Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CLINDAMYCIN LEVEL

Facility

$376.00

Service Code	HCPCS 80299
Hospital Charge Code	38473067
Hospital Revenue Code	301
Min. Negotiated Rate	$56.40
Max. Negotiated Rate	$56.40
Rate for Payer: Qualcare PPO/HMO/WC	$56.40

CLINDAMYCIN PHOSPHATE 2 % CRE

Facility

$900.35

Service Code	NDC 9344801
Hospital Charge Code	6011068
Hospital Revenue Code	250
Min. Negotiated Rate	$135.05
Max. Negotiated Rate	$135.05
Rate for Payer: Qualcare PPO/HMO/WC	$135.05

CLINDAMYCIN PHOSPHATE 2 % CRE

Facility

$900.35

Service Code	NDC 9344801
Hospital Charge Code	6011068
Hospital Revenue Code	250
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$450.18
Rate for Payer: Aetna Commercial	$342.13
Rate for Payer: Aetna Medicare Advantage	$270.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.59
Rate for Payer: Cigna Commercial	$450.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.09
Rate for Payer: Oxford Commercial	$180.07
Rate for Payer: Qualcare PPO/HMO/WC	$135.05
Rate for Payer: UnitedHealthcare Commercial	$180.07
Rate for Payer: UnitedHealthcare Community & State	$28.45
Rate for Payer: Wellpoint Medicaid Managed Care	$25.57

CLINICAL CHEMISTRY TEST

Facility

$760.50

Service Code	HCPCS 84999
Hospital Charge Code	401084999
Hospital Revenue Code	301
Min. Negotiated Rate	$114.08
Max. Negotiated Rate	$114.08
Rate for Payer: Qualcare PPO/HMO/WC	$114.08

CLINICAL CHEMISTRY TEST

Facility

$760.50

Service Code	HCPCS 84999
Hospital Charge Code	401084999
Hospital Revenue Code	301
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$380.25
Rate for Payer: Aetna Commercial	$288.99
Rate for Payer: Aetna Medicare Advantage	$228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.93
Rate for Payer: Cigna Commercial	$380.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.73
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.08
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$24.03
Rate for Payer: Wellpoint Medicaid Managed Care	$21.60

CLIP

Facility

$1,250.00

Hospital Charge Code	270704026
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

CLIP

Facility

$1,250.00

Hospital Charge Code	270704026
Hospital Revenue Code	272
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) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

CLIP ALLIGATOR 6FT

Facility

$200.00

Hospital Charge Code	270679183
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

CLIP ALLIGATOR 6FT

Facility

$200.00

Hospital Charge Code	270679183
Hospital Revenue Code	272
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$6.32
Rate for Payer: Wellpoint Medicaid Managed Care	$5.68

CLIP APPLICATOR SMALL

Facility

$14,000.00

Hospital Charge Code	270676498
Hospital Revenue Code	272
Min. Negotiated Rate	$397.60
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,640.00
Rate for Payer: Oxford Commercial	$2,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Commercial	$2,800.00
Rate for Payer: UnitedHealthcare Community & State	$442.40
Rate for Payer: Wellpoint Medicaid Managed Care	$397.60

CLIP APPLICATOR SMALL

Facility

$14,000.00

Hospital Charge Code	270676498
Hospital Revenue Code	272
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

CLIP APPLIER ENDO 5MM SINGLE

Facility

$736.13

Hospital Charge Code	270600112
Hospital Revenue Code	272
Min. Negotiated Rate	$110.42
Max. Negotiated Rate	$110.42
Rate for Payer: Qualcare PPO/HMO/WC	$110.42

CLIP APPLIER ENDO 5MM SINGLE

Facility

$736.13

Hospital Charge Code	270600112
Hospital Revenue Code	272
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$368.06
Rate for Payer: Aetna Commercial	$279.73
Rate for Payer: Aetna Medicare Advantage	$220.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.71
Rate for Payer: Cigna Commercial	$368.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.39
Rate for Payer: Oxford Commercial	$147.23
Rate for Payer: Qualcare PPO/HMO/WC	$110.42
Rate for Payer: UnitedHealthcare Commercial	$147.23
Rate for Payer: UnitedHealthcare Community & State	$23.26
Rate for Payer: Wellpoint Medicaid Managed Care	$20.91

CLIP APPLIER ENDO ROTA MCA LG

Facility

$950.95

Hospital Charge Code	270670859
Hospital Revenue Code	272
Min. Negotiated Rate	$27.01
Max. Negotiated Rate	$475.48
Rate for Payer: Aetna Commercial	$361.36
Rate for Payer: Aetna Medicare Advantage	$285.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.49
Rate for Payer: Cigna Commercial	$475.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.25
Rate for Payer: Oxford Commercial	$190.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.64
Rate for Payer: UnitedHealthcare Commercial	$190.19
Rate for Payer: UnitedHealthcare Community & State	$30.05
Rate for Payer: Wellpoint Medicaid Managed Care	$27.01

