Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WRIST SUPP COMFORTFORM LEFT

Facility

$27.90

Hospital Charge Code	270659173
Hospital Revenue Code	270
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$13.95
Rate for Payer: Aetna Commercial	$10.60
Rate for Payer: Aetna Medicare Advantage	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.11
Rate for Payer: Cigna Commercial	$13.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.25
Rate for Payer: Oxford Commercial	$5.58
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$5.58
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

WRIST SUPP COMFORTFORM LEFT

Facility

$27.90

Hospital Charge Code	270659173
Hospital Revenue Code	270
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

WRIST SUPP COMFORTFORM RIGH

Facility

$34.00

Hospital Charge Code	270659174
Hospital Revenue Code	270
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.84
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

WRIST SUPP COMFORTFORM RIGH

Facility

$34.00

Hospital Charge Code	270659174
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

WST SYNOVECTOMY - 1 COMPARTM

Facility

$30,595.00

Service Code	HCPCS 25118
Hospital Charge Code	16000504
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

WST SYNOVECTOMY - 1 COMPARTM

Facility

$30,595.00

Service Code	HCPCS 25118
Hospital Charge Code	16000504
Hospital Revenue Code	360
Min. Negotiated Rate	$868.90
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	$7,954.70
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$966.80
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	$868.90

X3 INS MDM LINER 22.2X38MM D

Facility

$3,623.35

Service Code	HCPCS C1776
Hospital Charge Code	270695717
Hospital Revenue Code	278
Min. Negotiated Rate	$102.90
Max. Negotiated Rate	$1,811.67
Rate for Payer: Aetna Commercial	$1,376.87
Rate for Payer: Aetna Medicare Advantage	$1,087.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$923.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$923.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$724.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$923.95
Rate for Payer: Cigna Commercial	$1,811.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.85
Rate for Payer: Qualcare PPO/HMO/WC	$543.50
Rate for Payer: UnitedHealthcare Community & State	$114.50
Rate for Payer: Wellpoint Medicaid Managed Care	$102.90

X3 INS MDM LINER 22.2X38MM D

Facility

$3,623.35

Service Code	HCPCS C1776
Hospital Charge Code	270695717
Hospital Revenue Code	278
Min. Negotiated Rate	$543.50
Max. Negotiated Rate	$876.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$724.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.85
Rate for Payer: Qualcare PPO/HMO/WC	$543.50

XANAX/1MG/TAB

Facility

$29.01

Service Code	NDC 9009001
Hospital Charge Code	60634177
Hospital Revenue Code	250
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.35

XANAX/1MG/TAB

Facility

$29.01

Service Code	NDC 9009001
Hospital Charge Code	60634177
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$14.51
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: Aetna Medicare Advantage	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.40
Rate for Payer: Cigna Commercial	$14.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.54
Rate for Payer: Oxford Commercial	$5.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.35
Rate for Payer: UnitedHealthcare Commercial	$5.80
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

XARELTO 10MG TAB

Facility

$84.35

Service Code	NDC 50458058030
Hospital Charge Code	60635799
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XARELTO 10MG TAB

Facility

$84.35

Service Code	NDC 50458058030
Hospital Charge Code	60635799
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$32.05
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.93
Rate for Payer: Oxford Commercial	$16.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$16.87
Rate for Payer: UnitedHealthcare Community & State	$2.67
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

XARELTO 15MG TAB

Facility

$84.35

Service Code	NDC 50458057830
Hospital Charge Code	60635802
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$32.05
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.93
Rate for Payer: Oxford Commercial	$16.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$16.87
Rate for Payer: UnitedHealthcare Community & State	$2.67
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

XARELTO 15MG TAB

Facility

$84.35

Service Code	NDC 50458057830
Hospital Charge Code	60635802
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XARELTO 20MG TAB

Facility

$84.35

Service Code	NDC 50458057930
Hospital Charge Code	60635800
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$42.17
Rate for Payer: Aetna Commercial	$32.05
Rate for Payer: Aetna Medicare Advantage	$25.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.51
Rate for Payer: Cigna Commercial	$42.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.93
Rate for Payer: Oxford Commercial	$16.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.65
Rate for Payer: UnitedHealthcare Commercial	$16.87
Rate for Payer: UnitedHealthcare Community & State	$2.67
Rate for Payer: Wellpoint Medicaid Managed Care	$2.40

XARELTO 20MG TAB

Facility

$84.35

Service Code	NDC 50458057930
Hospital Charge Code	60635800
Hospital Revenue Code	250
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$12.65

XBRAID SUTURE #2

Facility

$142.50

Hospital Charge Code	270697227
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$54.15
Rate for Payer: Aetna Medicare Advantage	$42.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.34
Rate for Payer: Cigna Commercial	$71.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.05
Rate for Payer: Oxford Commercial	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$21.38
Rate for Payer: UnitedHealthcare Commercial	$28.50
Rate for Payer: UnitedHealthcare Community & State	$4.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

XBRAID SUTURE #2

Facility

$142.50

Hospital Charge Code	270697227
Hospital Revenue Code	272
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$21.38
Rate for Payer: Qualcare PPO/HMO/WC	$21.38

XBRAID TT 1.4 MM BLUE BLACK WH

Facility

$750.00

Service Code	HCPCS C1716
Hospital Charge Code	270701823
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

XBRAID TT 1.4 MM BLUE BLACK WH

Facility

$750.00

Service Code	HCPCS C1716
Hospital Charge Code	270701823
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$2,166.34
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,166.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,166.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,166.34
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

XCLIP IMPLANT X 7.5X25MM

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270698458
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

XCLIP IMPLANT X 7.5X25MM

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270698458
Hospital Revenue Code	278
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: Wellpoint Medicaid Managed Care	$18.74

X-CORE MINI, 15-20MM 12MM

Facility

$36,725.00

Hospital Charge Code	270666084
Hospital Revenue Code	278
Min. Negotiated Rate	$5,508.75
Max. Negotiated Rate	$8,887.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,887.45
Rate for Payer: Qualcare PPO/HMO/WC	$5,508.75

X-CORE MINI, 15-20MM 12MM

Facility

$36,725.00

Hospital Charge Code	270666084
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.99
Max. Negotiated Rate	$18,362.50
Rate for Payer: Aetna Commercial	$13,955.50
Rate for Payer: Aetna Medicare Advantage	$11,017.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,364.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,364.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,364.88
Rate for Payer: Cigna Commercial	$18,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,887.45
Rate for Payer: Qualcare PPO/HMO/WC	$5,508.75
Rate for Payer: UnitedHealthcare Community & State	$1,160.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1,042.99

X-CORE MINI ENDCAP, 14 PAR

Facility

$9,425.00

Hospital Charge Code	270666085
Hospital Revenue Code	278
Min. Negotiated Rate	$267.67
Max. Negotiated Rate	$4,712.50
Rate for Payer: Aetna Commercial	$3,581.50
Rate for Payer: Aetna Medicare Advantage	$2,827.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,403.38
Rate for Payer: Cigna Commercial	$4,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75
Rate for Payer: UnitedHealthcare Community & State	$297.83
Rate for Payer: Wellpoint Medicaid Managed Care	$267.67

Know your out-of-pocket cost for care.

All Charges