Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIB INSERT ANKLE TMPROLONGSZ5

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697191
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

TIB INSERT ANKLE TMPROLONGSZ5

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697191
Hospital Revenue Code	278
Min. Negotiated Rate	$326.60
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$363.40
Rate for Payer: Wellpoint Medicaid Managed Care	$326.60

TIB INS POST STAB SZ 2 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697208
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TIB INS POST STAB SZ 2 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697208
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

TIB/PER PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37232LT
Hospital Charge Code	321037232L
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37232LT
Hospital Charge Code	321037232L
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

TIB/PER PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37232LT
Hospital Charge Code	366837232L
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37232LT
Hospital Charge Code	366837232L
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

TIB/PER PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37232LT
Hospital Charge Code	2691450
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

TIB/PER PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37232LT
Hospital Charge Code	7411942
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

TIB/PER PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37232LT
Hospital Charge Code	7411942
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-LT

Facility

$15,877.00

Service Code	HCPCS 37232LT
Hospital Charge Code	2691450
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	366837232R
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	366837232R
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	321037232R
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	411037232R
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	411037232R
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	2691455
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$7,938.50
Rate for Payer: Aetna Commercial	$6,033.26
Rate for Payer: Aetna Medicare Advantage	$4,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,048.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,048.64
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	$4,048.64
Rate for Payer: Cigna Commercial	$7,938.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	2691455
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER PTA ADD EA-RT

Facility

$15,877.00

Service Code	HCPCS 37232RT
Hospital Charge Code	321037232R
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

TIB/PER REVASC W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3723050
Hospital Charge Code	7411809
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB/PER REVASC W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3723050
Hospital Charge Code	7411809
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	7411938
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	321037230L
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB/PER REVASC W/STENT-LT

Facility

$93,917.89

Service Code	HCPCS 37230LT
Hospital Charge Code	2691430
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

Know your out-of-pocket cost for care.

All Charges