Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TORQUE DEVICE RADIFOCUS

Facility

$253.25

Service Code	HCPCS C1760
Hospital Charge Code	270623569S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$126.62
Rate for Payer: Aetna Commercial	$96.23
Rate for Payer: Aetna Medicare Advantage	$75.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.58
Rate for Payer: Cigna Commercial	$126.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.29
Rate for Payer: Qualcare PPO/HMO/WC	$37.99
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

TORQUE GUIDE WIRE DEVICE

Facility

$22.50

Service Code	HCPCS C1769
Hospital Charge Code	270654971N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

TORQUE GUIDE WIRE DEVICE

Facility

$18.30

Service Code	HCPCS C1769
Hospital Charge Code	270654971S
Hospital Revenue Code	278
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$4.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.75

TORQUE GUIDE WIRE DEVICE

Facility

$22.50

Service Code	HCPCS C1769
Hospital Charge Code	270654971N
Hospital Revenue Code	278
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

TORQUE GUIDE WIRE DEVICE

Facility

$18.30

Service Code	HCPCS C1769
Hospital Charge Code	270654971S
Hospital Revenue Code	278
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.15
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: Aetna Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.67
Rate for Payer: Cigna Commercial	$9.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.75
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

TORQUE GUIDE WIRE DEVICE

Facility

$18.30

Service Code	HCPCS C1769
Hospital Charge Code	270654971
Hospital Revenue Code	278
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$4.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.75

TORQUE GUIDE WIRE DEVICE

Facility

$18.30

Service Code	HCPCS C1769
Hospital Charge Code	270654971
Hospital Revenue Code	278
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.15
Rate for Payer: Aetna Commercial	$6.95
Rate for Payer: Aetna Medicare Advantage	$5.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.67
Rate for Payer: Cigna Commercial	$9.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.75
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

TORQUE LIMITING ATTACH 1.5NM

Facility

$8,139.00

Hospital Charge Code	270671056
Hospital Revenue Code	272
Min. Negotiated Rate	$1,220.85
Max. Negotiated Rate	$1,220.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.85

TORQUE LIMITING ATTACH 1.5NM

Facility

$8,139.00

Hospital Charge Code	270671056
Hospital Revenue Code	272
Min. Negotiated Rate	$231.15
Max. Negotiated Rate	$4,069.50
Rate for Payer: Aetna Commercial	$3,092.82
Rate for Payer: Aetna Medicare Advantage	$2,441.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,075.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,075.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,075.45
Rate for Payer: Cigna Commercial	$4,069.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.14
Rate for Payer: Oxford Commercial	$1,627.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.85
Rate for Payer: UnitedHealthcare Commercial	$1,627.80
Rate for Payer: UnitedHealthcare Community & State	$257.19
Rate for Payer: Wellpoint Medicaid Managed Care	$231.15

TORQUE SHAFT

Facility

$4,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270685773
Hospital Revenue Code	278
Min. Negotiated Rate	$129.22
Max. Negotiated Rate	$2,275.00
Rate for Payer: Aetna Commercial	$1,729.00
Rate for Payer: Aetna Medicare Advantage	$1,365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,160.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,160.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,160.25
Rate for Payer: Cigna Commercial	$2,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,101.10
Rate for Payer: Qualcare PPO/HMO/WC	$682.50
Rate for Payer: UnitedHealthcare Community & State	$143.78
Rate for Payer: Wellpoint Medicaid Managed Care	$129.22

TORQUE SHAFT

Facility

$4,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270685773
Hospital Revenue Code	278
Min. Negotiated Rate	$682.50
Max. Negotiated Rate	$1,101.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,101.10
Rate for Payer: Qualcare PPO/HMO/WC	$682.50

TORSEMIDE 10 MG TAB

Facility

$4.69

Service Code	NDC 31722053001
Hospital Charge Code	60628726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

TORSEMIDE 10 MG TAB

Facility

$4.69

Service Code	NDC 31722053001
Hospital Charge Code	60628726
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare Advantage	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.22
Rate for Payer: Oxford Commercial	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$0.94
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TORSEMIDE 20 MG TAB

