Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TLIF PEEK CORENT 8X9X30MM 8 DE

Facility

$33,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270682867
Hospital Revenue Code	278
Min. Negotiated Rate	$5,079.00
Max. Negotiated Rate	$8,194.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,194.12
Rate for Payer: Qualcare PPO/HMO/WC	$5,079.00

TLIF PEEK CORENT 8X9X30MM 8 DE

Facility

$33,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270682867
Hospital Revenue Code	278
Min. Negotiated Rate	$961.62
Max. Negotiated Rate	$16,930.00
Rate for Payer: Aetna Commercial	$12,866.80
Rate for Payer: Aetna Medicare Advantage	$10,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,634.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,634.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,634.30
Rate for Payer: Cigna Commercial	$16,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,194.12
Rate for Payer: Qualcare PPO/HMO/WC	$5,079.00
Rate for Payer: UnitedHealthcare Community & State	$1,069.98
Rate for Payer: Wellpoint Medicaid Managed Care	$961.62

T.L.S. DRAIN

Facility

$186.00

Hospital Charge Code	270331695
Hospital Revenue Code	278
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$70.68
Rate for Payer: Aetna Medicare Advantage	$55.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.43
Rate for Payer: Cigna Commercial	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: Qualcare PPO/HMO/WC	$27.90
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.28

T.L.S. DRAIN

Facility

$186.00

Hospital Charge Code	270331695
Hospital Revenue Code	278
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$45.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.01
Rate for Payer: Qualcare PPO/HMO/WC	$27.90

TLSO

Facility

$2,250.00

Service Code	HCPCS L0462
Hospital Charge Code	270621976
Hospital Revenue Code	274
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

TLSO

Facility

$2,250.00

Service Code	HCPCS L0462
Hospital Charge Code	270621976
Hospital Revenue Code	274
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

TLSO BRACE MOLDED

Facility

$9,056.15

Service Code	HCPCS L0460
Hospital Charge Code	270627303
Hospital Revenue Code	274
Min. Negotiated Rate	$257.19
Max. Negotiated Rate	$4,528.07
Rate for Payer: Aetna Commercial	$3,441.34
Rate for Payer: Aetna Medicare Advantage	$2,716.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,309.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,309.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,811.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,309.32
Rate for Payer: Cigna Commercial	$4,528.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,191.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.42
Rate for Payer: UnitedHealthcare Community & State	$286.17
Rate for Payer: Wellpoint Medicaid Managed Care	$257.19

TLSO BRACE MOLDED

Facility

$9,056.15

Service Code	HCPCS L0460
Hospital Charge Code	270627303
Hospital Revenue Code	274
Min. Negotiated Rate	$1,358.42
Max. Negotiated Rate	$2,191.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,811.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,191.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,358.42

T LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$299.00

Service Code	HCPCS 88182
Hospital Charge Code	38473054
Hospital Revenue Code	311
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$224.58
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.58
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

T LYMPHOCYTE HELPER/SUPPRESSOR

Facility

$299.00

Service Code	HCPCS 88182
Hospital Charge Code	38473054
Hospital Revenue Code	311
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

TMJ-BILAT

Facility

$5,100.00

Service Code	HCPCS 70330
Hospital Charge Code	94061017
Hospital Revenue Code	320
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

TMJ-BILAT

Facility

$5,100.00

Service Code	HCPCS 70330
Hospital Charge Code	94061017
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

TM MODULAR CUP 60MM MULTHOLE R

Facility

$8,660.65

Hospital Charge Code	270663137
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$2,095.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

TM MODULAR CUP 60MM MULTHOLE R

Facility

$8,660.65

Hospital Charge Code	270663137
Hospital Revenue Code	278
Min. Negotiated Rate	$245.96
Max. Negotiated Rate	$4,330.32
Rate for Payer: Aetna Commercial	$3,291.05
Rate for Payer: Aetna Medicare Advantage	$2,598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.47
Rate for Payer: Cigna Commercial	$4,330.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10
Rate for Payer: UnitedHealthcare Community & State	$273.68
Rate for Payer: Wellpoint Medicaid Managed Care	$245.96

