Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STAB PHLEB VEINS XTR 10-20

Facility

$17,623.95

Service Code	HCPCS 37765
Hospital Charge Code	421037765
Hospital Revenue Code	761
Min. Negotiated Rate	$2,643.59
Max. Negotiated Rate	$2,643.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59

STAB PHLEB VEINS XTR 10-20

Facility

$17,623.95

Service Code	HCPCS 37765
Hospital Charge Code	421037765
Hospital Revenue Code	761
Min. Negotiated Rate	$378.40
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,582.23
Rate for Payer: Oxford Commercial	$3,524.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.59
Rate for Payer: UnitedHealthcare Commercial	$3,524.79
Rate for Payer: UnitedHealthcare Community & State	$556.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$500.52

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	$721.55
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,605.77
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,811.02
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$802.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$721.55

STAGRAFT DBM PUTTY

Facility

$7,645.00

Service Code	HCPCS C1765
Hospital Charge Code	270704573
Hospital Revenue Code	278
Min. Negotiated Rate	$217.12
Max. Negotiated Rate	$3,822.50
Rate for Payer: Aetna Commercial	$2,905.10
Rate for Payer: Aetna Medicare Advantage	$2,293.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,949.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,949.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,529.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,949.47
Rate for Payer: Cigna Commercial	$3,822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,850.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,146.75
Rate for Payer: UnitedHealthcare Community & State	$241.58
Rate for Payer: Wellpoint Medicaid Managed Care	$217.12

STAGRAFT DBM PUTTY

Facility

$7,645.00

Service Code	HCPCS C1765
Hospital Charge Code	270704573
Hospital Revenue Code	278
Min. Negotiated Rate	$1,146.75
Max. Negotiated Rate	$1,850.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,529.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,850.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,146.75

STAGRAFT PUTTY 2CC DBM

Facility

$2,750.00

Hospital Charge Code	270703446
Hospital Revenue Code	278
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

STAGRAFT PUTTY 2CC DBM

Facility

$2,750.00

Hospital Charge Code	270703446
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

STAND ALONE ACDF 14X12X6MM

Facility

$18,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270705017
Hospital Revenue Code	278
Min. Negotiated Rate	$2,787.75
Max. Negotiated Rate	$4,497.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,717.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,497.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,787.75

STAND ALONE ACDF 14X12X6MM

Facility

$18,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270705017
Hospital Revenue Code	278
Min. Negotiated Rate	$527.81
Max. Negotiated Rate	$9,292.50
Rate for Payer: Aetna Commercial	$7,062.30
Rate for Payer: Aetna Medicare Advantage	$5,575.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,739.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,739.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,717.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,739.18
Rate for Payer: Cigna Commercial	$9,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,497.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,787.75
Rate for Payer: UnitedHealthcare Community & State	$587.29
Rate for Payer: Wellpoint Medicaid Managed Care	$527.81

STAND ALONE ALIF CAGE 25X35MM-

Facility

$26,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704764
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$6,352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

STAND ALONE ALIF CAGE 25X35MM-

Facility

$26,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704763
Hospital Revenue Code	278
Min. Negotiated Rate	$745.50
Max. Negotiated Rate	$13,125.00
Rate for Payer: Aetna Commercial	$9,975.00
Rate for Payer: Aetna Medicare Advantage	$7,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,693.75
Rate for Payer: Cigna Commercial	$13,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50
Rate for Payer: UnitedHealthcare Community & State	$829.50
Rate for Payer: Wellpoint Medicaid Managed Care	$745.50

STAND ALONE ALIF CAGE 25X35MM-

Facility

$26,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,937.50
Max. Negotiated Rate	$6,352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50