Facility

$24.72

Service Code	NDC 37352001
Hospital Charge Code	60628998
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna Commercial	$9.39
Rate for Payer: Aetna Medicare Advantage	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.30
Rate for Payer: Cigna Commercial	$12.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.43
Rate for Payer: Oxford Commercial	$4.94
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Commercial	$4.94
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

TORSEMIDE 20 MG TAB

Facility

$24.72

Service Code	NDC 37352001
Hospital Charge Code	60628998
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$3.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.71

TORSEMIDE 5 MG TAB

Facility

$4.22

Service Code	NDC 31722052901
Hospital Charge Code	60628728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

TORSEMIDE 5 MG TAB

Facility

$4.22

Service Code	NDC 31722052901
Hospital Charge Code	60628728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.11
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.10
Rate for Payer: Oxford Commercial	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.63
Rate for Payer: UnitedHealthcare Commercial	$0.84
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

TOTAL HIP ARTHOPLASTY

Facility

$76,260.00

Service Code	HCPCS 27132
Hospital Charge Code	1600000871
Hospital Revenue Code	360
Min. Negotiated Rate	$11,439.00
Max. Negotiated Rate	$11,439.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,439.00

TOTAL HIP ARTHOPLASTY

Facility

$76,260.00

Service Code	HCPCS 27132
Hospital Charge Code	1600000871
Hospital Revenue Code	360
Min. Negotiated Rate	$2,165.78
Max. Negotiated Rate	$55,329.13
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,329.13
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,827.60
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,439.00
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$2,409.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2,165.78

TOTAL HIP KIT

Facility

$568.00

Hospital Charge Code	270338756
Hospital Revenue Code	272
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$85.20
Rate for Payer: Qualcare PPO/HMO/WC	$85.20

TOTAL HIP KIT

Facility

$568.00

Hospital Charge Code	270338756
Hospital Revenue Code	272
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$215.84
Rate for Payer: Aetna Medicare Advantage	$170.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.84
Rate for Payer: Cigna Commercial	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.68
Rate for Payer: Oxford Commercial	$113.60
Rate for Payer: Qualcare PPO/HMO/WC	$85.20
Rate for Payer: UnitedHealthcare Commercial	$113.60
Rate for Payer: UnitedHealthcare Community & State	$17.95
Rate for Payer: Wellpoint Medicaid Managed Care	$16.13

TOTAL HIP REPLCEMNT(HOWMEDICA)

Facility

$16,768.00

Hospital Charge Code	270335460
Hospital Revenue Code	278
Min. Negotiated Rate	$476.21
Max. Negotiated Rate	$8,384.00
Rate for Payer: Aetna Commercial	$6,371.84
Rate for Payer: Aetna Medicare Advantage	$5,030.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,275.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,275.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,353.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,275.84
Rate for Payer: Cigna Commercial	$8,384.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,057.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,515.20
Rate for Payer: UnitedHealthcare Community & State	$529.87
Rate for Payer: Wellpoint Medicaid Managed Care	$476.21

TOTAL HIP REPLCEMNT(HOWMEDICA)

Facility

$16,768.00

Hospital Charge Code	270335460
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.20
Max. Negotiated Rate	$4,057.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,353.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,057.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,515.20

TOTAL HIP REPLCMNT(NO IMPT)

Facility

$75,763.70

Service Code	HCPCS 27130
Hospital Charge Code	16000339
Hospital Revenue Code	360
Min. Negotiated Rate	$2,151.69
Max. Negotiated Rate	$55,329.13
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,329.13
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,698.56
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,364.56
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$2,394.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2,151.69

TOTAL HIP REPLCMNT(NO IMPT)

Facility

$75,763.70

Service Code	HCPCS 27130
Hospital Charge Code	16000339
Hospital Revenue Code	360
Min. Negotiated Rate	$11,364.56
Max. Negotiated Rate	$11,364.56
Rate for Payer: Qualcare PPO/HMO/WC	$11,364.56

Know your out-of-pocket cost for care.

All Charges