Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BASKET ROTATABLE RETRIEVAL

Facility

$575.00

Hospital Charge Code	270664340
Hospital Revenue Code	270
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.50
Rate for Payer: Oxford Commercial	$115.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Commercial	$115.00
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

BASKET RX LITHOTRIPTER 2.5c

Facility

$1,371.55

Service Code	HCPCS C1727
Hospital Charge Code	270627946
Hospital Revenue Code	278
Min. Negotiated Rate	$205.73
Max. Negotiated Rate	$331.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$274.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.92
Rate for Payer: Qualcare PPO/HMO/WC	$205.73

BASKET RX LITHOTRIPTER 2.5c

Facility

$1,371.55

Service Code	HCPCS C1727
Hospital Charge Code	270627946
Hospital Revenue Code	278
Min. Negotiated Rate	$38.95
Max. Negotiated Rate	$685.77
Rate for Payer: Aetna Commercial	$521.19
Rate for Payer: Aetna Medicare Advantage	$411.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$274.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.75
Rate for Payer: Cigna Commercial	$685.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.92
Rate for Payer: Qualcare PPO/HMO/WC	$205.73
Rate for Payer: UnitedHealthcare Community & State	$43.34
Rate for Payer: Wellpoint Medicaid Managed Care	$38.95

BASKET RX LITHOTRIPTER 3.0c

Facility

$1,391.00

Service Code	HCPCS C1727
Hospital Charge Code	270642025
Hospital Revenue Code	278
Min. Negotiated Rate	$208.65
Max. Negotiated Rate	$336.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: Qualcare PPO/HMO/WC	$208.65

BASKET RX LITHOTRIPTER 3.0c

Facility

$1,391.00

Service Code	HCPCS C1727
Hospital Charge Code	270642025
Hospital Revenue Code	278
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$695.50
Rate for Payer: Aetna Commercial	$528.58
Rate for Payer: Aetna Medicare Advantage	$417.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.70
Rate for Payer: Cigna Commercial	$695.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.62
Rate for Payer: Qualcare PPO/HMO/WC	$208.65
Rate for Payer: UnitedHealthcare Community & State	$43.96
Rate for Payer: Wellpoint Medicaid Managed Care	$39.50

BASKET SEGURA 2.4F .80MMX90CM

Facility

$1,585.55

Service Code	HCPCS C1773
Hospital Charge Code	270697142
Hospital Revenue Code	278
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) NJ Health	$317.11
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	$383.70
Rate for Payer: Qualcare PPO/HMO/WC	$237.83
Rate for Payer: UnitedHealthcare Community & State	$50.10
Rate for Payer: Wellpoint Medicaid Managed Care	$45.03

BASKET SEGURA 2.4F .80MMX90CM

Facility

$1,585.55

Service Code	HCPCS C1773
Hospital Charge Code	270697142
Hospital Revenue Code	278
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$383.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$317.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$383.70
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET SEGURA MINI 2.4F 310105

Facility

$1,585.55

Hospital Charge Code	270612432
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 SEGURA MINI 2.4F 310105

Facility

$1,585.55

Hospital Charge Code	270612432
Hospital Revenue Code	272
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$237.83
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET STONE 3FR 60CM

Facility

$918.40

Hospital Charge Code	270658596
Hospital Revenue Code	272
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$137.76
Rate for Payer: Qualcare PPO/HMO/WC	$137.76

BASKET STONE 3FR 60CM

Facility

$918.40

Hospital Charge Code	270658596
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 STONE RETRIEVAL 7FR

Facility

$1,072.50

Hospital Charge Code	270655481
Hospital Revenue Code	272
Min. Negotiated Rate	$160.88
Max. Negotiated Rate	$160.88
Rate for Payer: Qualcare PPO/HMO/WC	$160.88

BASKET STONE RETRIEVAL 7FR

Facility

$1,072.50

Hospital Charge Code	270655481
Hospital Revenue Code	272
Min. Negotiated Rate	$30.46
Max. Negotiated Rate	$536.25
Rate for Payer: Aetna Commercial	$407.55
Rate for Payer: Aetna Medicare Advantage	$321.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.49
Rate for Payer: Cigna Commercial	$536.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.85
Rate for Payer: Oxford Commercial	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.88
Rate for Payer: UnitedHealthcare Commercial	$214.50
Rate for Payer: UnitedHealthcare Community & State	$33.89
Rate for Payer: Wellpoint Medicaid Managed Care	$30.46

