Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BRACE ANKLE RIGHT W/ WRAP SM 1

Facility

$101.70

Hospital Charge Code	270664515
Hospital Revenue Code	270
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$50.85
Rate for Payer: Aetna Commercial	$38.65
Rate for Payer: Aetna Medicare Advantage	$30.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.93
Rate for Payer: Cigna Commercial	$50.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.44
Rate for Payer: Oxford Commercial	$20.34
Rate for Payer: Qualcare PPO/HMO/WC	$15.26
Rate for Payer: UnitedHealthcare Commercial	$20.34
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

BRACE ANKLE RIGHT W/ WRAP SM 1

Facility

$101.70

Hospital Charge Code	270664515
Hospital Revenue Code	270
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$15.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.26

BRACE ANKLE RIGHT W/ WRAP SM 8

Facility

$101.70

Hospital Charge Code	270664500
Hospital Revenue Code	270
Min. Negotiated Rate	$15.26
Max. Negotiated Rate	$15.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.26

BRACE ANKLE RIGHT W/ WRAP SM 8

Facility

$101.70

Hospital Charge Code	270664500
Hospital Revenue Code	270
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$50.85
Rate for Payer: Aetna Commercial	$38.65
Rate for Payer: Aetna Medicare Advantage	$30.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.93
Rate for Payer: Cigna Commercial	$50.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.44
Rate for Payer: Oxford Commercial	$20.34
Rate for Payer: Qualcare PPO/HMO/WC	$15.26
Rate for Payer: UnitedHealthcare Commercial	$20.34
Rate for Payer: UnitedHealthcare Community & State	$3.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

BRACE HINGED KNEE

Facility

$1,250.00

Service Code	HCPCS L1833
Hospital Charge Code	270648595
Hospital Revenue Code	274
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BRACE HINGED KNEE

Facility

$1,250.00

Service Code	HCPCS L1833
Hospital Charge Code	270648595
Hospital Revenue Code	274
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) NJ Health	$250.00
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	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

BRACE HIP ABDUCTN W/PELVIC BND

Facility

$7,132.25

Hospital Charge Code	270643598
Hospital Revenue Code	272
Min. Negotiated Rate	$202.56
Max. Negotiated Rate	$3,566.12
Rate for Payer: Aetna Commercial	$2,710.26
Rate for Payer: Aetna Medicare Advantage	$2,139.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,818.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,818.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,818.72
Rate for Payer: Cigna Commercial	$3,566.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,854.38
Rate for Payer: Oxford Commercial	$1,426.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,069.84
Rate for Payer: UnitedHealthcare Commercial	$1,426.45
Rate for Payer: UnitedHealthcare Community & State	$225.38
Rate for Payer: Wellpoint Medicaid Managed Care	$202.56

BRACE HIP ABDUCTN W/PELVIC BND

Facility

$7,132.25

Hospital Charge Code	270643598
Hospital Revenue Code	272
Min. Negotiated Rate	$1,069.84
Max. Negotiated Rate	$1,069.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,069.84

BRACE HIP SPICA

Facility

$1,564.55

Hospital Charge Code	270647425
Hospital Revenue Code	270
Min. Negotiated Rate	$234.68
Max. Negotiated Rate	$234.68
Rate for Payer: Qualcare PPO/HMO/WC	$234.68

BRACE HIP SPICA

Facility

$1,564.55

Hospital Charge Code	270647425
Hospital Revenue Code	270
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$782.27
Rate for Payer: Aetna Commercial	$594.53
Rate for Payer: Aetna Medicare Advantage	$469.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.96
Rate for Payer: Cigna Commercial	$782.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.78
Rate for Payer: Oxford Commercial	$312.91
Rate for Payer: Qualcare PPO/HMO/WC	$234.68
Rate for Payer: UnitedHealthcare Commercial	$312.91
Rate for Payer: UnitedHealthcare Community & State	$49.44
Rate for Payer: Wellpoint Medicaid Managed Care	$44.43

BRACE IMPANT INTERNAL KIT

Facility

$4,875.00

Hospital Charge Code	270662540
Hospital Revenue Code	272
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$731.25
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