CLIP APPLIER ENDO ROTA MCA LG

Facility

$823.52

Hospital Charge Code	270628303
Hospital Revenue Code	272
Min. Negotiated Rate	$23.39
Max. Negotiated Rate	$411.76
Rate for Payer: Aetna Commercial	$312.94
Rate for Payer: Aetna Medicare Advantage	$247.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.00
Rate for Payer: Cigna Commercial	$411.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.12
Rate for Payer: Oxford Commercial	$164.70
Rate for Payer: Qualcare PPO/HMO/WC	$123.53
Rate for Payer: UnitedHealthcare Commercial	$164.70
Rate for Payer: UnitedHealthcare Community & State	$26.02
Rate for Payer: Wellpoint Medicaid Managed Care	$23.39

CLIP APPLIER ENDO ROTA MCA LG

Facility

$823.52

Hospital Charge Code	270628303
Hospital Revenue Code	272
Min. Negotiated Rate	$123.53
Max. Negotiated Rate	$123.53
Rate for Payer: Qualcare PPO/HMO/WC	$123.53

CLIP APPLIER ENDO ROTA MCA LG

Facility

$950.95

Hospital Charge Code	270670859
Hospital Revenue Code	272
Min. Negotiated Rate	$142.64
Max. Negotiated Rate	$142.64
Rate for Payer: Qualcare PPO/HMO/WC	$142.64

CLIP APPLIER LIGAMAX 5MM

Facility

$389.95

Hospital Charge Code	270608760
Hospital Revenue Code	272
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$194.97
Rate for Payer: Aetna Commercial	$148.18
Rate for Payer: Aetna Medicare Advantage	$116.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.44
Rate for Payer: Cigna Commercial	$194.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.39
Rate for Payer: Oxford Commercial	$77.99
Rate for Payer: Qualcare PPO/HMO/WC	$58.49
Rate for Payer: UnitedHealthcare Commercial	$77.99
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.07

CLIP APPLIER LIGAMAX 5MM

Facility

$389.95

Hospital Charge Code	270608760
Hospital Revenue Code	272
Min. Negotiated Rate	$58.49
Max. Negotiated Rate	$58.49
Rate for Payer: Qualcare PPO/HMO/WC	$58.49

CLIP APPLIER / REMOVER STR

Facility

$10,329.00

Hospital Charge Code	270665289
Hospital Revenue Code	272
Min. Negotiated Rate	$1,549.35
Max. Negotiated Rate	$1,549.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,549.35

CLIP APPLIER / REMOVER STR

Facility

$10,329.00

Hospital Charge Code	270665289
Hospital Revenue Code	272
Min. Negotiated Rate	$293.34
Max. Negotiated Rate	$5,164.50
Rate for Payer: Aetna Commercial	$3,925.02
Rate for Payer: Aetna Medicare Advantage	$3,098.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,633.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,633.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,633.89
Rate for Payer: Cigna Commercial	$5,164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,685.54
Rate for Payer: Oxford Commercial	$2,065.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,549.35
Rate for Payer: UnitedHealthcare Commercial	$2,065.80
Rate for Payer: UnitedHealthcare Community & State	$326.40
Rate for Payer: Wellpoint Medicaid Managed Care	$293.34

CLIP CLOSED TUBE GAMMA 3 SYS

Facility

$3,945.00

Hospital Charge Code	270645791
Hospital Revenue Code	270
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$591.75
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

CLIP CLOSED TUBE GAMMA 3 SYS

Facility

$3,945.00

Hospital Charge Code	270645791
Hospital Revenue Code	270
Min. Negotiated Rate	$112.04
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,499.10
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,025.70
Rate for Payer: Oxford Commercial	$789.00
Rate for Payer: Qualcare PPO/HMO/WC	$591.75
Rate for Payer: UnitedHealthcare Commercial	$789.00
Rate for Payer: UnitedHealthcare Community & State	$124.66
Rate for Payer: Wellpoint Medicaid Managed Care	$112.04

CLIP ENDO 5MM M/L

Facility

$846.50

Hospital Charge Code	270639937
Hospital Revenue Code	272
Min. Negotiated Rate	$24.04
Max. Negotiated Rate	$423.25
Rate for Payer: Aetna Commercial	$321.67
Rate for Payer: Aetna Medicare Advantage	$253.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.86
Rate for Payer: Cigna Commercial	$423.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.09
Rate for Payer: Oxford Commercial	$169.30
Rate for Payer: Qualcare PPO/HMO/WC	$126.97
Rate for Payer: UnitedHealthcare Commercial	$169.30
Rate for Payer: UnitedHealthcare Community & State	$26.75
Rate for Payer: Wellpoint Medicaid Managed Care	$24.04

CLIP ENDO 5MM M/L

Facility

$846.50

Hospital Charge Code	270639937
Hospital Revenue Code	272
Min. Negotiated Rate	$126.97
Max. Negotiated Rate	$126.97
Rate for Payer: Qualcare PPO/HMO/WC	$126.97

Know your out-of-pocket cost for care.

All Charges