Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BASIC LIFE SUPP(BLS) NON ER

Facility

$1,200.00

Hospital Charge Code	26000512
Hospital Revenue Code	540
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$3,644.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.00
Rate for Payer: Oxford Commercial	$3,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Commercial	$3,644.00
Rate for Payer: UnitedHealthcare Community & State	$37.92
Rate for Payer: Wellpoint Medicaid Managed Care	$34.08

BASIC LIFE SUPP(BLS) NON ER

Facility

$1,200.00

Hospital Charge Code	26000512
Hospital Revenue Code	540
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

BASIC METABOLIC

Facility

$365.40

Service Code	HCPCS 80048
Hospital Charge Code	38472014
Hospital Revenue Code	301
Min. Negotiated Rate	$54.81
Max. Negotiated Rate	$54.81
Rate for Payer: Qualcare PPO/HMO/WC	$54.81

BASIC METABOLIC

Facility

$365.40

Service Code	HCPCS 80048
Hospital Charge Code	38472014
Hospital Revenue Code	301
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna Commercial	$23.01
Rate for Payer: Aetna Medicare Advantage	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.69
Rate for Payer: Cigna Commercial	$182.70
Rate for Payer: Cigna Medicare Advantage	$8.46
Rate for Payer: Clover Medicare Advantage	$8.04
Rate for Payer: EmblemHealth Commercial	$25.38
Rate for Payer: Humana Medicare Advantage	$8.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.81
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.46
Rate for Payer: Wellcare Medicare Advantage	$8.46
Rate for Payer: Wellpoint Medicaid Managed Care	$10.38

BASIC METABOLIC PROFILE

Facility

$697.90

Service Code	HCPCS 80048
Hospital Charge Code	3004877
Hospital Revenue Code	301
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$348.95
Rate for Payer: Aetna Commercial	$23.01
Rate for Payer: Aetna Medicare Advantage	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.69
Rate for Payer: Cigna Commercial	$348.95
Rate for Payer: Cigna Medicare Advantage	$8.46
Rate for Payer: Clover Medicare Advantage	$8.04
Rate for Payer: EmblemHealth Commercial	$25.38
Rate for Payer: Humana Medicare Advantage	$8.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.69
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.46
Rate for Payer: Wellcare Medicare Advantage	$8.46
Rate for Payer: Wellpoint Medicaid Managed Care	$19.82

BASIC METABOLIC PROFILE

Facility

$697.90

Service Code	HCPCS 80048
Hospital Charge Code	3004877
Hospital Revenue Code	301
Min. Negotiated Rate	$104.69
Max. Negotiated Rate	$104.69
Rate for Payer: Qualcare PPO/HMO/WC	$104.69

BASKET 2.4 SEGURA TIP 120 CM 1

Facility

$1,585.55

Hospital Charge Code	270684766
Hospital Revenue Code	272
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$237.83
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET 2.4 SEGURA TIP 120 CM 1

Facility

$1,585.55

Hospital Charge Code	270684766
Hospital Revenue Code	272
Min. Negotiated Rate	$45.03
Max. Negotiated Rate	$792.77
Rate for Payer: Aetna Commercial	$602.51
Rate for Payer: Aetna Medicare Advantage	$475.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.32
Rate for Payer: Cigna Commercial	$792.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.24
Rate for Payer: Oxford Commercial	$317.11
Rate for Payer: Qualcare PPO/HMO/WC	$237.83
Rate for Payer: UnitedHealthcare Commercial	$317.11
Rate for Payer: UnitedHealthcare Community & State	$50.10
Rate for Payer: Wellpoint Medicaid Managed Care	$45.03

Basket 3.0F x 120cm x 4

Facility

$1,585.55

Hospital Charge Code	270645386
Hospital Revenue Code	272
Min. Negotiated Rate	$45.03
Max. Negotiated Rate	$792.77
Rate for Payer: Aetna Commercial	$602.51
Rate for Payer: Aetna Medicare Advantage	$475.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.32
Rate for Payer: Cigna Commercial	$792.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.24
Rate for Payer: Oxford Commercial	$317.11
Rate for Payer: Qualcare PPO/HMO/WC	$237.83
Rate for Payer: UnitedHealthcare Commercial	$317.11
Rate for Payer: UnitedHealthcare Community & State	$50.10
Rate for Payer: Wellpoint Medicaid Managed Care	$45.03

Basket 3.0F x 120cm x 4

Facility

$1,585.55

Hospital Charge Code	270645386
Hospital Revenue Code	272
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$237.83
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET CAPTURA HELICAL 1.7FR

Facility

$883.05

Hospital Charge Code	270647886
Hospital Revenue Code	272
Min. Negotiated Rate	$25.08
Max. Negotiated Rate	$441.52
Rate for Payer: Aetna Commercial	$335.56
Rate for Payer: Aetna Medicare Advantage	$264.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.18
Rate for Payer: Cigna Commercial	$441.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.59
Rate for Payer: Oxford Commercial	$176.61
Rate for Payer: Qualcare PPO/HMO/WC	$132.46
Rate for Payer: UnitedHealthcare Commercial	$176.61
Rate for Payer: UnitedHealthcare Community & State	$27.90
Rate for Payer: Wellpoint Medicaid Managed Care	$25.08

BASKET CAPTURA HELICAL 1.7FR

Facility

$883.05

Hospital Charge Code	270647886
Hospital Revenue Code	272
Min. Negotiated Rate	$132.46
Max. Negotiated Rate	$132.46
Rate for Payer: Qualcare PPO/HMO/WC	$132.46