BRACE IMPANT INTERNAL KIT

Facility

$4,875.00

Hospital Charge Code	270662540
Hospital Revenue Code	272
Min. Negotiated Rate	$138.45
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.50
Rate for Payer: Oxford Commercial	$975.00
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Commercial	$975.00
Rate for Payer: UnitedHealthcare Community & State	$154.05
Rate for Payer: Wellpoint Medicaid Managed Care	$138.45

BRACE INTERNAL FOREFOOT

Facility

$6,975.00

Hospital Charge Code	270684478
Hospital Revenue Code	271
Min. Negotiated Rate	$198.09
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,813.50
Rate for Payer: Oxford Commercial	$1,395.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Commercial	$1,395.00
Rate for Payer: UnitedHealthcare Community & State	$220.41
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

BRACE INTERNAL FOREFOOT

Facility

$6,975.00

Hospital Charge Code	270684478
Hospital Revenue Code	271
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

BRACE KNEE COOL X-ACT

Facility

$625.00

Hospital Charge Code	270678079
Hospital Revenue Code	270
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BRACE KNEE COOL X-ACT

Facility

$625.00

Hospital Charge Code	270678079
Hospital Revenue Code	270
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BRACE KNEE LG

Facility

$49.55

Hospital Charge Code	270649575
Hospital Revenue Code	272
Min. Negotiated Rate	$7.43
Max. Negotiated Rate	$7.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.43

BRACE KNEE LG

Facility

$49.55

Hospital Charge Code	270649575
Hospital Revenue Code	272
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$24.77
Rate for Payer: Aetna Commercial	$18.83
Rate for Payer: Aetna Medicare Advantage	$14.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.64
Rate for Payer: Cigna Commercial	$24.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.88
Rate for Payer: Oxford Commercial	$9.91
Rate for Payer: Qualcare PPO/HMO/WC	$7.43
Rate for Payer: UnitedHealthcare Commercial	$9.91
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

BRACE KNEE MEDIUM

Facility

$49.55

Hospital Charge Code	270649576
Hospital Revenue Code	272
Min. Negotiated Rate	$7.43
Max. Negotiated Rate	$7.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.43

BRACE KNEE MEDIUM

Facility

$49.55

Hospital Charge Code	270649576
Hospital Revenue Code	272
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$24.77
Rate for Payer: Aetna Commercial	$18.83
Rate for Payer: Aetna Medicare Advantage	$14.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.64
Rate for Payer: Cigna Commercial	$24.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.88
Rate for Payer: Oxford Commercial	$9.91
Rate for Payer: Qualcare PPO/HMO/WC	$7.43
Rate for Payer: UnitedHealthcare Commercial	$9.91
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

BRACE KNEE POST OP LARGE FULL

Facility

$610.15

Hospital Charge Code	270636638
Hospital Revenue Code	270
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$91.52
Rate for Payer: Qualcare PPO/HMO/WC	$91.52

BRACE KNEE POST OP LARGE FULL

Facility

$610.15

Hospital Charge Code	270636638
Hospital Revenue Code	270
Min. Negotiated Rate	$17.33
Max. Negotiated Rate	$305.07
Rate for Payer: Aetna Commercial	$231.86
Rate for Payer: Aetna Medicare Advantage	$183.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.59
Rate for Payer: Cigna Commercial	$305.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.64
Rate for Payer: Oxford Commercial	$122.03
Rate for Payer: Qualcare PPO/HMO/WC	$91.52
Rate for Payer: UnitedHealthcare Commercial	$122.03
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$17.33

BRACE KNEE POST-OP LG 19

Facility

$74.70

Hospital Charge Code	270649581S
Hospital Revenue Code	272
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$11.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.21

BRACE KNEE POST-OP LG 19

Facility

$74.90

Hospital Charge Code	270649581N
Hospital Revenue Code	272
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$11.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.23

BRACE KNEE POST-OP LG 19

Facility

$74.70

Hospital Charge Code	270649581
Hospital Revenue Code	272
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$11.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.21

Know your out-of-pocket cost for care.

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