BASKET TIPLESS 115CM 3 WIRE

Facility

$1,093.50

Hospital Charge Code	270690428
Hospital Revenue Code	272
Min. Negotiated Rate	$31.06
Max. Negotiated Rate	$546.75
Rate for Payer: Aetna Commercial	$415.53
Rate for Payer: Aetna Medicare Advantage	$328.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.84
Rate for Payer: Cigna Commercial	$546.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.31
Rate for Payer: Oxford Commercial	$218.70
Rate for Payer: Qualcare PPO/HMO/WC	$164.03
Rate for Payer: UnitedHealthcare Commercial	$218.70
Rate for Payer: UnitedHealthcare Community & State	$34.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.06

BASKET TIPLESS 115CM 3 WIRE

Facility

$1,093.50

Hospital Charge Code	270690428
Hospital Revenue Code	272
Min. Negotiated Rate	$164.03
Max. Negotiated Rate	$164.03
Rate for Payer: Qualcare PPO/HMO/WC	$164.03

BASKETTRAPEZOID 1.5cmx.035

Facility

$1,353.40

Hospital Charge Code	270672229
Hospital Revenue Code	272
Min. Negotiated Rate	$203.01
Max. Negotiated Rate	$203.01
Rate for Payer: Qualcare PPO/HMO/WC	$203.01

BASKETTRAPEZOID 1.5cmx.035

Facility

$1,353.40

Hospital Charge Code	270672229
Hospital Revenue Code	272
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$676.70
Rate for Payer: Aetna Commercial	$514.29
Rate for Payer: Aetna Medicare Advantage	$406.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.12
Rate for Payer: Cigna Commercial	$676.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.88
Rate for Payer: Oxford Commercial	$270.68
Rate for Payer: Qualcare PPO/HMO/WC	$203.01
Rate for Payer: UnitedHealthcare Commercial	$270.68
Rate for Payer: UnitedHealthcare Community & State	$42.77
Rate for Payer: Wellpoint Medicaid Managed Care	$38.44

BASKET TRAPEZOID 2.0cmx.035

Facility

$1,353.40

Hospital Charge Code	270627940
Hospital Revenue Code	272
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$676.70
Rate for Payer: Aetna Commercial	$514.29
Rate for Payer: Aetna Medicare Advantage	$406.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.12
Rate for Payer: Cigna Commercial	$676.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.88
Rate for Payer: Oxford Commercial	$270.68
Rate for Payer: Qualcare PPO/HMO/WC	$203.01
Rate for Payer: UnitedHealthcare Commercial	$270.68
Rate for Payer: UnitedHealthcare Community & State	$42.77
Rate for Payer: Wellpoint Medicaid Managed Care	$38.44

BASKET TRAPEZOID 2.0cmx.035

Facility

$1,353.40

Hospital Charge Code	270627940
Hospital Revenue Code	272
Min. Negotiated Rate	$203.01
Max. Negotiated Rate	$203.01
Rate for Payer: Qualcare PPO/HMO/WC	$203.01

BASKET ZERO TIP 3.0FX120CM

Facility

$1,878.95

Hospital Charge Code	270698291
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 ZERO TIP 3.0FX120CM

Facility

$1,878.95

Hospital Charge Code	270698291
Hospital Revenue Code	272
Min. Negotiated Rate	$281.84
Max. Negotiated Rate	$281.84
Rate for Payer: Qualcare PPO/HMO/WC	$281.84

BASKET ZERO TIP 3.0X90CM

Facility

$1,875.00

Hospital Charge Code	270698290
Hospital Revenue Code	272
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

BASKET ZERO TIP 3.0X90CM

Facility

$1,875.00

Hospital Charge Code	270698290
Hospital Revenue Code	272
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Commercial	$375.00
Rate for Payer: UnitedHealthcare Community & State	$59.25
Rate for Payer: Wellpoint Medicaid Managed Care	$53.25

BASKET ZEROTIP AIRWAY RET 12MM

Facility

$1,305.15

Hospital Charge Code	270676470
Hospital Revenue Code	272
Min. Negotiated Rate	$195.77
Max. Negotiated Rate	$195.77
Rate for Payer: Qualcare PPO/HMO/WC	$195.77

BASKET ZEROTIP AIRWAY RET 12MM

Facility

$1,305.15

Hospital Charge Code	270676470
Hospital Revenue Code	272
Min. Negotiated Rate	$37.07
Max. Negotiated Rate	$652.58
Rate for Payer: Aetna Commercial	$495.96
Rate for Payer: Aetna Medicare Advantage	$391.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.81
Rate for Payer: Cigna Commercial	$652.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.34
Rate for Payer: Oxford Commercial	$261.03
Rate for Payer: Qualcare PPO/HMO/WC	$195.77
Rate for Payer: UnitedHealthcare Commercial	$261.03
Rate for Payer: UnitedHealthcare Community & State	$41.24
Rate for Payer: Wellpoint Medicaid Managed Care	$37.07

Know your out-of-pocket cost for care.

All Charges