STAND ALONE ALIF CAGE 25X35MM-

Facility

$26,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270704764
Hospital Revenue Code	278
Min. Negotiated Rate	$745.50
Max. Negotiated Rate	$13,125.00
Rate for Payer: Aetna Commercial	$9,975.00
Rate for Payer: Aetna Medicare Advantage	$7,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,693.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,693.75
Rate for Payer: Cigna Commercial	$13,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,352.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,937.50
Rate for Payer: UnitedHealthcare Community & State	$829.50
Rate for Payer: Wellpoint Medicaid Managed Care	$745.50

STAND ALONE SCREW 16MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704435
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

STAND ALONE SCREW 16MM

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704435
Hospital Revenue Code	278
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$28.44
Rate for Payer: Wellpoint Medicaid Managed Care	$25.56

STAND ALONE TRUSS 12D X 15W

Facility

$12,000.00

Hospital Charge Code	270698533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

STAND ALONE TRUSS 12D X 15W

Facility

$12,000.00

Hospital Charge Code	270698533
Hospital Revenue Code	278
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

STANDARD GLIDEWIRE .018X 80 CM

Facility

$1,392.50

Service Code	HCPCS C1769
Hospital Charge Code	270688479
Hospital Revenue Code	272
Min. Negotiated Rate	$39.55
Max. Negotiated Rate	$696.25
Rate for Payer: Aetna Commercial	$529.15
Rate for Payer: Aetna Medicare Advantage	$417.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.09
Rate for Payer: Cigna Commercial	$696.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$362.05
Rate for Payer: Oxford Commercial	$278.50
Rate for Payer: Qualcare PPO/HMO/WC	$208.88
Rate for Payer: UnitedHealthcare Commercial	$278.50
Rate for Payer: UnitedHealthcare Community & State	$44.00
Rate for Payer: Wellpoint Medicaid Managed Care	$39.55

STANDARD GLIDEWIRE .018X 80 CM

Facility

$1,392.50

Service Code	HCPCS C1769
Hospital Charge Code	270688479
Hospital Revenue Code	272
Min. Negotiated Rate	$208.88
Max. Negotiated Rate	$208.88
Rate for Payer: Qualcare PPO/HMO/WC	$208.88

STANDARD HUMERAL DIAPHYSIS

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687835
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

STANDARD HUMERAL DIAPHYSIS

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687835
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

STANDARDIZED COGNITIVE EVAL

Facility

$554.50

Service Code	HCPCS 96125GN
Hospital Charge Code	74204032
Hospital Revenue Code	444
Min. Negotiated Rate	$83.17
Max. Negotiated Rate	$83.17
Rate for Payer: Qualcare PPO/HMO/WC	$83.17

STANDARDIZED COGNITIVE EVAL

Facility

$554.50

Service Code	HCPCS 96125GN
Hospital Charge Code	74204032
Hospital Revenue Code	444
Min. Negotiated Rate	$17.52
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$210.71
Rate for Payer: Aetna Medicare Advantage	$166.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.40
Rate for Payer: Cigna Commercial	$277.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.17
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.17
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$17.52
Rate for Payer: Wellpoint Medicaid Managed Care	$65.00

STANDARD POLY LINER SZ 9

Facility

$9,860.25

Service Code	HCPCS C1776
Hospital Charge Code	270688863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,479.04
Max. Negotiated Rate	$2,386.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.04

STANDARD POLY LINER SZ 9

Facility

$9,860.25

Service Code	HCPCS C1776
Hospital Charge Code	270688863
Hospital Revenue Code	278
Min. Negotiated Rate	$280.03
Max. Negotiated Rate	$4,930.12
Rate for Payer: Aetna Commercial	$3,746.89
Rate for Payer: Aetna Medicare Advantage	$2,958.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,514.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,514.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,972.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,514.36
Rate for Payer: Cigna Commercial	$4,930.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,386.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,479.04
Rate for Payer: UnitedHealthcare Community & State	$311.58
Rate for Payer: Wellpoint Medicaid Managed Care	$280.03

Know your out-of-pocket cost for care.

All Charges