BASKET ENGAGE 2.8FRx115cm

Facility

$918.40

Hospital Charge Code	270650763
Hospital Revenue Code	272
Min. Negotiated Rate	$26.08
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna Commercial	$348.99
Rate for Payer: Aetna Medicare Advantage	$275.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.19
Rate for Payer: Cigna Commercial	$459.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.78
Rate for Payer: Oxford Commercial	$183.68
Rate for Payer: Qualcare PPO/HMO/WC	$137.76
Rate for Payer: UnitedHealthcare Commercial	$183.68
Rate for Payer: UnitedHealthcare Community & State	$29.02
Rate for Payer: Wellpoint Medicaid Managed Care	$26.08

BASKET ENGAGE 2.8FRx115cm

Facility

$918.40

Hospital Charge Code	270650763
Hospital Revenue Code	272
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$137.76
Rate for Payer: Qualcare PPO/HMO/WC	$137.76

BASKET GEMINI

Facility

$1,315.00

Hospital Charge Code	270651472
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$657.50
Rate for Payer: Aetna Commercial	$499.70
Rate for Payer: Aetna Medicare Advantage	$394.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$335.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$335.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$263.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$335.32
Rate for Payer: Cigna Commercial	$657.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.23
Rate for Payer: Qualcare PPO/HMO/WC	$197.25
Rate for Payer: UnitedHealthcare Community & State	$41.55
Rate for Payer: Wellpoint Medicaid Managed Care	$37.35

BASKET GEMINI

Facility

$1,315.00

Hospital Charge Code	270651472
Hospital Revenue Code	278
Min. Negotiated Rate	$197.25
Max. Negotiated Rate	$318.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$263.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.23
Rate for Payer: Qualcare PPO/HMO/WC	$197.25

BASKET GRASPIT GEMINI

Facility

$1,488.75

Hospital Charge Code	270651298
Hospital Revenue Code	270
Min. Negotiated Rate	$42.28
Max. Negotiated Rate	$744.38
Rate for Payer: Aetna Commercial	$565.73
Rate for Payer: Aetna Medicare Advantage	$446.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.63
Rate for Payer: Cigna Commercial	$744.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.07
Rate for Payer: Oxford Commercial	$297.75
Rate for Payer: Qualcare PPO/HMO/WC	$223.31
Rate for Payer: UnitedHealthcare Commercial	$297.75
Rate for Payer: UnitedHealthcare Community & State	$47.04
Rate for Payer: Wellpoint Medicaid Managed Care	$42.28

BASKET GRASPIT GEMINI

Facility

$1,488.75

Hospital Charge Code	270651298
Hospital Revenue Code	270
Min. Negotiated Rate	$223.31
Max. Negotiated Rate	$223.31
Rate for Payer: Qualcare PPO/HMO/WC	$223.31

BASKET LARGE 9040-08

Facility

$2,010.00

Hospital Charge Code	270638008
Hospital Revenue Code	278
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$1,005.00
Rate for Payer: Aetna Commercial	$763.80
Rate for Payer: Aetna Medicare Advantage	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$512.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$512.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$402.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$512.55
Rate for Payer: Cigna Commercial	$1,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.42
Rate for Payer: Qualcare PPO/HMO/WC	$301.50
Rate for Payer: UnitedHealthcare Community & State	$63.52
Rate for Payer: Wellpoint Medicaid Managed Care	$57.08

BASKET LARGE 9040-08

Facility

$2,010.00

Hospital Charge Code	270638008
Hospital Revenue Code	278
Min. Negotiated Rate	$301.50
Max. Negotiated Rate	$486.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$402.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.42
Rate for Payer: Qualcare PPO/HMO/WC	$301.50

BASKET RETRIEVAL FB 00711152

Facility

$525.00

Hospital Charge Code	270637475
Hospital Revenue Code	272
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.50
Rate for Payer: Oxford Commercial	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Commercial	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

BASKET RETRIEVAL FB 00711152

Facility

$525.00

Hospital Charge Code	270637475
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

BASKET RETRIEVAL ZERO 1.9FX90

Facility

$1,878.95

Hospital Charge Code	270698287
Hospital Revenue Code	272
Min. Negotiated Rate	$53.36
Max. Negotiated Rate	$939.48
Rate for Payer: Aetna Commercial	$714.00
Rate for Payer: Aetna Medicare Advantage	$563.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.13
Rate for Payer: Cigna Commercial	$939.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$488.53
Rate for Payer: Oxford Commercial	$375.79
Rate for Payer: Qualcare PPO/HMO/WC	$281.84
Rate for Payer: UnitedHealthcare Commercial	$375.79
Rate for Payer: UnitedHealthcare Community & State	$59.37
Rate for Payer: Wellpoint Medicaid Managed Care	$53.36

BASKET RETRIEVAL ZERO 1.9FX90

Facility

$1,878.95

Hospital Charge Code	270698287
Hospital Revenue Code	272
Min. Negotiated Rate	$281.84
Max. Negotiated Rate	$281.84
Rate for Payer: Qualcare PPO/HMO/WC	$281.84

BASKET ROTATABLE RETRIEVAL

Facility

$575.00

Hospital Charge Code	270664340
Hospital Revenue Code	270
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

Know your out-of-pocket cost for care.

All Charges