Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

THROMBECTOMY SET SOLENT OMNI U

Facility

$9,600.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,440.00
Max. Negotiated Rate	$2,323.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,920.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,323.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,440.00

THROMBECTOMY SET SOLENT OMNI U

Facility

$8,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270648590S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,267.50
Max. Negotiated Rate	$2,044.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,044.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,267.50

THROMBECTOMY SET SOLENT PROXI

Facility

$9,100.00

Service Code	HCPCS C1757
Hospital Charge Code	270657885
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.00
Max. Negotiated Rate	$2,202.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,202.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00

THROMBECTOMY SET SOLENT PROXI

Facility

$9,100.00

Service Code	HCPCS C1757
Hospital Charge Code	270657885
Hospital Revenue Code	278
Min. Negotiated Rate	$258.44
Max. Negotiated Rate	$4,550.00
Rate for Payer: Aetna Commercial	$3,458.00
Rate for Payer: Aetna Medicare Advantage	$2,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,320.50
Rate for Payer: Cigna Commercial	$4,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,202.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,365.00
Rate for Payer: UnitedHealthcare Community & State	$287.56
Rate for Payer: Wellpoint Medicaid Managed Care	$258.44

THROMBECTOMY SET SPIROFLEX

Facility

$2,070.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707N
Hospital Revenue Code	278
Min. Negotiated Rate	$58.79
Max. Negotiated Rate	$1,035.00
Rate for Payer: Aetna Commercial	$786.60
Rate for Payer: Aetna Medicare Advantage	$621.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$527.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$527.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$414.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$527.85
Rate for Payer: Cigna Commercial	$1,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$500.94
Rate for Payer: Qualcare PPO/HMO/WC	$310.50
Rate for Payer: UnitedHealthcare Community & State	$65.41
Rate for Payer: Wellpoint Medicaid Managed Care	$58.79

THROMBECTOMY SET SPIROFLEX

Facility

$2,070.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707N
Hospital Revenue Code	278
Min. Negotiated Rate	$310.50
Max. Negotiated Rate	$500.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$414.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$500.94
Rate for Payer: Qualcare PPO/HMO/WC	$310.50

THROMBECTOMY SET SPIROFLEX

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

THROMBECTOMY SET SPIROFLEX

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707S
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

THROMBECTOMY SET SPIROFLEX UL

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

THROMBECTOMY SET SPIROFLEX UL

Facility

$10,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270645707
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

THROMBIN (BOVINE) 5000 U VIAL

Facility

$577.00

Service Code	NDC 60793021505
Hospital Charge Code	606390276
Hospital Revenue Code	250
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$288.50
Rate for Payer: Aetna Commercial	$219.26
Rate for Payer: Aetna Medicare Advantage	$173.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.13
Rate for Payer: Cigna Commercial	$288.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.02
Rate for Payer: Oxford Commercial	$115.40
Rate for Payer: Qualcare PPO/HMO/WC	$86.55
Rate for Payer: UnitedHealthcare Commercial	$115.40
Rate for Payer: UnitedHealthcare Community & State	$18.23
Rate for Payer: Wellpoint Medicaid Managed Care	$16.39

THROMBIN (BOVINE) 5000 U VIAL

Facility

$577.00

Service Code	NDC 60793021505
Hospital Charge Code	606390276
Hospital Revenue Code	250
Min. Negotiated Rate	$86.55
Max. Negotiated Rate	$86.55
Rate for Payer: Qualcare PPO/HMO/WC	$86.55

THROMBIN CLOTTING TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900183
Hospital Revenue Code	305
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.93
Rate for Payer: Cigna Commercial	$19.82
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.31
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

THROMBIN CLOTTING TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900183
Hospital Revenue Code	305
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.95

