Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

X-CORE MINI ENDCAP, 14 PAR

Facility

$9,425.00

Hospital Charge Code	270666085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.75
Max. Negotiated Rate	$2,280.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75

XENADERM 60GM

Facility

$53.73

Service Code	NDC 51079062181
Hospital Charge Code	60635901
Hospital Revenue Code	250
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$8.06
Rate for Payer: Qualcare PPO/HMO/WC	$8.06

XENADERM 60GM

Facility

$53.73

Service Code	NDC 51079062181
Hospital Charge Code	60635901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$26.86
Rate for Payer: Aetna Commercial	$20.42
Rate for Payer: Aetna Medicare Advantage	$16.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.70
Rate for Payer: Cigna Commercial	$26.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.97
Rate for Payer: Oxford Commercial	$10.75
Rate for Payer: Qualcare PPO/HMO/WC	$8.06
Rate for Payer: UnitedHealthcare Commercial	$10.75
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

XENMATRIX AB GRAFT 20CM X 25CM

Facility

$73,100.00

Service Code	HCPCS C1781
Hospital Charge Code	270686972
Hospital Revenue Code	278
Min. Negotiated Rate	$2,076.04
Max. Negotiated Rate	$36,550.00
Rate for Payer: Aetna Commercial	$27,778.00
Rate for Payer: Aetna Medicare Advantage	$21,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,640.50
Rate for Payer: Cigna Commercial	$36,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,690.20
Rate for Payer: Qualcare PPO/HMO/WC	$10,965.00
Rate for Payer: UnitedHealthcare Community & State	$2,309.96
Rate for Payer: Wellpoint Medicaid Managed Care	$2,076.04

XENMATRIX AB GRAFT 20CM X 25CM

Facility

$73,100.00

Service Code	HCPCS C1781
Hospital Charge Code	270686972
Hospital Revenue Code	278
Min. Negotiated Rate	$10,965.00
Max. Negotiated Rate	$17,690.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,690.20
Rate for Payer: Qualcare PPO/HMO/WC	$10,965.00

XENON 133 GAS 1.0 MCI VIAL

Facility

$315.58

Service Code	HCPCS A9558
Hospital Charge Code	4509095
Hospital Revenue Code	343
Min. Negotiated Rate	$47.34
Max. Negotiated Rate	$47.34
Rate for Payer: Qualcare PPO/HMO/WC	$47.34

XENON 133 GAS 1.0 MCI VIAL

Facility

$315.58

Service Code	HCPCS A9558
Hospital Charge Code	4509095
Hospital Revenue Code	343
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$191.94
Rate for Payer: Aetna Commercial	$119.92
Rate for Payer: Aetna Medicare Advantage	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.47
Rate for Payer: Cigna Commercial	$157.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.05
Rate for Payer: Qualcare PPO/HMO/WC	$47.34
Rate for Payer: UnitedHealthcare Community & State	$9.97
Rate for Payer: Wellpoint Medicaid Managed Care	$8.96

XI 8MM BLADELES OBDURATOR LONG

Facility

$150.00

Hospital Charge Code	270680253
Hospital Revenue Code	272
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

XI 8MM BLADELES OBDURATOR LONG

Facility

$150.00

Hospital Charge Code	270680253
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

XI 8MM BLADELES OBDURATOR OPTL

Facility

$150.00

Hospital Charge Code	270677942
Hospital Revenue Code	272
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

XI 8MM BLADELES OBDURATOR OPTL

Facility

$150.00

Hospital Charge Code	270677942
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

XIA 3 BLOCKER

Facility

$480.00

Hospital Charge Code	270332631
Hospital Revenue Code	272
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

XIA 3 BLOCKER

Facility

$480.00

Hospital Charge Code	270332631
Hospital Revenue Code	272
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.80
Rate for Payer: Oxford Commercial	$96.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Commercial	$96.00
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.63

XLIF KIT

Facility

$5,980.00

Hospital Charge Code	270657325
Hospital Revenue Code	272
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$897.00
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

XLIF KIT

Facility

$5,980.00

Hospital Charge Code	270657325
Hospital Revenue Code	272
Min. Negotiated Rate	$169.83
Max. Negotiated Rate	$2,990.00
Rate for Payer: Aetna Commercial	$2,272.40
Rate for Payer: Aetna Medicare Advantage	$1,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,524.90
Rate for Payer: Cigna Commercial	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.80
Rate for Payer: Oxford Commercial	$1,196.00
Rate for Payer: Qualcare PPO/HMO/WC	$897.00
Rate for Payer: UnitedHealthcare Commercial	$1,196.00
Rate for Payer: UnitedHealthcare Community & State	$188.97
Rate for Payer: Wellpoint Medicaid Managed Care	$169.83

X-LORDOTIC PLATE 12MM

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688732
Hospital Revenue Code	278
Min. Negotiated Rate	$376.30
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$5,035.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Community & State	$418.70
Rate for Payer: Wellpoint Medicaid Managed Care	$376.30

X-LORDOTIC PLATE 12MM

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688732
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$3,206.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

XM PREWARM

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100544
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

XM PREWARM

Facility

$390.00

Service Code	HCPCS 86921
Hospital Charge Code	3100544
Hospital Revenue Code	309
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

XOMED TUBING

Facility

$87.00

Hospital Charge Code	270335206
Hospital Revenue Code	272
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

XOMED TUBING

Facility

$87.00

Hospital Charge Code	270335206
Hospital Revenue Code	272
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Oxford Commercial	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$17.40
Rate for Payer: UnitedHealthcare Community & State	$2.75
Rate for Payer: Wellpoint Medicaid Managed Care	$2.47

XPAC TLIF 10X28MM PARALELL

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704189
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

XPAC TLIF 10X28MM PARALELL

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704189
Hospital Revenue Code	278
Min. Negotiated Rate	$710.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$790.00
Rate for Payer: Wellpoint Medicaid Managed Care	$710.00

XP EXPANDABLE LUMBAR INTERBODY

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270704667
Hospital Revenue Code	278
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

XP EXPANDABLE LUMBAR INTERBODY

Facility

$20,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270704667
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

Know your out-of-pocket cost for care.

All Charges