Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TRAY FOLEY PEDIATRIN URI 8FR

Facility

$106.90

Hospital Charge Code	270669764
Hospital Revenue Code	272
Min. Negotiated Rate	$16.04
Max. Negotiated Rate	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$16.04

TRAY FOLEY TEMP SILVER IC 1

Facility

$128.50

Hospital Charge Code	270654036
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$64.25
Rate for Payer: Aetna Commercial	$48.83
Rate for Payer: Aetna Medicare Advantage	$38.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.77
Rate for Payer: Cigna Commercial	$64.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.41
Rate for Payer: Oxford Commercial	$25.70
Rate for Payer: Qualcare PPO/HMO/WC	$19.27
Rate for Payer: UnitedHealthcare Commercial	$25.70
Rate for Payer: UnitedHealthcare Community & State	$4.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.65

TRAY FOLEY TEMP SILVER IC 1

Facility

$128.50

Hospital Charge Code	270654036
Hospital Revenue Code	272
Min. Negotiated Rate	$19.27
Max. Negotiated Rate	$19.27
Rate for Payer: Qualcare PPO/HMO/WC	$19.27

TRAY FOLEY W/16FR CATH

Facility

$107.14

Hospital Charge Code	270302238
Hospital Revenue Code	272
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$16.07
Rate for Payer: Qualcare PPO/HMO/WC	$16.07

TRAY FOLEY W/16FR CATH

Facility

$107.14

Hospital Charge Code	270302238
Hospital Revenue Code	272
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$53.57
Rate for Payer: Aetna Commercial	$40.71
Rate for Payer: Aetna Medicare Advantage	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.32
Rate for Payer: Cigna Commercial	$53.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.86
Rate for Payer: Oxford Commercial	$21.43
Rate for Payer: Qualcare PPO/HMO/WC	$16.07
Rate for Payer: UnitedHealthcare Commercial	$21.43
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

TRAY FOLEY W/18FR CATH

Facility

$107.14

Hospital Charge Code	270302239
Hospital Revenue Code	272
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$53.57
Rate for Payer: Aetna Commercial	$40.71
Rate for Payer: Aetna Medicare Advantage	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.32
Rate for Payer: Cigna Commercial	$53.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.86
Rate for Payer: Oxford Commercial	$21.43
Rate for Payer: Qualcare PPO/HMO/WC	$16.07
Rate for Payer: UnitedHealthcare Commercial	$21.43
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

TRAY FOLEY W/18FR CATH

Facility

$107.14

Hospital Charge Code	270302239
Hospital Revenue Code	272
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$16.07
Rate for Payer: Qualcare PPO/HMO/WC	$16.07

TRAY FOLEY W/18FR CATHETER

Facility

$174.00

Hospital Charge Code	270331128
Hospital Revenue Code	272
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.24
Rate for Payer: Oxford Commercial	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$34.80
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.94

TRAY FOLEY W/18FR CATHETER

Facility

$174.00

Hospital Charge Code	270331128
Hospital Revenue Code	272
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

TRAY FOLEY W/URINE METER 16FR

Facility

$84.57

Hospital Charge Code	270639722
Hospital Revenue Code	272
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$42.28
Rate for Payer: Aetna Commercial	$32.14
Rate for Payer: Aetna Medicare Advantage	$25.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.57
Rate for Payer: Cigna Commercial	$42.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.99
Rate for Payer: Oxford Commercial	$16.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.69
Rate for Payer: UnitedHealthcare Commercial	$16.91
Rate for Payer: UnitedHealthcare Community & State	$2.67
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

TRAY FOLEY W/URINE METER 16FR

Facility

$84.57

Hospital Charge Code	270639722
Hospital Revenue Code	272
Min. Negotiated Rate	$12.69
Max. Negotiated Rate	$12.69
Rate for Payer: Qualcare PPO/HMO/WC	$12.69

TRAY GENERAL LAPAROSCOPY

Facility

$559.65

Hospital Charge Code	270654112
Hospital Revenue Code	272
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$279.82
Rate for Payer: Aetna Commercial	$212.67
Rate for Payer: Aetna Medicare Advantage	$167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.71
Rate for Payer: Cigna Commercial	$279.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.51
Rate for Payer: Oxford Commercial	$111.93
Rate for Payer: Qualcare PPO/HMO/WC	$83.95
Rate for Payer: UnitedHealthcare Commercial	$111.93
Rate for Payer: UnitedHealthcare Community & State	$17.68
Rate for Payer: Wellpoint Medicaid Managed Care	$15.89

TRAY GENERAL LAPAROSCOPY

Facility

$559.65

Hospital Charge Code	270654112
Hospital Revenue Code	272
Min. Negotiated Rate	$83.95
Max. Negotiated Rate	$83.95
Rate for Payer: Qualcare PPO/HMO/WC	$83.95

TRAY GMK TIBIAL CEMENTED L S5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270678754
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY GMK TIBIAL CEMENTED L S5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270678754
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681148
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681148
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672222
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TRAY GMK TIBIAL CEMENTED R S2

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672222
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TRAY GYN LAPAROSCOPY

Facility

$328.15

Hospital Charge Code	270654113
Hospital Revenue Code	272
Min. Negotiated Rate	$9.32
Max. Negotiated Rate	$164.07
Rate for Payer: Aetna Commercial	$124.70
Rate for Payer: Aetna Medicare Advantage	$98.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.68
Rate for Payer: Cigna Commercial	$164.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.32
Rate for Payer: Oxford Commercial	$65.63
Rate for Payer: Qualcare PPO/HMO/WC	$49.22
Rate for Payer: UnitedHealthcare Commercial	$65.63
Rate for Payer: UnitedHealthcare Community & State	$10.37
Rate for Payer: Wellpoint Medicaid Managed Care	$9.32

TRAY GYN LAPAROSCOPY

Facility

$328.15

Hospital Charge Code	270654113
Hospital Revenue Code	272
Min. Negotiated Rate	$49.22
Max. Negotiated Rate	$49.22
Rate for Payer: Qualcare PPO/HMO/WC	$49.22

TRAY HEMODIALYSIS 14.5FR 31CML

Facility

$1,750.00

Hospital Charge Code	270655796
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TRAY HEMODIALYSIS 14.5FR 31CML

Facility

$1,750.00

Hospital Charge Code	270655796
Hospital Revenue Code	278
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

TRAY HEMODIALYSIS 14.5FR 35CLM

Facility

$1,750.00

Hospital Charge Code	270655790
Hospital Revenue Code	278
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

TRAY HEMODIALYSIS 14.5FR 35CLM

Facility

$1,750.00

Hospital Charge Code	270655790
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

Know your out-of-pocket cost for care.

All Charges