Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CA 15-3

Facility

$390.00

Service Code	HCPCS 86300
Hospital Charge Code	39900426
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CA 15-3

Facility

$390.00

Service Code	HCPCS 86300
Hospital Charge Code	39900426
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
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	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CA 19-9

Facility

$143.05

Service Code	HCPCS 86301
Hospital Charge Code	39900421
Hospital Revenue Code	302
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

CA 19-9

Facility

$143.05

Service Code	HCPCS 86301
Hospital Charge Code	39900421
Hospital Revenue Code	302
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.19
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.06

CA 27 - 29

Facility

$493.00

Service Code	HCPCS 86300
Hospital Charge Code	38476249
Hospital Revenue Code	302
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$73.95
Rate for Payer: Qualcare PPO/HMO/WC	$73.95

CA 27 - 29

Facility

$493.00

Service Code	HCPCS 86300
Hospital Charge Code	38476249
Hospital Revenue Code	302
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$246.50
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$246.50
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.18
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$14.00

CA 27.29

Facility

$390.00

Service Code	HCPCS 86300
Hospital Charge Code	39990029EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CA 27.29

Facility

$390.00

Service Code	HCPCS 86300
Hospital Charge Code	39990029EX
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
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	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CA 27.29, I

Facility

$143.05

Service Code	HCPCS 86300
Hospital Charge Code	39990029A
Hospital Revenue Code	306
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.19
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.06

CA 27.29, I

Facility

$143.05

Service Code	HCPCS 86300
Hospital Charge Code	39990029A
Hospital Revenue Code	306
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

CA 27.29, II

Facility

$143.05

Service Code	HCPCS 86316
Hospital Charge Code	39990029B
Hospital Revenue Code	306
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$71.53
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.19
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.06

CA 27.29, II

Facility

$143.05

Service Code	HCPCS 86316
Hospital Charge Code	39990029B
Hospital Revenue Code	306
Min. Negotiated Rate	$21.46
Max. Negotiated Rate	$21.46
Rate for Payer: Qualcare PPO/HMO/WC	$21.46

CABEZA FEMORAL28MM+5 12/14CONE

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270696053
Hospital Revenue Code	278
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

CABEZA FEMORAL28MM+5 12/14CONE

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270696053
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

CABLE 12 PIN 3/5 LEAD ECG

Facility

$371.25

Hospital Charge Code	270647388
Hospital Revenue Code	272
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$185.62
Rate for Payer: Aetna Commercial	$141.07
Rate for Payer: Aetna Medicare Advantage	$111.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.67
Rate for Payer: Cigna Commercial	$185.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.53
Rate for Payer: Oxford Commercial	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$55.69
Rate for Payer: UnitedHealthcare Commercial	$74.25
Rate for Payer: UnitedHealthcare Community & State	$11.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10.54

CABLE 12 PIN 3/5 LEAD ECG

Facility

$371.25

Hospital Charge Code	270647388
Hospital Revenue Code	272
Min. Negotiated Rate	$55.69
Max. Negotiated Rate	$55.69
Rate for Payer: Qualcare PPO/HMO/WC	$55.69

CABLE 1.7MM WITH CRIMP 750MM

Facility

$2,631.55

Service Code	HCPCS C1713
Hospital Charge Code	270634208
Hospital Revenue Code	278
Min. Negotiated Rate	$394.73
Max. Negotiated Rate	$636.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$526.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$636.84
Rate for Payer: Qualcare PPO/HMO/WC	$394.73

CABLE 1.7MM WITH CRIMP 750MM

Facility

$2,631.55

Service Code	HCPCS C1713
Hospital Charge Code	270634208
Hospital Revenue Code	278
Min. Negotiated Rate	$74.74
Max. Negotiated Rate	$1,315.78
Rate for Payer: Aetna Commercial	$999.99
Rate for Payer: Aetna Medicare Advantage	$789.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$671.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$671.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$526.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$671.05
Rate for Payer: Cigna Commercial	$1,315.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$636.84
Rate for Payer: Qualcare PPO/HMO/WC	$394.73
Rate for Payer: UnitedHealthcare Community & State	$83.16
Rate for Payer: Wellpoint Medicaid Managed Care	$74.74

CABLE 1DOUBLE 2 CRIMPS

Facility

$1,627.50

Hospital Charge Code	270670521
Hospital Revenue Code	278
Min. Negotiated Rate	$244.12
Max. Negotiated Rate	$393.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.86
Rate for Payer: Qualcare PPO/HMO/WC	$244.12

CABLE 1DOUBLE 2 CRIMPS

Facility

$1,627.50

Hospital Charge Code	270670521
Hospital Revenue Code	278
Min. Negotiated Rate	$46.22
Max. Negotiated Rate	$813.75
Rate for Payer: Aetna Commercial	$618.45
Rate for Payer: Aetna Medicare Advantage	$488.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.01
Rate for Payer: Cigna Commercial	$813.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.86
Rate for Payer: Qualcare PPO/HMO/WC	$244.12
Rate for Payer: UnitedHealthcare Community & State	$51.43
Rate for Payer: Wellpoint Medicaid Managed Care	$46.22

CABLE 1X16 MM

Facility

$1,000.00

Hospital Charge Code	270701877
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CABLE 1X16 MM

Facility

$1,000.00

Hospital Charge Code	270701877
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

CABLE ASSY C/C 1.8mm x 559mm

Facility

$1,537.00

Hospital Charge Code	270627500
Hospital Revenue Code	272
Min. Negotiated Rate	$230.55
Max. Negotiated Rate	$230.55
Rate for Payer: Qualcare PPO/HMO/WC	$230.55

CABLE ASSY C/C 1.8mm x 559mm

Facility

$1,537.00

Hospital Charge Code	270627500
Hospital Revenue Code	272
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$768.50
Rate for Payer: Aetna Commercial	$584.06
Rate for Payer: Aetna Medicare Advantage	$461.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$391.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$391.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$391.94
Rate for Payer: Cigna Commercial	$768.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.62
Rate for Payer: Oxford Commercial	$307.40
Rate for Payer: Qualcare PPO/HMO/WC	$230.55
Rate for Payer: UnitedHealthcare Commercial	$307.40
Rate for Payer: UnitedHealthcare Community & State	$48.57
Rate for Payer: Wellpoint Medicaid Managed Care	$43.65

CABLE BEAD ALLOY 1.6MM

Facility

$2,910.00

Service Code	HCPCS C1713
Hospital Charge Code	270669266
Hospital Revenue Code	278
Min. Negotiated Rate	$436.50
Max. Negotiated Rate	$704.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.22
Rate for Payer: Qualcare PPO/HMO/WC	$436.50

Know your out-of-pocket cost for care.

All Charges