Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STAPLE SYSTEM 10X10X10MM

Facility

$6,270.00

Service Code	HCPCS C1713
Hospital Charge Code	270690538
Hospital Revenue Code	278
Min. Negotiated Rate	$940.50
Max. Negotiated Rate	$1,517.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,517.34
Rate for Payer: Qualcare PPO/HMO/WC	$940.50

STAPLE UNI-CLIP NTCH 15x12MM L

Facility

$3,868.55

Hospital Charge Code	270668132
Hospital Revenue Code	272
Min. Negotiated Rate	$109.87
Max. Negotiated Rate	$1,934.28
Rate for Payer: Aetna Commercial	$1,470.05
Rate for Payer: Aetna Medicare Advantage	$1,160.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$986.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$986.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$986.48
Rate for Payer: Cigna Commercial	$1,934.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.82
Rate for Payer: Oxford Commercial	$773.71
Rate for Payer: Qualcare PPO/HMO/WC	$580.28
Rate for Payer: UnitedHealthcare Commercial	$773.71
Rate for Payer: UnitedHealthcare Community & State	$122.25
Rate for Payer: Wellpoint Medicaid Managed Care	$109.87

STAPLE UNI-CLIP NTCH 15x12MM L

Facility

$3,868.55

Hospital Charge Code	270668132
Hospital Revenue Code	272
Min. Negotiated Rate	$580.28
Max. Negotiated Rate	$580.28
Rate for Payer: Qualcare PPO/HMO/WC	$580.28

STAPLE Z 10/11MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695607
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

STAPLE Z 10/11MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695607
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STAPLR RLDABL TA 30V-3 TA30V3S

Facility

$459.92

Hospital Charge Code	270630405
Hospital Revenue Code	272
Min. Negotiated Rate	$68.99
Max. Negotiated Rate	$68.99
Rate for Payer: Qualcare PPO/HMO/WC	$68.99

STAPLR RLDABL TA 30V-3 TA30V3S

Facility

$459.92

Hospital Charge Code	270630405
Hospital Revenue Code	272
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$229.96
Rate for Payer: Aetna Commercial	$174.77
Rate for Payer: Aetna Medicare Advantage	$137.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.28
Rate for Payer: Cigna Commercial	$229.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.58
Rate for Payer: Oxford Commercial	$91.98
Rate for Payer: Qualcare PPO/HMO/WC	$68.99
Rate for Payer: UnitedHealthcare Commercial	$91.98
Rate for Payer: UnitedHealthcare Community & State	$14.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.06

STARLIX 120MG TAB

Facility

$21.78

Service Code	NDC 78035205
Hospital Charge Code	60632258
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$10.89
Rate for Payer: Aetna Commercial	$8.28
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.55
Rate for Payer: Cigna Commercial	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$3.27
Rate for Payer: UnitedHealthcare Commercial	$4.36
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

STARLIX 120MG TAB

Facility

$21.78

Service Code	NDC 78035205
Hospital Charge Code	60632258
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.27

STARSLEEVE VELCRO

Facility

$500.00

Hospital Charge Code	270656578
Hospital Revenue Code	272
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) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

STARSLEEVE VELCRO

Facility

$500.00

Hospital Charge Code	270656578
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

STATAK ANCHORS

Facility

$1,077.00

Hospital Charge Code	270335086
Hospital Revenue Code	278
Min. Negotiated Rate	$161.55
Max. Negotiated Rate	$260.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.63
Rate for Payer: Qualcare PPO/HMO/WC	$161.55

STATAK ANCHORS

Facility

$1,077.00

Hospital Charge Code	270335086
Hospital Revenue Code	278
Min. Negotiated Rate	$30.59
Max. Negotiated Rate	$538.50
Rate for Payer: Aetna Commercial	$409.26
Rate for Payer: Aetna Medicare Advantage	$323.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.63
Rate for Payer: Cigna Commercial	$538.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.63
Rate for Payer: Qualcare PPO/HMO/WC	$161.55
Rate for Payer: UnitedHealthcare Community & State	$34.03
Rate for Payer: Wellpoint Medicaid Managed Care	$30.59

STATAK SOFT TISSUE DEV 3.5MM

Facility

$4,589.50

Hospital Charge Code	270657940
Hospital Revenue Code	272
Min. Negotiated Rate	$688.42
Max. Negotiated Rate	$688.42
Rate for Payer: Qualcare PPO/HMO/WC	$688.42

