Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BRA SURGICAL SUPPORT SURGI SM.

Facility

$209.10

Hospital Charge Code	270655494
Hospital Revenue Code	272
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$104.55
Rate for Payer: Aetna Commercial	$79.46
Rate for Payer: Aetna Medicare Advantage	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.32
Rate for Payer: Cigna Commercial	$104.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.37
Rate for Payer: Oxford Commercial	$41.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.36
Rate for Payer: UnitedHealthcare Commercial	$41.82
Rate for Payer: UnitedHealthcare Community & State	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

BRA SURGICAL SUPPORT SURGI XL

Facility

$183.65

Hospital Charge Code	270655491
Hospital Revenue Code	270
Min. Negotiated Rate	$27.55
Max. Negotiated Rate	$27.55
Rate for Payer: Qualcare PPO/HMO/WC	$27.55

BRA SURGICAL SUPPORT SURGI XL

Facility

$183.65

Hospital Charge Code	270655491
Hospital Revenue Code	270
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$91.83
Rate for Payer: Aetna Commercial	$69.79
Rate for Payer: Aetna Medicare Advantage	$55.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.83
Rate for Payer: Cigna Commercial	$91.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.75
Rate for Payer: Oxford Commercial	$36.73
Rate for Payer: Qualcare PPO/HMO/WC	$27.55
Rate for Payer: UnitedHealthcare Commercial	$36.73
Rate for Payer: UnitedHealthcare Community & State	$5.80
Rate for Payer: Wellpoint Medicaid Managed Care	$5.22

BRA SURGI SUPP W VEL SZ XL 958

Facility

$215.80

Hospital Charge Code	270616011
Hospital Revenue Code	272
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$107.90
Rate for Payer: Aetna Commercial	$82.00
Rate for Payer: Aetna Medicare Advantage	$64.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.03
Rate for Payer: Cigna Commercial	$107.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.11
Rate for Payer: Oxford Commercial	$43.16
Rate for Payer: Qualcare PPO/HMO/WC	$32.37
Rate for Payer: UnitedHealthcare Commercial	$43.16
Rate for Payer: UnitedHealthcare Community & State	$6.82
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

BRA SURGI SUPP W VEL SZ XL 958

Facility

$215.80

Hospital Charge Code	270616011
Hospital Revenue Code	272
Min. Negotiated Rate	$32.37
Max. Negotiated Rate	$32.37
Rate for Payer: Qualcare PPO/HMO/WC	$32.37

BRA SURGI SZ LG

Facility

$192.20

Hospital Charge Code	270600425
Hospital Revenue Code	272
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$96.10
Rate for Payer: Aetna Commercial	$73.04
Rate for Payer: Aetna Medicare Advantage	$57.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.01
Rate for Payer: Cigna Commercial	$96.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.97
Rate for Payer: Oxford Commercial	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$28.83
Rate for Payer: UnitedHealthcare Commercial	$38.44
Rate for Payer: UnitedHealthcare Community & State	$6.07
Rate for Payer: Wellpoint Medicaid Managed Care	$5.46

BRA SURGI SZ LG

Facility

$192.20

Hospital Charge Code	270600425
Hospital Revenue Code	272
Min. Negotiated Rate	$28.83
Max. Negotiated Rate	$28.83
Rate for Payer: Qualcare PPO/HMO/WC	$28.83

BRA SURGI SZ XLG

Facility

$204.50

Hospital Charge Code	270600426
Hospital Revenue Code	272
Min. Negotiated Rate	$30.68
Max. Negotiated Rate	$30.68
Rate for Payer: Qualcare PPO/HMO/WC	$30.68

BRA SURGI SZ XLG

Facility

$204.50

Hospital Charge Code	270600426
Hospital Revenue Code	272
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$102.25
Rate for Payer: Aetna Commercial	$77.71
Rate for Payer: Aetna Medicare Advantage	$61.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.15
Rate for Payer: Cigna Commercial	$102.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.17
Rate for Payer: Oxford Commercial	$40.90
Rate for Payer: Qualcare PPO/HMO/WC	$30.68
Rate for Payer: UnitedHealthcare Commercial	$40.90
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: Wellpoint Medicaid Managed Care	$5.81

BRAVO DELIVERY DEV CF

Facility

$7,765.00

Hospital Charge Code	270691424
Hospital Revenue Code	272
Min. Negotiated Rate	$220.53
Max. Negotiated Rate	$3,882.50
Rate for Payer: Aetna Commercial	$2,950.70
Rate for Payer: Aetna Medicare Advantage	$2,329.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,980.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,980.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,980.08
Rate for Payer: Cigna Commercial	$3,882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,018.90
Rate for Payer: Oxford Commercial	$1,553.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.75
Rate for Payer: UnitedHealthcare Commercial	$1,553.00
Rate for Payer: UnitedHealthcare Community & State	$245.37
Rate for Payer: Wellpoint Medicaid Managed Care	$220.53

BRAVO DELIVERY DEV CF

Facility

$7,765.00

Hospital Charge Code	270691424
Hospital Revenue Code	272
Min. Negotiated Rate	$1,164.75
Max. Negotiated Rate	$1,164.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,164.75

