Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BIPAP PROCEDURE

Facility

$585.00

Service Code	HCPCS 94660
Hospital Charge Code	9500175
Hospital Revenue Code	410
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$87.75
Rate for Payer: Qualcare PPO/HMO/WC	$87.75

BIPAP PROCEDURE

Facility

$585.00

Service Code	HCPCS 94660
Hospital Charge Code	9500175
Hospital Revenue Code	410
Min. Negotiated Rate	$16.61
Max. Negotiated Rate	$1,440.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$943.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$943.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$943.69
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.10
Rate for Payer: Oxford Commercial	$1,367.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.75
Rate for Payer: UnitedHealthcare Commercial	$1,440.00
Rate for Payer: UnitedHealthcare Community & State	$18.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$16.61

BIPOLAR 28 MM 46MM OD

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270701914
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

BIPOLAR 28 MM 46MM OD

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270701914
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

BIPOLAR COMPONENT 25x50mm

Facility

$3,000.00

Hospital Charge Code	270675125
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

BIPOLAR COMPONENT 25x50mm

Facility

$3,000.00

Hospital Charge Code	270675125
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BIPOLAR COMPONENT 28x46mm

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675059
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BIPOLAR COMPONENT 28x46mm

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675059
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

BIPOLAR COMPONENT 28X48MM

Facility

$1,500.00

Hospital Charge Code	270669545
Hospital Revenue Code	278
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) NJ Health	$300.00
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	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BIPOLAR COMPONENT 28X48MM

Facility

$1,500.00

Hospital Charge Code	270669545
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BIPOLAR COMPONENT 28x49MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270674252
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BIPOLAR COMPONENT 28x49MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270674252
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

BIPOLAR COMPONENT-LEFT HIP

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270676774
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

BIPOLAR COMPONENT-LEFT HIP

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270676774
Hospital Revenue Code	278
Min. Negotiated Rate	$159.31
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$2,131.61
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: Qualcare PPO/HMO/WC	$841.42
Rate for Payer: UnitedHealthcare Community & State	$177.26
Rate for Payer: Wellpoint Medicaid Managed Care	$159.31

BIPOLAR CUP 28 X 48

Facility

$6,325.00

Service Code	HCPCS C1776
Hospital Charge Code	270667718
Hospital Revenue Code	278
Min. Negotiated Rate	$179.63
Max. Negotiated Rate	$3,162.50
Rate for Payer: Aetna Commercial	$2,403.50
Rate for Payer: Aetna Medicare Advantage	$1,897.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,612.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,612.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,612.88
Rate for Payer: Cigna Commercial	$3,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.65
Rate for Payer: Qualcare PPO/HMO/WC	$948.75
Rate for Payer: UnitedHealthcare Community & State	$199.87
Rate for Payer: Wellpoint Medicaid Managed Care	$179.63

BIPOLAR CUP 28 X 48

Facility

$6,325.00

Service Code	HCPCS C1776
Hospital Charge Code	270667718
Hospital Revenue Code	278
Min. Negotiated Rate	$948.75
Max. Negotiated Rate	$1,530.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.65
Rate for Payer: Qualcare PPO/HMO/WC	$948.75

BIPOLAR DISORDERS

Facility

$12,691.41

Service Code	APR-DRG 7533
Min. Negotiated Rate	$12,442.56
Max. Negotiated Rate	$12,691.41
Rate for Payer: UnitedHealthcare Community & State	$12,442.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,691.41
Rate for Payer: Wellpoint Medicaid Managed Care	$12,442.56

BIPOLAR DISORDERS

Facility

$25,217.06

Service Code	APR-DRG 7534
Min. Negotiated Rate	$24,722.61
Max. Negotiated Rate	$25,217.06
Rate for Payer: UnitedHealthcare Community & State	$24,722.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,217.06
Rate for Payer: Wellpoint Medicaid Managed Care	$24,722.61

BIPOLAR DISORDERS

Facility

$7,304.21

Service Code	APR-DRG 7532
Min. Negotiated Rate	$7,160.99
Max. Negotiated Rate	$7,304.21
Rate for Payer: UnitedHealthcare Community & State	$7,160.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,304.21
Rate for Payer: Wellpoint Medicaid Managed Care	$7,160.99

BIPOLAR DISORDERS

Facility

$5,413.92

Service Code	APR-DRG 7531
Min. Negotiated Rate	$5,307.76
Max. Negotiated Rate	$5,413.92
Rate for Payer: UnitedHealthcare Community & State	$5,307.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,413.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5,307.76

BIPOLAR ENDO COAGULATN FORCEPS

Facility

$267.00

Hospital Charge Code	270338806
Hospital Revenue Code	272
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

BIPOLAR ENDO COAGULATN FORCEPS

Facility

$267.00

Hospital Charge Code	270338806
Hospital Revenue Code	272
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna Commercial	$101.46
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.42
Rate for Payer: Oxford Commercial	$53.40
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$53.40
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

BIPOLAR FORCEPS

Facility

$1,250.00

Hospital Charge Code	270693159
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BIPOLAR FORCEPS

Facility

$1,250.00

Hospital Charge Code	270693159
Hospital Revenue Code	272
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

BIPOLAR HEAD

Facility

$9,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688351
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

Know your out-of-pocket cost for care.

All Charges