STATAK SOFT TISSUE DEV 3.5MM

Facility

$4,589.50

Hospital Charge Code	270657940
Hospital Revenue Code	272
Min. Negotiated Rate	$130.34
Max. Negotiated Rate	$2,294.75
Rate for Payer: Aetna Commercial	$1,744.01
Rate for Payer: Aetna Medicare Advantage	$1,376.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,170.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,170.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,170.32
Rate for Payer: Cigna Commercial	$2,294.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,193.27
Rate for Payer: Oxford Commercial	$917.90
Rate for Payer: Qualcare PPO/HMO/WC	$688.42
Rate for Payer: UnitedHealthcare Commercial	$917.90
Rate for Payer: UnitedHealthcare Community & State	$145.03
Rate for Payer: Wellpoint Medicaid Managed Care	$130.34

STATAK SOFT TISSUE DEV 5MM

Facility

$945.44

Hospital Charge Code	270631040
Hospital Revenue Code	272
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$472.72
Rate for Payer: Aetna Commercial	$359.27
Rate for Payer: Aetna Medicare Advantage	$283.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.09
Rate for Payer: Cigna Commercial	$472.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.81
Rate for Payer: Oxford Commercial	$189.09
Rate for Payer: Qualcare PPO/HMO/WC	$141.82
Rate for Payer: UnitedHealthcare Commercial	$189.09
Rate for Payer: UnitedHealthcare Community & State	$29.88
Rate for Payer: Wellpoint Medicaid Managed Care	$26.85

STATAK SOFT TISSUE DEV 5MM

Facility

$945.44

Hospital Charge Code	270631040
Hospital Revenue Code	272
Min. Negotiated Rate	$141.82
Max. Negotiated Rate	$141.82
Rate for Payer: Qualcare PPO/HMO/WC	$141.82

STATAK SOFT TISSUE DEVICE 5MM

Facility

$945.40

Hospital Charge Code	270656604
Hospital Revenue Code	272
Min. Negotiated Rate	$141.81
Max. Negotiated Rate	$141.81
Rate for Payer: Qualcare PPO/HMO/WC	$141.81

STATAK SOFT TISSUE DEVICE 5MM

Facility

$945.40

Hospital Charge Code	270656604
Hospital Revenue Code	272
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$472.70
Rate for Payer: Aetna Commercial	$359.25
Rate for Payer: Aetna Medicare Advantage	$283.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.08
Rate for Payer: Cigna Commercial	$472.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.80
Rate for Payer: Oxford Commercial	$189.08
Rate for Payer: Qualcare PPO/HMO/WC	$141.81
Rate for Payer: UnitedHealthcare Commercial	$189.08
Rate for Payer: UnitedHealthcare Community & State	$29.87
Rate for Payer: Wellpoint Medicaid Managed Care	$26.85

STATIC STRUT LRF 60MM

Facility

$497.15

Service Code	HCPCS C1713
Hospital Charge Code	270699594
Hospital Revenue Code	278
Min. Negotiated Rate	$74.57
Max. Negotiated Rate	$120.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.31
Rate for Payer: Qualcare PPO/HMO/WC	$74.57

STATIC STRUT LRF 60MM

Facility

$497.15

Service Code	HCPCS C1713
Hospital Charge Code	270699594
Hospital Revenue Code	278
Min. Negotiated Rate	$14.12
Max. Negotiated Rate	$248.57
Rate for Payer: Aetna Commercial	$188.92
Rate for Payer: Aetna Medicare Advantage	$149.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.77
Rate for Payer: Cigna Commercial	$248.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.31
Rate for Payer: Qualcare PPO/HMO/WC	$74.57
Rate for Payer: UnitedHealthcare Community & State	$15.71
Rate for Payer: Wellpoint Medicaid Managed Care	$14.12

STATLOCK FOR INTRA AORTIC BALL

Facility

$379.00

Hospital Charge Code	270657663N
Hospital Revenue Code	270
Min. Negotiated Rate	$56.85
Max. Negotiated Rate	$56.85
Rate for Payer: Qualcare PPO/HMO/WC	$56.85

STATLOCK FOR INTRA AORTIC BALL

Facility

$89.50

Hospital Charge Code	270657663
Hospital Revenue Code	270
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

STATLOCK FOR INTRA AORTIC BALL

Facility

$379.00

Hospital Charge Code	270657663N
Hospital Revenue Code	270
Min. Negotiated Rate	$10.76
Max. Negotiated Rate	$189.50
Rate for Payer: Aetna Commercial	$144.02
Rate for Payer: Aetna Medicare Advantage	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.64
Rate for Payer: Cigna Commercial	$189.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.54
Rate for Payer: Oxford Commercial	$75.80
Rate for Payer: Qualcare PPO/HMO/WC	$56.85
Rate for Payer: UnitedHealthcare Commercial	$75.80
Rate for Payer: UnitedHealthcare Community & State	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.76

STATLOCK FOR INTRA AORTIC BALL

Facility

$89.50

Hospital Charge Code	270657663S
Hospital Revenue Code	270
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

Know your out-of-pocket cost for care.

All Charges