Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SRW CORT LOPROF SLF-TPN 3.5X70

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681558
Hospital Revenue Code	278
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27
Rate for Payer: UnitedHealthcare Community & State	$4.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.41

SRW CORT LOPROF SLF-TPN 3.5X70

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681558
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x80

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681559
Hospital Revenue Code	278
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27
Rate for Payer: UnitedHealthcare Community & State	$4.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.41

SRW CORT LOPROF SLF-TPN 3.5x80

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681559
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x90

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681560
Hospital Revenue Code	278
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27
Rate for Payer: UnitedHealthcare Community & State	$4.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.41

SRW CORT LOPROF SLF-TPN 3.5x90

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681560
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SRW CORT LOPROF SLF-TPN 3.5x95

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681561
Hospital Revenue Code	278
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$77.58
Rate for Payer: Aetna Commercial	$58.96
Rate for Payer: Aetna Medicare Advantage	$46.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.56
Rate for Payer: Cigna Commercial	$77.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27
Rate for Payer: UnitedHealthcare Community & State	$4.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.41

SRW CORT LOPROF SLF-TPN 3.5x95

Facility

$155.15

Service Code	HCPCS C1713
Hospital Charge Code	270681561
Hospital Revenue Code	278
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$37.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.27

SS-A & SS-B (SJOGREN'S) I

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SS-A & SS-B (SJOGREN'S) I

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SS-A & SS-B (SJOGREN'S) II

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.04
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SS-A & SS-B (SJOGREN'S) II

Facility

$390.00

Service Code	HCPCS 86235
Hospital Charge Code	39990027B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SS CEMENT RESTRICTOR TRAIL 1

Facility

$547.00

Hospital Charge Code	270332108
Hospital Revenue Code	272
Min. Negotiated Rate	$82.05
Max. Negotiated Rate	$82.05
Rate for Payer: Qualcare PPO/HMO/WC	$82.05

SS CEMENT RESTRICTOR TRAIL 1

Facility

$547.00

Hospital Charge Code	270332108
Hospital Revenue Code	272
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$273.50
Rate for Payer: Aetna Commercial	$207.86
Rate for Payer: Aetna Medicare Advantage	$164.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.49
Rate for Payer: Cigna Commercial	$273.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.22
Rate for Payer: Oxford Commercial	$109.40
Rate for Payer: Qualcare PPO/HMO/WC	$82.05
Rate for Payer: UnitedHealthcare Commercial	$109.40
Rate for Payer: UnitedHealthcare Community & State	$17.29
Rate for Payer: Wellpoint Medicaid Managed Care	$15.53

SS DNA IGG AB

Facility

$83.25

Service Code	HCPCS 86226
Hospital Charge Code	39900201
Hospital Revenue Code	302
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$12.49
Rate for Payer: Qualcare PPO/HMO/WC	$12.49

SS DNA IGG AB

Facility

$83.25

Service Code	HCPCS 86226
Hospital Charge Code	39900201
Hospital Revenue Code	302
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.93
Rate for Payer: Cigna Commercial	$41.62
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.64
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.49
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

SSEP/MEP/EMG SURFACE

Facility

$19,310.00

Hospital Charge Code	270665927
Hospital Revenue Code	270
Min. Negotiated Rate	$2,896.50
Max. Negotiated Rate	$2,896.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,896.50

SSEP/MEP/EMG SURFACE

Facility

$19,310.00

Hospital Charge Code	270665927
Hospital Revenue Code	270
Min. Negotiated Rate	$548.40
Max. Negotiated Rate	$9,655.00
Rate for Payer: Aetna Commercial	$7,337.80
Rate for Payer: Aetna Medicare Advantage	$5,793.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,924.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,924.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,924.05
Rate for Payer: Cigna Commercial	$9,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,020.60
Rate for Payer: Oxford Commercial	$3,862.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,896.50
Rate for Payer: UnitedHealthcare Commercial	$3,862.00
Rate for Payer: UnitedHealthcare Community & State	$610.20
Rate for Payer: Wellpoint Medicaid Managed Care	$548.40

S-SERIES TI CANN SRW 2.0 X11mm

Facility

$1,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270679982
Hospital Revenue Code	278
Min. Negotiated Rate	$40.47
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$541.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Qualcare PPO/HMO/WC	$213.75
Rate for Payer: UnitedHealthcare Community & State	$45.03
Rate for Payer: Wellpoint Medicaid Managed Care	$40.47

S-SERIES TI CANN SRW 2.0 X11mm

Facility

$1,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270679982
Hospital Revenue Code	278
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$344.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

STABILIZATION STORM BOOT

Facility

$2,232.00

Hospital Charge Code	270335599
Hospital Revenue Code	270
Min. Negotiated Rate	$334.80
Max. Negotiated Rate	$334.80
Rate for Payer: Qualcare PPO/HMO/WC	$334.80

STABILIZATION STORM BOOT

Facility

$2,232.00

Hospital Charge Code	270335599
Hospital Revenue Code	270
Min. Negotiated Rate	$63.39
Max. Negotiated Rate	$1,116.00
Rate for Payer: Aetna Commercial	$848.16
Rate for Payer: Aetna Medicare Advantage	$669.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$569.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$569.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$569.16
Rate for Payer: Cigna Commercial	$1,116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.32
Rate for Payer: Oxford Commercial	$446.40
Rate for Payer: Qualcare PPO/HMO/WC	$334.80
Rate for Payer: UnitedHealthcare Commercial	$446.40
Rate for Payer: UnitedHealthcare Community & State	$70.53
Rate for Payer: Wellpoint Medicaid Managed Care	$63.39

STABILIZ TIB INS TRIATHLN X3

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270693020
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$5,789.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

STABILIZ TIB INS TRIATHLN X3

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270693020
Hospital Revenue Code	278
Min. Negotiated Rate	$679.47
Max. Negotiated Rate	$11,962.50
Rate for Payer: Aetna Commercial	$9,091.50
Rate for Payer: Aetna Medicare Advantage	$7,177.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,100.88
Rate for Payer: Cigna Commercial	$11,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75
Rate for Payer: UnitedHealthcare Community & State	$756.03
Rate for Payer: Wellpoint Medicaid Managed Care	$679.47

STAB PHLEB VEINS XTR 10-20

Facility

$25,406.80

Service Code	HCPCS 37765
Hospital Charge Code	16000739
Hospital Revenue Code	360
Min. Negotiated Rate	$3,811.02
Max. Negotiated Rate	$3,811.02
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02

Know your out-of-pocket cost for care.

All Charges