Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIP PROGEL APPLICTR SPRAY 16CM

Facility

$1,800.00

Service Code	HCPCS C2615
Hospital Charge Code	270662137
Hospital Revenue Code	278
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Community & State	$56.88
Rate for Payer: Wellpoint Medicaid Managed Care	$51.12

TIP PROGEL APPLICTR SPRAY 16CM

Facility

$1,800.00

Service Code	HCPCS C2615
Hospital Charge Code	270662137
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$435.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

TIP PROGEL APPLICTR SPRAY 29CM

Facility

$1,800.00

Service Code	HCPCS C2615
Hospital Charge Code	270662138
Hospital Revenue Code	278
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Community & State	$56.88
Rate for Payer: Wellpoint Medicaid Managed Care	$51.12

TIP PROGEL APPLICTR SPRAY 29CM

Facility

$1,800.00

Service Code	HCPCS C2615
Hospital Charge Code	270662138
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$435.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

TIP PROTECTOR SMALL ENDO BOOT

Facility

$12.50

Hospital Charge Code	270669846
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

TIP PROTECTOR SMALL ENDO BOOT

Facility

$12.50

Hospital Charge Code	270669846
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$6.25
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare Advantage	$3.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.19
Rate for Payer: Cigna Commercial	$6.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.50
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

TIP PULSAVAC IM 9

Facility

$129.00

Hospital Charge Code	270600374
Hospital Revenue Code	272
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$64.50
Rate for Payer: Aetna Commercial	$49.02
Rate for Payer: Aetna Medicare Advantage	$38.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.90
Rate for Payer: Cigna Commercial	$64.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.54
Rate for Payer: Oxford Commercial	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.35
Rate for Payer: UnitedHealthcare Commercial	$25.80
Rate for Payer: UnitedHealthcare Community & State	$4.08
Rate for Payer: Wellpoint Medicaid Managed Care	$3.66

TIP PULSAVAC IM 9

Facility

$129.00

Hospital Charge Code	270600374
Hospital Revenue Code	272
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

TIP ROUND 30 DEG 6/BX

Facility

$225.00

Hospital Charge Code	270650891
Hospital Revenue Code	271
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

TIP ROUND 30 DEG 6/BX

Facility

$225.00

Hospital Charge Code	270650891
Hospital Revenue Code	271
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

TIP, RUBBER GREY NIPPLES SMAL

Facility

$43.00

Hospital Charge Code	270331539
Hospital Revenue Code	272
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.18
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

TIP, RUBBER GREY NIPPLES SMAL

Facility

$43.00

Hospital Charge Code	270331539
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

TIP SCISSORS CVD METZ DISP

Facility

$235.00

Hospital Charge Code	270662868
Hospital Revenue Code	270
Min. Negotiated Rate	$6.67
Max. Negotiated Rate	$117.50
Rate for Payer: Aetna Commercial	$89.30
Rate for Payer: Aetna Medicare Advantage	$70.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.92
Rate for Payer: Cigna Commercial	$117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.10
Rate for Payer: Oxford Commercial	$47.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.25
Rate for Payer: UnitedHealthcare Commercial	$47.00
Rate for Payer: UnitedHealthcare Community & State	$7.43
Rate for Payer: Wellpoint Medicaid Managed Care	$6.67

TIP SCISSORS CVD METZ DISP

Facility

$235.00

Hospital Charge Code	270662868
Hospital Revenue Code	270
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$35.25
Rate for Payer: Qualcare PPO/HMO/WC	$35.25

TIP SET OPEN SUCTION 11

Facility

$94.00

Hospital Charge Code	270331365
Hospital Revenue Code	272
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$47.00
Rate for Payer: Aetna Commercial	$35.72
Rate for Payer: Aetna Medicare Advantage	$28.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.97
Rate for Payer: Cigna Commercial	$47.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.44
Rate for Payer: Oxford Commercial	$18.80
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$18.80
Rate for Payer: UnitedHealthcare Community & State	$2.97
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

TIP SET OPEN SUCTION 11

Facility

$94.00

Hospital Charge Code	270331365
Hospital Revenue Code	272
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.10

TIP SHARP VAC NEXUS

Facility

$4,068.75

Hospital Charge Code	270696884
Hospital Revenue Code	272
Min. Negotiated Rate	$610.31
Max. Negotiated Rate	$610.31
Rate for Payer: Qualcare PPO/HMO/WC	$610.31

TIP SHARP VAC NEXUS

Facility

$4,068.75

Hospital Charge Code	270696884
Hospital Revenue Code	272
Min. Negotiated Rate	$115.55
Max. Negotiated Rate	$2,034.38
Rate for Payer: Aetna Commercial	$1,546.12
Rate for Payer: Aetna Medicare Advantage	$1,220.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,037.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,037.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,037.53
Rate for Payer: Cigna Commercial	$2,034.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,057.88
Rate for Payer: Oxford Commercial	$813.75
Rate for Payer: Qualcare PPO/HMO/WC	$610.31
Rate for Payer: UnitedHealthcare Commercial	$813.75
Rate for Payer: UnitedHealthcare Community & State	$128.57
Rate for Payer: Wellpoint Medicaid Managed Care	$115.55

TIP SUCTION INSTRUMENT FRAZIER

Facility

$8.57

Hospital Charge Code	270655501
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.71
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$1.71
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

TIP SUCTION INSTRUMENT FRAZIER

Facility

$8.57

Hospital Charge Code	270655501
Hospital Revenue Code	272
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

TIP SUCTION POOLE

Facility

$27.25

Hospital Charge Code	270061380
Hospital Revenue Code	272
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

TIP SUCTION POOLE

Facility

$27.25

Hospital Charge Code	270061380
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$13.62
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna Medicare Advantage	$8.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.95
Rate for Payer: Cigna Commercial	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.08
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$5.45
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

TIRBOLOX INTERVERT BODY FUSION

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704564
Hospital Revenue Code	278
Min. Negotiated Rate	$440.20
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$5,890.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00
Rate for Payer: UnitedHealthcare Community & State	$489.80
Rate for Payer: Wellpoint Medicaid Managed Care	$440.20

TIRBOLOX INTERVERT BODY FUSION

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704564
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

TI ROD 70MM PREBENT LORDOTI

Facility

$4,580.00

Hospital Charge Code	270660949
Hospital Revenue Code	278
Min. Negotiated Rate	$130.07
Max. Negotiated Rate	$2,290.00
Rate for Payer: Aetna Commercial	$1,740.40
Rate for Payer: Aetna Medicare Advantage	$1,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,167.90
Rate for Payer: Cigna Commercial	$2,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,108.36
Rate for Payer: Qualcare PPO/HMO/WC	$687.00
Rate for Payer: UnitedHealthcare Community & State	$144.73
Rate for Payer: Wellpoint Medicaid Managed Care	$130.07

Know your out-of-pocket cost for care.

All Charges