Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CAGE 7X14X12MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	27070454
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

CAGE 7X14X12MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704540
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAGE 7X14X12MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270704540
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

CAGE 8MM PEEK MONET

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270693271
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

CAGE 8MM PEEK MONET

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270693271
Hospital Revenue Code	278
Min. Negotiated Rate	$268.38
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$298.62
Rate for Payer: Wellpoint Medicaid Managed Care	$268.38

CAGE 8 MM ZERO PAV

Facility

$1,627.25

Service Code	HCPCS C1889
Hospital Charge Code	270692349
Hospital Revenue Code	278
Min. Negotiated Rate	$244.09
Max. Negotiated Rate	$393.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.79
Rate for Payer: Qualcare PPO/HMO/WC	$244.09

CAGE 8 MM ZERO PAV

Facility

$1,627.25

Service Code	HCPCS C1889
Hospital Charge Code	270692349
Hospital Revenue Code	278
Min. Negotiated Rate	$46.21
Max. Negotiated Rate	$813.62
Rate for Payer: Aetna Commercial	$618.36
Rate for Payer: Aetna Medicare Advantage	$488.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.95
Rate for Payer: Cigna Commercial	$813.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.79
Rate for Payer: Qualcare PPO/HMO/WC	$244.09
Rate for Payer: UnitedHealthcare Community & State	$51.42
Rate for Payer: Wellpoint Medicaid Managed Care	$46.21

CAGE 8X16X14MM 10DEGREE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704432
Hospital Revenue Code	279
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CAGE 8X16X14MM 10DEGREE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704432
Hospital Revenue Code	279
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,210.00
Rate for Payer: Oxford Commercial	$1,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Commercial	$1,700.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

CAGE 8 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667336
Hospital Revenue Code	278
Min. Negotiated Rate	$757.14
Max. Negotiated Rate	$13,330.00
Rate for Payer: Aetna Commercial	$10,130.80
Rate for Payer: Aetna Medicare Advantage	$7,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,798.30
Rate for Payer: Cigna Commercial	$13,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00
Rate for Payer: UnitedHealthcare Community & State	$842.46
Rate for Payer: Wellpoint Medicaid Managed Care	$757.14

CAGE 8 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667336
Hospital Revenue Code	278
Min. Negotiated Rate	$3,999.00
Max. Negotiated Rate	$6,451.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00

CAGE 9MM X 11 MM X 23 MM

Facility

$20,270.00

Service Code	HCPCS C1889
Hospital Charge Code	270689800
Hospital Revenue Code	278
Min. Negotiated Rate	$575.67
Max. Negotiated Rate	$10,135.00
Rate for Payer: Aetna Commercial	$7,702.60
Rate for Payer: Aetna Medicare Advantage	$6,081.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,168.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,168.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,054.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,168.85
Rate for Payer: Cigna Commercial	$10,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,040.50
Rate for Payer: UnitedHealthcare Community & State	$640.53
Rate for Payer: Wellpoint Medicaid Managed Care	$575.67

CAGE 9MM X 11 MM X 23 MM

Facility

$20,270.00

Service Code	HCPCS C1889
Hospital Charge Code	270689800
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.50
Max. Negotiated Rate	$4,905.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,054.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,040.50

CAGE 9MM X 11MM X 23 MM

Facility

$24,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688260
Hospital Revenue Code	278
Min. Negotiated Rate	$681.60
Max. Negotiated Rate	$12,000.00
Rate for Payer: Aetna Commercial	$9,120.00
Rate for Payer: Aetna Medicare Advantage	$7,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,120.00
Rate for Payer: Cigna Commercial	$12,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00
Rate for Payer: UnitedHealthcare Community & State	$758.40
Rate for Payer: Wellpoint Medicaid Managed Care	$681.60

CAGE 9MM X 11MM X 23 MM

Facility

$24,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688260
Hospital Revenue Code	278
Min. Negotiated Rate	$3,600.00
Max. Negotiated Rate	$5,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00

