PPO/HMO/WC	$234.00

SOFRADIM MESH PCO-2520 10X8

Facility

$1,560.00

Hospital Charge Code	270338748
Hospital Revenue Code	278
Min. Negotiated Rate	$44.30
Max. Negotiated Rate	$780.00
Rate for Payer: Aetna Commercial	$592.80
Rate for Payer: Aetna Medicare Advantage	$468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$397.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$397.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$397.80
Rate for Payer: Cigna Commercial	$780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.52
Rate for Payer: Qualcare PPO/HMO/WC	$234.00
Rate for Payer: UnitedHealthcare Community & State	$49.30
Rate for Payer: Wellpoint Medicaid Managed Care	$44.30

SOFRADIM MESH PCO-3020 12X8

Facility

$1,923.00

Hospital Charge Code	270338749
Hospital Revenue Code	278
Min. Negotiated Rate	$288.45
Max. Negotiated Rate	$465.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$384.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.37
Rate for Payer: Qualcare PPO/HMO/WC	$288.45

SOFRADIM MESH PCO-3020 12X8

Facility

$1,923.00

Hospital Charge Code	270338749
Hospital Revenue Code	278
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) NJ Health	$384.60
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	$465.37
Rate for Payer: Qualcare PPO/HMO/WC	$288.45
Rate for Payer: UnitedHealthcare Community & State	$60.77
Rate for Payer: Wellpoint Medicaid Managed Care	$54.61

SOFT SPLASH SHIELD STERILE

Facility

$172.00

Hospital Charge Code	270330544
Hospital Revenue Code	272
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$25.80

SOFT SPLASH SHIELD STERILE

Facility

$172.00

Hospital Charge Code	270330544
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$86.00
Rate for Payer: Aetna Commercial	$65.36
Rate for Payer: Aetna Medicare Advantage	$51.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.86
Rate for Payer: Cigna Commercial	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.72
Rate for Payer: Oxford Commercial	$34.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.80
Rate for Payer: UnitedHealthcare Commercial	$34.40
Rate for Payer: UnitedHealthcare Community & State	$5.44
Rate for Payer: Wellpoint Medicaid Managed Care	$4.88

SOFT TISSUE PATCH 2 MM

Facility

$962.00

Hospital Charge Code	270335125
Hospital Revenue Code	278
Min. Negotiated Rate	$27.32
Max. Negotiated Rate	$481.00
Rate for Payer: Aetna Commercial	$365.56
Rate for Payer: Aetna Medicare Advantage	$288.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.31
Rate for Payer: Cigna Commercial	$481.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.80
Rate for Payer: Qualcare PPO/HMO/WC	$144.30
Rate for Payer: UnitedHealthcare Community & State	$30.40
Rate for Payer: Wellpoint Medicaid Managed Care	$27.32

SOFT TISSUE PATCH 2 MM

Facility

$962.00

Hospital Charge Code	270335125
Hospital Revenue Code	278
Min. Negotiated Rate	$144.30
Max. Negotiated Rate	$232.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.80
Rate for Payer: Qualcare PPO/HMO/WC	$144.30

SOFT TISSUE PROCEDURES WITH CC

Facility

$74,693.33

Service Code	MSDRG 501
Min. Negotiated Rate	$22,743.16
Max. Negotiated Rate	$74,693.33
Rate for Payer: Aetna Commercial	$55,055.95
Rate for Payer: Aetna Medicare Advantage	$74,693.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48,206.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48,206.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,940.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48,206.70
Rate for Payer: Cigna Commercial	$38,970.39
Rate for Payer: Cigna Medicare Advantage	$23,940.17
Rate for Payer: Clover Medicare Advantage	$22,743.16
Rate for Payer: EmblemHealth Commercial	$71,820.51
Rate for Payer: Humana Medicare Advantage	$24,658.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,940.17
Rate for Payer: Oxford Commercial	$30,801.52
Rate for Payer: UnitedHealthcare Commercial	$41,228.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,940.17
Rate for Payer: Wellcare Medicare Advantage	$23,940.17

SOFT TISSUE PROCEDURES WITH MCC

Facility

$119,451.95

Service Code	MSDRG 500
Min. Negotiated Rate	$36,371.59
Max. Negotiated Rate	$119,451.95
Rate for Payer: Aetna Commercial	$86,933.57
Rate for Payer: Aetna Medicare Advantage	$119,451.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89,764.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89,764.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38,285.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89,764.20
Rate for Payer: Cigna Commercial	$70,552.89
Rate for Payer: Cigna Medicare Advantage	$38,285.88
Rate for Payer: Clover Medicare Advantage	$36,371.59
Rate for Payer: EmblemHealth Commercial	$114,857.64
Rate for Payer: Humana Medicare Advantage	$39,434.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38,285.88
Rate for Payer: Oxford Commercial	$55,763.78
Rate for Payer: UnitedHealthcare Commercial	$74,641.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$38,285.88
Rate for Payer: Wellcare Medicare Advantage	$38,285.88

