Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	83653115
Hospital Revenue Code	402
Min. Negotiated Rate	$344.82
Max. Negotiated Rate	$344.82
Rate for Payer: Qualcare PPO/HMO/WC	$344.82

ULTRASOUND TRI TRAREC PROBE

Facility

$1,500.00

Hospital Charge Code	270688357
Hospital Revenue Code	272
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

ULTRASOUND TRI TRAREC PROBE

Facility

$1,500.00

Hospital Charge Code	270688357
Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Ultratag RBC Vial Kit

Facility

$471.56

Hospital Charge Code	4509091
Hospital Revenue Code	272
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$235.78
Rate for Payer: Aetna Commercial	$179.19
Rate for Payer: Aetna Medicare Advantage	$141.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.25
Rate for Payer: Cigna Commercial	$235.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.61
Rate for Payer: Oxford Commercial	$94.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.73
Rate for Payer: UnitedHealthcare Commercial	$94.31
Rate for Payer: UnitedHealthcare Community & State	$14.90
Rate for Payer: Wellpoint Medicaid Managed Care	$13.39

Ultratag RBC Vial Kit

Facility

$471.56

Hospital Charge Code	4509091
Hospital Revenue Code	272
Min. Negotiated Rate	$70.73
Max. Negotiated Rate	$70.73
Rate for Payer: Qualcare PPO/HMO/WC	$70.73

UL TRATAPE 2MM CORD BLUE

Facility

$667.50

Hospital Charge Code	270679417
Hospital Revenue Code	272
Min. Negotiated Rate	$100.12
Max. Negotiated Rate	$100.12
Rate for Payer: Qualcare PPO/HMO/WC	$100.12

UL TRATAPE 2MM CORD BLUE

Facility

$667.50

Hospital Charge Code	270679417
Hospital Revenue Code	272
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$333.75
Rate for Payer: Aetna Commercial	$253.65
Rate for Payer: Aetna Medicare Advantage	$200.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.21
Rate for Payer: Cigna Commercial	$333.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.55
Rate for Payer: Oxford Commercial	$133.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.12
Rate for Payer: UnitedHealthcare Commercial	$133.50
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ULTRA THIN BLADES

Facility

$191.00

Hospital Charge Code	270332553
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$95.50
Rate for Payer: Aetna Commercial	$72.58
Rate for Payer: Aetna Medicare Advantage	$57.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.70
Rate for Payer: Cigna Commercial	$95.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.66
Rate for Payer: Oxford Commercial	$38.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.65
Rate for Payer: UnitedHealthcare Commercial	$38.20
Rate for Payer: UnitedHealthcare Community & State	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.42

ULTRA THIN BLADES

Facility

$191.00

Hospital Charge Code	270332553
Hospital Revenue Code	272
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$28.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$63,085.84

Service Code	MSDRG 383
Min. Negotiated Rate	$19,208.83
Max. Negotiated Rate	$63,085.84
Rate for Payer: Aetna Commercial	$46,788.97
Rate for Payer: Aetna Medicare Advantage	$63,085.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38,787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38,787.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,219.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38,787.00
Rate for Payer: Cigna Commercial	$30,779.95
Rate for Payer: Cigna Medicare Advantage	$20,219.82
Rate for Payer: Clover Medicare Advantage	$19,208.83
Rate for Payer: EmblemHealth Commercial	$60,659.46
Rate for Payer: Humana Medicare Advantage	$20,826.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,219.82
Rate for Payer: Oxford Commercial	$24,327.93
Rate for Payer: UnitedHealthcare Commercial	$32,563.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,219.82
Rate for Payer: Wellcare Medicare Advantage	$20,219.82

UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$46,470.81

Service Code	MSDRG 384
Min. Negotiated Rate	$14,149.77
Max. Negotiated Rate	$46,470.81
Rate for Payer: Aetna Commercial	$34,955.55
Rate for Payer: Aetna Medicare Advantage	$46,470.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,380.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,380.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14,894.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,380.40
Rate for Payer: Cigna Commercial	$19,056.06
Rate for Payer: Cigna Medicare Advantage	$14,894.49
Rate for Payer: Clover Medicare Advantage	$14,149.77
Rate for Payer: EmblemHealth Commercial	$44,683.47
Rate for Payer: Humana Medicare Advantage	$15,341.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14,894.49
Rate for Payer: Oxford Commercial	$15,061.58
Rate for Payer: UnitedHealthcare Commercial	$20,160.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$14,894.49
Rate for Payer: Wellcare Medicare Advantage	$14,894.49