THROMBIN JMI 5K SPRAY KIT

Facility

$588.60

Service Code	NDC 60793070505
Hospital Charge Code	60630116
Hospital Revenue Code	250
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$294.30
Rate for Payer: Aetna Commercial	$223.67
Rate for Payer: Aetna Medicare Advantage	$176.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.09
Rate for Payer: Cigna Commercial	$294.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.04
Rate for Payer: Oxford Commercial	$117.72
Rate for Payer: Qualcare PPO/HMO/WC	$88.29
Rate for Payer: UnitedHealthcare Commercial	$117.72
Rate for Payer: UnitedHealthcare Community & State	$18.60
Rate for Payer: Wellpoint Medicaid Managed Care	$16.72

THROMBIN JMI 5K SPRAY KIT

Facility

$588.60

Service Code	NDC 60793070505
Hospital Charge Code	60630116
Hospital Revenue Code	250
Min. Negotiated Rate	$88.29
Max. Negotiated Rate	$88.29
Rate for Payer: Qualcare PPO/HMO/WC	$88.29

THROMBIN RECOMB TPICAL 20000IU

Facility

$2,765.76

Service Code	NDC 43825070741
Hospital Charge Code	606390452
Hospital Revenue Code	250
Min. Negotiated Rate	$414.86
Max. Negotiated Rate	$414.86
Rate for Payer: Qualcare PPO/HMO/WC	$414.86

THROMBIN RECOMB TPICAL 20000IU

Facility

$2,765.76

Service Code	NDC 43825070741
Hospital Charge Code	606390452
Hospital Revenue Code	250
Min. Negotiated Rate	$78.55
Max. Negotiated Rate	$1,382.88
Rate for Payer: Aetna Commercial	$1,050.99
Rate for Payer: Aetna Medicare Advantage	$829.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$705.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$705.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$705.27
Rate for Payer: Cigna Commercial	$1,382.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.10
Rate for Payer: Oxford Commercial	$553.15
Rate for Payer: Qualcare PPO/HMO/WC	$414.86
Rate for Payer: UnitedHealthcare Commercial	$553.15
Rate for Payer: UnitedHealthcare Community & State	$87.40
Rate for Payer: Wellpoint Medicaid Managed Care	$78.55

THROMBIN TIME

Facility

$95.00

Service Code	HCPCS 85670
Hospital Charge Code	38478017
Hospital Revenue Code	305
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

THROMBIN TIME

Facility

$95.00

Service Code	HCPCS 85670
Hospital Charge Code	38478017
Hospital Revenue Code	305
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.93
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

THROMBIN TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900184
Hospital Revenue Code	305
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.95

THROMBIN TIME

Facility

$39.65

Service Code	HCPCS 85670
Hospital Charge Code	39900184
Hospital Revenue Code	305
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.93
Rate for Payer: Cigna Commercial	$19.82
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.31
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

THROMBIN TOPICAL KIT 20,000U

Facility

$2,275.66

Service Code	NDC 60793021720
Hospital Charge Code	60629270
Hospital Revenue Code	250
Min. Negotiated Rate	$64.63
Max. Negotiated Rate	$1,137.83
Rate for Payer: Aetna Commercial	$864.75
Rate for Payer: Aetna Medicare Advantage	$682.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$580.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$580.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$580.29
Rate for Payer: Cigna Commercial	$1,137.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.67
Rate for Payer: Oxford Commercial	$455.13
Rate for Payer: Qualcare PPO/HMO/WC	$341.35
Rate for Payer: UnitedHealthcare Commercial	$455.13
Rate for Payer: UnitedHealthcare Community & State	$71.91
Rate for Payer: Wellpoint Medicaid Managed Care	$64.63

THROMBIN TOPICAL KIT 20,000U

Facility

$2,275.66

Service Code	NDC 60793021720
Hospital Charge Code	60629270
Hospital Revenue Code	250
Min. Negotiated Rate	$341.35
Max. Negotiated Rate	$341.35
Rate for Payer: Qualcare PPO/HMO/WC	$341.35

THROMBO CATH REMOVAL

Facility

$5,762.95

Service Code	HCPCS 37214
Hospital Charge Code	366837214
Hospital Revenue Code	361
Min. Negotiated Rate	$163.67
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	$1,498.37
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$864.44
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$182.11
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	$163.67

Know your out-of-pocket cost for care.

All Charges