Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	9109125
Hospital Revenue Code	440
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Qualcare PPO/HMO/WC	$236.14

ST MODIFIED VIDEO SWALLOW

Facility

$1,574.25

Service Code	HCPCS 92611
Hospital Charge Code	74204003
Hospital Revenue Code	440
Min. Negotiated Rate	$44.71
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$598.22
Rate for Payer: Aetna Medicare Advantage	$472.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.43
Rate for Payer: Cigna Commercial	$787.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.31
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.14
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$49.75
Rate for Payer: Wellpoint Medicaid Managed Care	$44.71

ST MOTION FLUOROSCO SWALL

Facility

$2,400.00

Service Code	HCPCS 92611GN
Hospital Charge Code	74204029
Hospital Revenue Code	444
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
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	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$65.00

ST MOTION FLUOROSCO SWALL

Facility

$2,400.00

Service Code	HCPCS 92611GN
Hospital Charge Code	74204029
Hospital Revenue Code	444
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

STN PN THD TIP .125X2.5IN 2PK

Facility

$1,110.00

Service Code	HCPCS C1713
Hospital Charge Code	270679751
Hospital Revenue Code	278
Min. Negotiated Rate	$166.50
Max. Negotiated Rate	$268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.62
Rate for Payer: Qualcare PPO/HMO/WC	$166.50

STN PN THD TIP .125X2.5IN 2PK

Facility

$1,110.00

Service Code	HCPCS C1713
Hospital Charge Code	270679751
Hospital Revenue Code	278
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$555.00
Rate for Payer: Aetna Commercial	$421.80
Rate for Payer: Aetna Medicare Advantage	$333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$283.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$283.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$283.05
Rate for Payer: Cigna Commercial	$555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.62
Rate for Payer: Qualcare PPO/HMO/WC	$166.50
Rate for Payer: UnitedHealthcare Community & State	$35.08
Rate for Payer: Wellpoint Medicaid Managed Care	$31.52

STNT BIL GORE V 10MM X 100MM

Facility

$4,043.00

Hospital Charge Code	270326007
Hospital Revenue Code	278
Min. Negotiated Rate	$114.82
Max. Negotiated Rate	$2,021.50
Rate for Payer: Aetna Commercial	$1,536.34
Rate for Payer: Aetna Medicare Advantage	$1,212.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,030.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,030.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,030.96
Rate for Payer: Cigna Commercial	$2,021.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.41
Rate for Payer: Qualcare PPO/HMO/WC	$606.45
Rate for Payer: UnitedHealthcare Community & State	$127.76
Rate for Payer: Wellpoint Medicaid Managed Care	$114.82

STNT BIL GORE V 10MM X 100MM

Facility

$4,043.00

Hospital Charge Code	270326007
Hospital Revenue Code	278
Min. Negotiated Rate	$606.45
Max. Negotiated Rate	$978.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.41
Rate for Payer: Qualcare PPO/HMO/WC	$606.45

STNT BIL GORE V 10MM X 40MM

Facility

$4,043.00

Hospital Charge Code	270326005
Hospital Revenue Code	278
Min. Negotiated Rate	$114.82
Max. Negotiated Rate	$2,021.50
Rate for Payer: Aetna Commercial	$1,536.34
Rate for Payer: Aetna Medicare Advantage	$1,212.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,030.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,030.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,030.96
Rate for Payer: Cigna Commercial	$2,021.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.41
Rate for Payer: Qualcare PPO/HMO/WC	$606.45
Rate for Payer: UnitedHealthcare Community & State	$127.76
Rate for Payer: Wellpoint Medicaid Managed Care	$114.82

STNT BIL GORE V 10MM X 40MM

Facility

$4,043.00

Hospital Charge Code	270326005
Hospital Revenue Code	278
Min. Negotiated Rate	$606.45
Max. Negotiated Rate	$978.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.41
Rate for Payer: Qualcare PPO/HMO/WC	$606.45

STNT HRCLK6.5X15X80 1011501-15

Facility

$5,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270646394C
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

STNT HRCLK6.5X15X80 1011501-15

Facility

$5,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270646394C
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STNT VIABHN 6X10X120 VBJ061002

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638C
Hospital Revenue Code	278
Min. Negotiated Rate	$547.27
Max. Negotiated Rate	$9,635.00
Rate for Payer: Aetna Commercial	$7,322.60
Rate for Payer: Aetna Medicare Advantage	$5,781.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,913.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,913.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,913.85
Rate for Payer: Cigna Commercial	$9,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,890.50
Rate for Payer: UnitedHealthcare Community & State	$608.93
Rate for Payer: Wellpoint Medicaid Managed Care	$547.27