CAGE 9MM X11 MM X 23 MM

Facility

$24,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270683546
Hospital Revenue Code	278
Min. Negotiated Rate	$3,600.00
Max. Negotiated Rate	$5,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00

CAGE 9MM X11 MM X 23 MM

Facility

$24,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270683546
Hospital Revenue Code	278
Min. Negotiated Rate	$681.60
Max. Negotiated Rate	$12,000.00
Rate for Payer: Aetna Commercial	$9,120.00
Rate for Payer: Aetna Medicare Advantage	$7,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,120.00
Rate for Payer: Cigna Commercial	$12,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00
Rate for Payer: UnitedHealthcare Community & State	$758.40
Rate for Payer: Wellpoint Medicaid Managed Care	$681.60

CAGE 9MM X11 MM X 23 MM

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270688471
Hospital Revenue Code	278
Min. Negotiated Rate	$688.70
Max. Negotiated Rate	$12,125.00
Rate for Payer: Aetna Commercial	$9,215.00
Rate for Payer: Aetna Medicare Advantage	$7,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,183.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,183.75
Rate for Payer: Cigna Commercial	$12,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50
Rate for Payer: UnitedHealthcare Community & State	$766.30
Rate for Payer: Wellpoint Medicaid Managed Care	$688.70

CAGE 9MM X11 MM X 23 MM

Facility

$24,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270688471
Hospital Revenue Code	278
Min. Negotiated Rate	$3,637.50
Max. Negotiated Rate	$5,868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,868.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,637.50

CAGE 9MM X-WIDE TI

Facility

$9,175.00

Hospital Charge Code	270703142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.25
Max. Negotiated Rate	$2,220.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.25

CAGE 9MM X-WIDE TI

Facility

$9,175.00

Hospital Charge Code	270703142
Hospital Revenue Code	278
Min. Negotiated Rate	$260.57
Max. Negotiated Rate	$4,587.50
Rate for Payer: Aetna Commercial	$3,486.50
Rate for Payer: Aetna Medicare Advantage	$2,752.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.62
Rate for Payer: Cigna Commercial	$4,587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,220.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.25
Rate for Payer: UnitedHealthcare Community & State	$289.93
Rate for Payer: Wellpoint Medicaid Managed Care	$260.57

CAGE 9X 10 X 27 MM

Facility

$20,273.00

Service Code	HCPCS C1889
Hospital Charge Code	270690581
Hospital Revenue Code	278
Min. Negotiated Rate	$575.75
Max. Negotiated Rate	$10,136.50
Rate for Payer: Aetna Commercial	$7,703.74
Rate for Payer: Aetna Medicare Advantage	$6,081.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,169.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,169.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,054.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,169.61
Rate for Payer: Cigna Commercial	$10,136.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,906.07
Rate for Payer: Qualcare PPO/HMO/WC	$3,040.95
Rate for Payer: UnitedHealthcare Community & State	$640.63
Rate for Payer: Wellpoint Medicaid Managed Care	$575.75

CAGE 9X 10 X 27 MM

Facility

$20,273.00

Service Code	HCPCS C1889
Hospital Charge Code	270690581
Hospital Revenue Code	278
Min. Negotiated Rate	$3,040.95
Max. Negotiated Rate	$4,906.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,054.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,906.07
Rate for Payer: Qualcare PPO/HMO/WC	$3,040.95

CAGE 9 X 11 X 22

Facility

$30,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693960
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

CAGE 9 X 11 X 22

Facility

$30,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270693960
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$15,000.00
Rate for Payer: Aetna Commercial	$11,400.00
Rate for Payer: Aetna Medicare Advantage	$9,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,650.00
Rate for Payer: Cigna Commercial	$15,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$948.00
Rate for Payer: Wellpoint Medicaid Managed Care	$852.00

Know your out-of-pocket cost for care.

All Charges