BRCA COMPREHENSIVE A

Facility

$10,196.45

Service Code	HCPCS 81162
Hospital Charge Code	39708013A
Hospital Revenue Code	310
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$6,619.75
Rate for Payer: Aetna Commercial	$4,963.67
Rate for Payer: Aetna Medicare Advantage	$5,912.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,619.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,619.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,824.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,619.75
Rate for Payer: Cigna Commercial	$5,098.23
Rate for Payer: Cigna Medicare Advantage	$1,824.88
Rate for Payer: Clover Medicare Advantage	$1,733.64
Rate for Payer: EmblemHealth Commercial	$5,474.64
Rate for Payer: Humana Medicare Advantage	$1,879.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,824.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,651.08
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,529.47
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1,459.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,824.88
Rate for Payer: Wellcare Medicare Advantage	$1,824.88
Rate for Payer: Wellpoint Medicaid Managed Care	$289.58

BRCA COMPREHENSIVE A

Facility

$10,196.45

Service Code	HCPCS 81162
Hospital Charge Code	39708013A
Hospital Revenue Code	310
Min. Negotiated Rate	$1,529.47
Max. Negotiated Rate	$1,529.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,529.47

BRCA COMPREHENSIVE B

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39708013B
Hospital Revenue Code	310
Min. Negotiated Rate	$82.75
Max. Negotiated Rate	$1,456.80
Rate for Payer: Aetna Commercial	$1,107.17
Rate for Payer: Aetna Medicare Advantage	$874.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.97
Rate for Payer: Cigna Commercial	$1,456.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$437.04
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$92.07
Rate for Payer: Wellpoint Medicaid Managed Care	$82.75

BRCA COMPREHENSIVE B

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39708013B
Hospital Revenue Code	310
Min. Negotiated Rate	$437.04
Max. Negotiated Rate	$437.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.04

BREAK OFF SCREW 1/2 THD 2X11MM

Facility

$991.95

Service Code	HCPCS C1713
Hospital Charge Code	270702742
Hospital Revenue Code	278
Min. Negotiated Rate	$148.79
Max. Negotiated Rate	$240.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.05
Rate for Payer: Qualcare PPO/HMO/WC	$148.79

BREAK OFF SCREW 1/2 THD 2X11MM

Facility

$991.95

Service Code	HCPCS C1713
Hospital Charge Code	270702742
Hospital Revenue Code	278
Min. Negotiated Rate	$28.17
Max. Negotiated Rate	$495.98
Rate for Payer: Aetna Commercial	$376.94
Rate for Payer: Aetna Medicare Advantage	$297.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.95
Rate for Payer: Cigna Commercial	$495.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.05
Rate for Payer: Qualcare PPO/HMO/WC	$148.79
Rate for Payer: UnitedHealthcare Community & State	$31.35
Rate for Payer: Wellpoint Medicaid Managed Care	$28.17

BREAST 310CC HIGH PROFILE

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270701714
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BREAST 310CC HIGH PROFILE

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270701714
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

BREAST 350 CC SMOOTH

Facility

$5,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270701440
Hospital Revenue Code	278
Min. Negotiated Rate	$152.65
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$169.85
Rate for Payer: Wellpoint Medicaid Managed Care	$152.65

BREAST 350 CC SMOOTH

Facility

$5,375.00

Service Code	HCPCS C1789
Hospital Charge Code	270701440
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$87,097.02

Service Code	MSDRG 584
Min. Negotiated Rate	$26,519.92
Max. Negotiated Rate	$87,097.02
Rate for Payer: Aetna Commercial	$63,889.99
Rate for Payer: Aetna Medicare Advantage	$87,097.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54,301.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54,301.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,915.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54,301.80
Rate for Payer: Cigna Commercial	$47,722.63
Rate for Payer: Cigna Medicare Advantage	$27,915.71
Rate for Payer: Clover Medicare Advantage	$26,519.92
Rate for Payer: EmblemHealth Commercial	$83,747.13
Rate for Payer: Humana Medicare Advantage	$28,753.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,915.71
Rate for Payer: Oxford Commercial	$37,719.13
Rate for Payer: UnitedHealthcare Commercial	$50,488.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,915.71
Rate for Payer: Wellcare Medicare Advantage	$27,915.71

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$80,411.82

Service Code	MSDRG 585
Min. Negotiated Rate	$24,484.37
Max. Negotiated Rate	$80,411.82
Rate for Payer: Aetna Commercial	$59,128.73
Rate for Payer: Aetna Medicare Advantage	$80,411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,544.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,544.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25,773.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,544.40
Rate for Payer: Cigna Commercial	$43,005.43
Rate for Payer: Cigna Medicare Advantage	$25,773.02
Rate for Payer: Clover Medicare Advantage	$24,484.37
Rate for Payer: EmblemHealth Commercial	$77,319.06
Rate for Payer: Humana Medicare Advantage	$26,546.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25,773.02
Rate for Payer: Oxford Commercial	$33,990.74
Rate for Payer: UnitedHealthcare Commercial	$45,497.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$25,773.02
Rate for Payer: Wellcare Medicare Advantage	$25,773.02

BREAST EXPANDER 300CC

Facility

$5,650.00

Hospital Charge Code	270667482
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

BREAST EXPANDER 300CC

Facility

$5,650.00

Hospital Charge Code	270667482
Hospital Revenue Code	278
Min. Negotiated Rate	$160.46
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$178.54
Rate for Payer: Wellpoint Medicaid Managed Care	$160.46

Know your out-of-pocket cost for care.

All Charges