STNT VIABHN 6X10X120 VBJ061002

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.50
Max. Negotiated Rate	$4,663.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,854.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,890.50

STNT VIABHN 6X5X120 VBJ060502

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648637N
Hospital Revenue Code	278
Min. Negotiated Rate	$417.76
Max. Negotiated Rate	$7,355.00
Rate for Payer: Aetna Commercial	$5,589.80
Rate for Payer: Aetna Medicare Advantage	$4,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,751.05
Rate for Payer: Cigna Commercial	$7,355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50
Rate for Payer: UnitedHealthcare Community & State	$464.84
Rate for Payer: Wellpoint Medicaid Managed Care	$417.76

STNT VIABHN 6X5X120 VBJ060502

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648637N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,206.50
Max. Negotiated Rate	$3,559.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50

STNT VIABHN 6X5X120 VBJ060502

Facility

$17,615.00

Service Code	HCPCS C1876
Hospital Charge Code	270648637C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$4,262.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

STNT VIABHN 6X5X120 VBJ060502

Facility

$17,615.00

Service Code	HCPCS C1876
Hospital Charge Code	270648637C
Hospital Revenue Code	278
Min. Negotiated Rate	$500.27
Max. Negotiated Rate	$8,807.50
Rate for Payer: Aetna Commercial	$6,693.70
Rate for Payer: Aetna Medicare Advantage	$5,284.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,491.82
Rate for Payer: Cigna Commercial	$8,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25
Rate for Payer: UnitedHealthcare Community & State	$556.63
Rate for Payer: Wellpoint Medicaid Managed Care	$500.27

STNT VIABHN 7X10X120 VBJ071002

Facility

$16,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270647585N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,452.50
Max. Negotiated Rate	$3,956.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,956.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50

STNT VIABHN 7X10X120 VBJ071002

Facility

$16,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270647585N
Hospital Revenue Code	278
Min. Negotiated Rate	$464.34
Max. Negotiated Rate	$8,175.00
Rate for Payer: Aetna Commercial	$6,213.00
Rate for Payer: Aetna Medicare Advantage	$4,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,169.25
Rate for Payer: Cigna Commercial	$8,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,956.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50
Rate for Payer: UnitedHealthcare Community & State	$516.66
Rate for Payer: Wellpoint Medicaid Managed Care	$464.34

STNT VIABHN 7X10X120 VBJ071002

Facility

$18,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270647585
Hospital Revenue Code	278
Min. Negotiated Rate	$521.14
Max. Negotiated Rate	$9,175.00
Rate for Payer: Aetna Commercial	$6,973.00
Rate for Payer: Aetna Medicare Advantage	$5,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,679.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,679.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,679.25
Rate for Payer: Cigna Commercial	$9,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,440.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.50
Rate for Payer: UnitedHealthcare Community & State	$579.86
Rate for Payer: Wellpoint Medicaid Managed Care	$521.14

STNT VIABHN 7X10X120 VBJ071002

Facility

$18,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270647585
Hospital Revenue Code	278
Min. Negotiated Rate	$2,752.50
Max. Negotiated Rate	$4,440.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,440.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.50

STNT VIA BHN 7X5X120 VBJ071502

Facility

$19,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648641C
Hospital Revenue Code	278
Min. Negotiated Rate	$566.58
Max. Negotiated Rate	$9,975.00
Rate for Payer: Aetna Commercial	$7,581.00
Rate for Payer: Aetna Medicare Advantage	$5,985.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,087.25
Rate for Payer: Cigna Commercial	$9,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,827.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,992.50
Rate for Payer: UnitedHealthcare Community & State	$630.42
Rate for Payer: Wellpoint Medicaid Managed Care	$566.58

STNT VIA BHN 7X5X120 VBJ071502

Facility

$19,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648641C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,992.50
Max. Negotiated Rate	$4,827.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,827.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,992.50

STOCK ANTI-EM KNEE LG L

Facility

$18.71

Hospital Charge Code	270302986
Hospital Revenue Code	270
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$9.36
Rate for Payer: Aetna Commercial	$7.11
Rate for Payer: Aetna Medicare Advantage	$5.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.77
Rate for Payer: Cigna Commercial	$9.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.86
Rate for Payer: Oxford Commercial	$3.74
Rate for Payer: Qualcare PPO/HMO/WC	$2.81
Rate for Payer: UnitedHealthcare Commercial	$3.74
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

Know your out-of-pocket cost for care.

All Charges