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$61,986.38

Service Code	MSDRG 502
Min. Negotiated Rate	$18,874.06
Max. Negotiated Rate	$61,986.38
Rate for Payer: Aetna Commercial	$46,005.93
Rate for Payer: Aetna Medicare Advantage	$61,986.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38,232.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38,232.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,867.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38,232.90
Rate for Payer: Cigna Commercial	$30,004.15
Rate for Payer: Cigna Medicare Advantage	$19,867.43
Rate for Payer: Clover Medicare Advantage	$18,874.06
Rate for Payer: EmblemHealth Commercial	$59,602.29
Rate for Payer: Humana Medicare Advantage	$20,463.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,867.43
Rate for Payer: Oxford Commercial	$23,714.76
Rate for Payer: UnitedHealthcare Commercial	$31,743.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,867.43
Rate for Payer: Wellcare Medicare Advantage	$19,867.43

SOFT TISSUE SHAVER PLUS

Facility

$2,336.50

Hospital Charge Code	270701400
Hospital Revenue Code	278
Min. Negotiated Rate	$350.48
Max. Negotiated Rate	$565.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$467.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$565.43
Rate for Payer: Qualcare PPO/HMO/WC	$350.48

SOFT TISSUE SHAVER PLUS

Facility

$2,336.50

Hospital Charge Code	270701400
Hospital Revenue Code	278
Min. Negotiated Rate	$66.36
Max. Negotiated Rate	$1,168.25
Rate for Payer: Aetna Commercial	$887.87
Rate for Payer: Aetna Medicare Advantage	$700.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$595.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$595.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$467.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$595.81
Rate for Payer: Cigna Commercial	$1,168.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$565.43
Rate for Payer: Qualcare PPO/HMO/WC	$350.48
Rate for Payer: UnitedHealthcare Community & State	$73.83
Rate for Payer: Wellpoint Medicaid Managed Care	$66.36

SOLAR-S ALIF SPACER 40X28X16MM

Facility

$30,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705627
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

SOLAR-S ALIF SPACER 40X28X16MM

Facility

$30,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705627
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$948.00
Rate for Payer: Wellpoint Medicaid Managed Care	$852.00

SOLENT OMNI THROMBECTOMY SET

Facility

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,267.50
Max. Negotiated Rate	$2,044.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50

SOLENT OMNI THROMBECTOMY SET

Facility

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590C
Hospital Revenue Code	278
Min. Negotiated Rate	$239.98
Max. Negotiated Rate	$4,225.00
Rate for Payer: Aetna Commercial	$3,211.00
Rate for Payer: Aetna Medicare Advantage	$2,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,154.75
Rate for Payer: Cigna Commercial	$4,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50
Rate for Payer: UnitedHealthcare Community & State	$267.02
Rate for Payer: Wellpoint Medicaid Managed Care	$239.98

SOLENT OMNI THROMBECTOMY SET

Facility

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590A
Hospital Revenue Code	278
Min. Negotiated Rate	$239.98
Max. Negotiated Rate	$4,225.00
Rate for Payer: Aetna Commercial	$3,211.00
Rate for Payer: Aetna Medicare Advantage	$2,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,154.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,154.75
Rate for Payer: Cigna Commercial	$4,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50
Rate for Payer: UnitedHealthcare Community & State	$267.02
Rate for Payer: Wellpoint Medicaid Managed Care	$239.98

SOLENT OMNI THROMBECTOMY SET

Facility

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,267.50
Max. Negotiated Rate	$2,044.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50

SOL FL THD SCR BLNT HD 2.7X18

Facility

$783.75

Service Code	HCPCS C1713
Hospital Charge Code	270701335
Hospital Revenue Code	278
Min. Negotiated Rate	$117.56
Max. Negotiated Rate	$189.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.67
Rate for Payer: Qualcare PPO/HMO/WC	$117.56

SOL FL THD SCR BLNT HD 2.7X18

Facility

$783.75

Service Code	HCPCS C1713
Hospital Charge Code	270701335
Hospital Revenue Code	278
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$391.88
Rate for Payer: Aetna Commercial	$297.82
Rate for Payer: Aetna Medicare Advantage	$235.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.86
Rate for Payer: Cigna Commercial	$391.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.67
Rate for Payer: Qualcare PPO/HMO/WC	$117.56
Rate for Payer: UnitedHealthcare Community & State	$24.77
Rate for Payer: Wellpoint Medicaid Managed Care	$22.26

SOLID JOUST 7.2X135

Facility

$5,458.75

Service Code	HCPCS C1713
Hospital Charge Code	270701937
Hospital Revenue Code	278
Min. Negotiated Rate	$818.81
Max. Negotiated Rate	$1,321.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,091.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,321.02
Rate for Payer: Qualcare PPO/HMO/WC	$818.81

SOLID JOUST 7.2X135

Facility

$5,458.75

Service Code	HCPCS C1713
Hospital Charge Code	270701937
Hospital Revenue Code	278
Min. Negotiated Rate	$155.03
Max. Negotiated Rate	$2,729.38
Rate for Payer: Aetna Commercial	$2,074.32
Rate for Payer: Aetna Medicare Advantage	$1,637.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,391.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,391.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,091.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,391.98
Rate for Payer: Cigna Commercial	$2,729.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,321.02
Rate for Payer: Qualcare PPO/HMO/WC	$818.81
Rate for Payer: UnitedHealthcare Community & State	$172.50
Rate for Payer: Wellpoint Medicaid Managed Care	$155.03

SOLIDLOK HEX TIP 3.5MM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	270689271
Hospital Revenue Code	278
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

Know your out-of-pocket cost for care.

All Charges