TM PRIMARY STEM, 13MM STAND

Facility

$21,430.00

Hospital Charge Code	270666710
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.50
Max. Negotiated Rate	$5,186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50

TM PRIMARY STEM, 13MM STAND

Facility

$21,430.00

Hospital Charge Code	270666710
Hospital Revenue Code	278
Min. Negotiated Rate	$608.61
Max. Negotiated Rate	$10,715.00
Rate for Payer: Aetna Commercial	$8,143.40
Rate for Payer: Aetna Medicare Advantage	$6,429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,464.65
Rate for Payer: Cigna Commercial	$10,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50
Rate for Payer: UnitedHealthcare Community & State	$677.19
Rate for Payer: Wellpoint Medicaid Managed Care	$608.61

TMPT GENOTYPE

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900028
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

TMPT GENOTYPE

Facility

$2,375.00

Service Code	HCPCS 81401
Hospital Charge Code	39900028
Hospital Revenue Code	310
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$372.64
Rate for Payer: Aetna Medicare Advantage	$443.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$496.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$496.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$496.97
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$137.00
Rate for Payer: Clover Medicare Advantage	$130.15
Rate for Payer: EmblemHealth Commercial	$411.00
Rate for Payer: Humana Medicare Advantage	$141.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$109.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.00
Rate for Payer: Wellcare Medicare Advantage	$137.00
Rate for Payer: Wellpoint Medicaid Managed Care	$67.45

TNDN SHEATH INCSN,RDL STYLOID

Facility

$19,467.90

Service Code	HCPCS 25000
Hospital Charge Code	16000393
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

TNDN SHEATH INCSN,RDL STYLOID

Facility

$19,467.90

Service Code	HCPCS 25000
Hospital Charge Code	16000393
Hospital Revenue Code	360
Min. Negotiated Rate	$552.89
Max. Negotiated Rate	$8,192.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,061.65
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$615.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$552.89

TNFA SCREW 75MM

Facility

$5,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270699727
Hospital Revenue Code	278
Min. Negotiated Rate	$166.28
Max. Negotiated Rate	$2,927.50
Rate for Payer: Aetna Commercial	$2,224.90
Rate for Payer: Aetna Medicare Advantage	$1,756.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,493.03
Rate for Payer: Cigna Commercial	$2,927.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.91
Rate for Payer: Qualcare PPO/HMO/WC	$878.25
Rate for Payer: UnitedHealthcare Community & State	$185.02
Rate for Payer: Wellpoint Medicaid Managed Care	$166.28

TNFA SCREW 75MM

Facility

$5,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270699727
Hospital Revenue Code	278
Min. Negotiated Rate	$878.25
Max. Negotiated Rate	$1,416.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.91
Rate for Payer: Qualcare PPO/HMO/WC	$878.25

TOBACCO USE CESSATION >10MIN

Facility

$178.05

Service Code	HCPCS 99407
Hospital Charge Code	451199407
Hospital Revenue Code	942
Min. Negotiated Rate	$26.71
Max. Negotiated Rate	$26.71
Rate for Payer: Qualcare PPO/HMO/WC	$26.71

TOBACCO USE CESSATION >10MIN

Facility

$178.05

Service Code	HCPCS 99407
Hospital Charge Code	451199407
Hospital Revenue Code	942
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$1,203.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.46
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.29
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.71
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$5.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

TOBACCO USE CESSATION 3-10MIN

Facility

$178.05

Service Code	HCPCS 99406
Hospital Charge Code	451199406
Hospital Revenue Code	942
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$1,203.00
Rate for Payer: Aetna Commercial	$121.07
Rate for Payer: Aetna Medicare Advantage	$144.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.46
Rate for Payer: Cigna Commercial	$89.22
Rate for Payer: Cigna Medicare Advantage	$44.51
Rate for Payer: Clover Medicare Advantage	$42.28
Rate for Payer: EmblemHealth Commercial	$133.53
Rate for Payer: Humana Medicare Advantage	$45.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.29
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.71
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$5.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.51
Rate for Payer: Wellcare Medicare Advantage	$44.51
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

Know your out-of-pocket cost for care.

All Charges