Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CARTRIDGE, MONARCH II IOL

Facility

$1,000.00

Hospital Charge Code	270655285
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CARTRIDGE, MONARCH II IOL

Facility

$1,000.00

Hospital Charge Code	270655285
Hospital Revenue Code	270
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) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

CARTRIDGE RELOAD THICK TISSUE

Facility

$599.00

Hospital Charge Code	270334714
Hospital Revenue Code	272
Min. Negotiated Rate	$89.85
Max. Negotiated Rate	$89.85
Rate for Payer: Qualcare PPO/HMO/WC	$89.85

CARTRIDGE RELOAD THICK TISSUE

Facility

$599.00

Hospital Charge Code	270334714
Hospital Revenue Code	272
Min. Negotiated Rate	$17.01
Max. Negotiated Rate	$299.50
Rate for Payer: Aetna Commercial	$227.62
Rate for Payer: Aetna Medicare Advantage	$179.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.75
Rate for Payer: Cigna Commercial	$299.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.74
Rate for Payer: Oxford Commercial	$119.80
Rate for Payer: Qualcare PPO/HMO/WC	$89.85
Rate for Payer: UnitedHealthcare Commercial	$119.80
Rate for Payer: UnitedHealthcare Community & State	$18.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17.01

CARVEDILOL 12.5 MG TAB

Facility

$126.03

Service Code	NDC 80725014120
Hospital Charge Code	60628811
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CARVEDILOL 12.5 MG TAB

Facility

$126.03

Service Code	NDC 80725014120
Hospital Charge Code	60628811
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.77
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

CARVEDILOL 25 MG TAB

Facility

$126.03

Service Code	NDC 80725014220
Hospital Charge Code	60628812
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.77
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

CARVEDILOL 25 MG TAB

Facility

$126.03

Service Code	NDC 80725014220
Hospital Charge Code	60628812
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CARVEDILOL 3.125 MG TAB

Facility

$126.03

Service Code	NDC 80725013920
Hospital Charge Code	60627623
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.77
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

CARVEDILOL 3.125 MG TAB

Facility

$126.03

Service Code	NDC 80725013920
Hospital Charge Code	60627623
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CARVEDILOL 6.25 MG TAB

Facility

$126.03

Service Code	NDC 80725014020
Hospital Charge Code	60628586
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$63.02
Rate for Payer: Aetna Commercial	$47.89
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.14
Rate for Payer: Cigna Commercial	$63.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.77
Rate for Payer: Oxford Commercial	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.21
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

CARVEDILOL 6.25 MG TAB

Facility

$126.03

Service Code	NDC 80725014020
Hospital Charge Code	60628586
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CASCADE 910046

Facility

$750.00

Hospital Charge Code	270646505
Hospital Revenue Code	272
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

CASCADE 910046

Facility

$750.00

Hospital Charge Code	270646505
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

CASCADE PLATELET SYST PRFM KIT

Facility

$1,750.00

Hospital Charge Code	270678210
Hospital Revenue Code	272
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

CASCADE PLATELET SYST PRFM KIT

Facility

$1,750.00

Hospital Charge Code	270678210
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CASCADE PLATELET SYST PRP MEMB

Facility

$3,300.00

Hospital Charge Code	270678212
Hospital Revenue Code	272
Min. Negotiated Rate	$93.72
Max. Negotiated Rate	$1,650.00
Rate for Payer: Aetna Commercial	$1,254.00
Rate for Payer: Aetna Medicare Advantage	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.50
Rate for Payer: Cigna Commercial	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.00
Rate for Payer: Oxford Commercial	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.00
Rate for Payer: UnitedHealthcare Commercial	$660.00
Rate for Payer: UnitedHealthcare Community & State	$104.28
Rate for Payer: Wellpoint Medicaid Managed Care	$93.72

CASCADE PLATELET SYST PRP MEMB

Facility

$3,300.00

Hospital Charge Code	270678212
Hospital Revenue Code	272
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.00

CASCADE PLATELET SYST PRP x2

Facility

$2,625.00

Hospital Charge Code	270678211
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

CASCADE PLATELET SYST PRP x2

Facility

$2,625.00

Hospital Charge Code	270678211
Hospital Revenue Code	272
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) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

CASE 2.7/3.5MM VA-LCP ELBW SYS

Facility

$6,201.65

Hospital Charge Code	270677662
Hospital Revenue Code	272
Min. Negotiated Rate	$176.13
Max. Negotiated Rate	$3,100.82
Rate for Payer: Aetna Commercial	$2,356.63
Rate for Payer: Aetna Medicare Advantage	$1,860.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.42
Rate for Payer: Cigna Commercial	$3,100.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.43
Rate for Payer: Oxford Commercial	$1,240.33
Rate for Payer: Qualcare PPO/HMO/WC	$930.25
Rate for Payer: UnitedHealthcare Commercial	$1,240.33
Rate for Payer: UnitedHealthcare Community & State	$195.97
Rate for Payer: Wellpoint Medicaid Managed Care	$176.13

CASE 2.7/3.5MM VA-LCP ELBW SYS

Facility

$6,201.65

Hospital Charge Code	270677662
Hospital Revenue Code	272
Min. Negotiated Rate	$930.25
Max. Negotiated Rate	$930.25
Rate for Payer: Qualcare PPO/HMO/WC	$930.25

CASE SURGICAL W/O BRACKETS 11

Facility

$3,495.00

Hospital Charge Code	270665199
Hospital Revenue Code	270
Min. Negotiated Rate	$524.25
Max. Negotiated Rate	$524.25
Rate for Payer: Qualcare PPO/HMO/WC	$524.25

CASE SURGICAL W/O BRACKETS 11

Facility

$3,495.00

Hospital Charge Code	270665199
Hospital Revenue Code	270
Min. Negotiated Rate	$99.26
Max. Negotiated Rate	$1,747.50
Rate for Payer: Aetna Commercial	$1,328.10
Rate for Payer: Aetna Medicare Advantage	$1,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$891.23
Rate for Payer: Cigna Commercial	$1,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$908.70
Rate for Payer: Oxford Commercial	$699.00
Rate for Payer: Qualcare PPO/HMO/WC	$524.25
Rate for Payer: UnitedHealthcare Commercial	$699.00
Rate for Payer: UnitedHealthcare Community & State	$110.44
Rate for Payer: Wellpoint Medicaid Managed Care	$99.26

CASE TRIMANO

Facility

$1,850.00

Hospital Charge Code	270676551
Hospital Revenue Code	272
Min. Negotiated Rate	$277.50
Max. Negotiated Rate	$277.50
Rate for Payer: Qualcare PPO/HMO/WC	$277.50

Know your out-of-pocket cost for care.

All Charges