UNDERGAURD FOR PLASMA

Facility

$309.05

Hospital Charge Code	270665038
Hospital Revenue Code	270
Min. Negotiated Rate	$46.36
Max. Negotiated Rate	$46.36
Rate for Payer: Qualcare PPO/HMO/WC	$46.36

UNDERGAURD FOR PLASMA

Facility

$309.05

Hospital Charge Code	270665038
Hospital Revenue Code	270
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$154.53
Rate for Payer: Aetna Commercial	$117.44
Rate for Payer: Aetna Medicare Advantage	$92.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.81
Rate for Payer: Cigna Commercial	$154.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.35
Rate for Payer: Oxford Commercial	$61.81
Rate for Payer: Qualcare PPO/HMO/WC	$46.36
Rate for Payer: UnitedHealthcare Commercial	$61.81
Rate for Payer: UnitedHealthcare Community & State	$9.77
Rate for Payer: Wellpoint Medicaid Managed Care	$8.78

UNDERPAD ULTRASORB 31x36

Facility

$9.61

Hospital Charge Code	270644336
Hospital Revenue Code	270
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna Commercial	$3.65
Rate for Payer: Aetna Medicare Advantage	$2.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.45
Rate for Payer: Cigna Commercial	$4.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$1.92
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

UNDERPAD ULTRASORB 31x36

Facility

$9.61

Hospital Charge Code	270644336
Hospital Revenue Code	270
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

UNDERPAD ULTRASORB AP 24x36

Facility

$405.20

Hospital Charge Code	270648397
Hospital Revenue Code	272
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$202.60
Rate for Payer: Aetna Commercial	$153.98
Rate for Payer: Aetna Medicare Advantage	$121.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.33
Rate for Payer: Cigna Commercial	$202.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.35
Rate for Payer: Oxford Commercial	$81.04
Rate for Payer: Qualcare PPO/HMO/WC	$60.78
Rate for Payer: UnitedHealthcare Commercial	$81.04
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.51

UNDERPAD ULTRASORB AP 24x36

Facility

$405.20

Hospital Charge Code	270648397
Hospital Revenue Code	272
Min. Negotiated Rate	$60.78
Max. Negotiated Rate	$60.78
Rate for Payer: Qualcare PPO/HMO/WC	$60.78

UNIPAK SURGICAL SUPPLIES

Facility

$680.00

Hospital Charge Code	270331454
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

UNIPAK SURGICAL SUPPLIES

Facility

$680.00

Hospital Charge Code	270331454
Hospital Revenue Code	272
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.80
Rate for Payer: Oxford Commercial	$136.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$136.00
Rate for Payer: UnitedHealthcare Community & State	$21.49
Rate for Payer: Wellpoint Medicaid Managed Care	$19.31

UNIPLATE 16 MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270686054
Hospital Revenue Code	278
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$177.75
Rate for Payer: Wellpoint Medicaid Managed Care	$159.75

UNIPLATE 16 MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270686054
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

UNIT PLURAL VAC/SUC DRNG

Facility

$392.00

Hospital Charge Code	270608495
Hospital Revenue Code	272
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$58.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.80

UNIT PLURAL VAC/SUC DRNG

Facility

$392.00

Hospital Charge Code	270608495
Hospital Revenue Code	272
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$196.00
Rate for Payer: Aetna Commercial	$148.96
Rate for Payer: Aetna Medicare Advantage	$117.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.96
Rate for Payer: Cigna Commercial	$196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.92
Rate for Payer: Oxford Commercial	$78.40
Rate for Payer: Qualcare PPO/HMO/WC	$58.80
Rate for Payer: UnitedHealthcare Commercial	$78.40
Rate for Payer: UnitedHealthcare Community & State	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

UNIVERSAL 5TH METATRSAL HOOK P

Facility

$6,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270686301
Hospital Revenue Code	278
Min. Negotiated Rate	$991.50
Max. Negotiated Rate	$1,599.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,322.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.62
Rate for Payer: Qualcare PPO/HMO/WC	$991.50

UNIVERSAL 5TH METATRSAL HOOK P

Facility

$6,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270686301
Hospital Revenue Code	278
Min. Negotiated Rate	$187.72
Max. Negotiated Rate	$3,305.00
Rate for Payer: Aetna Commercial	$2,511.80
Rate for Payer: Aetna Medicare Advantage	$1,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,685.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,685.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,685.55
Rate for Payer: Cigna Commercial	$3,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,599.62
Rate for Payer: Qualcare PPO/HMO/WC	$991.50
Rate for Payer: UnitedHealthcare Community & State	$208.88
Rate for Payer: Wellpoint Medicaid Managed Care	$187.72

Know your out-of-pocket cost for care.

All Charges