Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CLIP ENDO II ML 10MM PISTOL

Facility

$390.97

Hospital Charge Code	270600104
Hospital Revenue Code	272
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

CLIP ENDO II ML 10MM PISTOL

Facility

$390.97

Hospital Charge Code	270600104
Hospital Revenue Code	272
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$195.49
Rate for Payer: Aetna Commercial	$148.57
Rate for Payer: Aetna Medicare Advantage	$117.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.65
Rate for Payer: Oxford Commercial	$78.19
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$78.19
Rate for Payer: UnitedHealthcare Community & State	$12.35
Rate for Payer: Wellpoint Medicaid Managed Care	$11.10

CLIP HEMO LOK MLK LARGE

Facility

$261.28

Hospital Charge Code	270619751
Hospital Revenue Code	272
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$130.64
Rate for Payer: Aetna Commercial	$99.29
Rate for Payer: Aetna Medicare Advantage	$78.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.63
Rate for Payer: Cigna Commercial	$130.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.93
Rate for Payer: Oxford Commercial	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$39.19
Rate for Payer: UnitedHealthcare Commercial	$52.26
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7.42

CLIP HEMO LOK MLK LARGE

Facility

$261.28

Hospital Charge Code	270619751
Hospital Revenue Code	272
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$39.19
Rate for Payer: Qualcare PPO/HMO/WC	$39.19

CLIP INSTRUMENT ENDO CLINCH II

Facility

$1,066.58

Hospital Charge Code	270670510
Hospital Revenue Code	272
Min. Negotiated Rate	$30.29
Max. Negotiated Rate	$533.29
Rate for Payer: Aetna Commercial	$405.30
Rate for Payer: Aetna Medicare Advantage	$319.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.98
Rate for Payer: Cigna Commercial	$533.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.31
Rate for Payer: Oxford Commercial	$213.32
Rate for Payer: Qualcare PPO/HMO/WC	$159.99
Rate for Payer: UnitedHealthcare Commercial	$213.32
Rate for Payer: UnitedHealthcare Community & State	$33.70
Rate for Payer: Wellpoint Medicaid Managed Care	$30.29

CLIP INSTRUMENT ENDO CLINCH II

Facility

$1,066.58

Hospital Charge Code	270670510
Hospital Revenue Code	272
Min. Negotiated Rate	$159.99
Max. Negotiated Rate	$159.99
Rate for Payer: Qualcare PPO/HMO/WC	$159.99

CLIP IRRIGATION EMAX 2

Facility

$280.00

Hospital Charge Code	270668484
Hospital Revenue Code	272
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Oxford Commercial	$56.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$56.00
Rate for Payer: UnitedHealthcare Community & State	$8.85
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

CLIP IRRIGATION EMAX 2

Facility

$280.00

Hospital Charge Code	270668484
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

CLIP LIGATING 2200 MEDIUM

Facility

$59.35

Hospital Charge Code	270673283
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$29.68
Rate for Payer: Aetna Commercial	$22.55
Rate for Payer: Aetna Medicare Advantage	$17.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.13
Rate for Payer: Cigna Commercial	$29.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.43
Rate for Payer: Oxford Commercial	$11.87
Rate for Payer: Qualcare PPO/HMO/WC	$8.90
Rate for Payer: UnitedHealthcare Commercial	$11.87
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$1.69

CLIP LIGATING 2200 MEDIUM

Facility

$59.35

Hospital Charge Code	270673283
Hospital Revenue Code	272
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$8.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.90

CLIP LIGAT RESOLUTION 360ULTRA

Facility

$1,127.50

Service Code	HCPCS L8699
Hospital Charge Code	270692937
Hospital Revenue Code	278
Min. Negotiated Rate	$32.02
Max. Negotiated Rate	$563.75
Rate for Payer: Aetna Commercial	$428.45
Rate for Payer: Aetna Medicare Advantage	$338.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.51
Rate for Payer: Cigna Commercial	$563.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.86
Rate for Payer: Qualcare PPO/HMO/WC	$169.12
Rate for Payer: UnitedHealthcare Community & State	$35.63
Rate for Payer: Wellpoint Medicaid Managed Care	$32.02

CLIP LIGAT RESOLUTION 360ULTRA

Facility

$1,127.50

Service Code	HCPCS L8699
Hospital Charge Code	270692937
Hospital Revenue Code	278
Min. Negotiated Rate	$169.12
Max. Negotiated Rate	$272.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.86
Rate for Payer: Qualcare PPO/HMO/WC	$169.12

CLIPPER SURGICAL HANDLE

Facility

$182.90

Hospital Charge Code	270651870
Hospital Revenue Code	272
Min. Negotiated Rate	$27.43
Max. Negotiated Rate	$27.43
Rate for Payer: Qualcare PPO/HMO/WC	$27.43

CLIPPER SURGICAL HANDLE

Facility

$182.90

Hospital Charge Code	270651870
Hospital Revenue Code	272
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$91.45
Rate for Payer: Aetna Commercial	$69.50
Rate for Payer: Aetna Medicare Advantage	$54.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.64
Rate for Payer: Cigna Commercial	$91.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.55
Rate for Payer: Oxford Commercial	$36.58
Rate for Payer: Qualcare PPO/HMO/WC	$27.43
Rate for Payer: UnitedHealthcare Commercial	$36.58
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

CLIP PLACEMENT PERCUTANEOUS

Facility

$867.00

Hospital Charge Code	75190115
Hospital Revenue Code	361
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$130.05
Rate for Payer: Qualcare PPO/HMO/WC	$130.05

CLIP PLACEMENT PERCUTANEOUS

Facility

$867.00

Hospital Charge Code	75190115
Hospital Revenue Code	361
Min. Negotiated Rate	$24.62
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna Medicare Advantage	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.09
Rate for Payer: Cigna Commercial	$433.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.42
Rate for Payer: Qualcare PPO/HMO/WC	$130.05
Rate for Payer: UnitedHealthcare Community & State	$27.40
Rate for Payer: Wellpoint Medicaid Managed Care	$24.62

CLIP RESOLUTION M00522612

Facility

$800.00

Hospital Charge Code	270635097
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

CLIP RESOLUTION M00522612

Facility

$800.00

Hospital Charge Code	270635097
Hospital Revenue Code	272
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$25.28
Rate for Payer: Wellpoint Medicaid Managed Care	$22.72

CLIPS 360 RESOLUTION

Facility

$1,027.50

Hospital Charge Code	270677227
Hospital Revenue Code	272
Min. Negotiated Rate	$29.18
Max. Negotiated Rate	$513.75
Rate for Payer: Aetna Commercial	$390.45
Rate for Payer: Aetna Medicare Advantage	$308.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.01
Rate for Payer: Cigna Commercial	$513.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.15
Rate for Payer: Oxford Commercial	$205.50
Rate for Payer: Qualcare PPO/HMO/WC	$154.12
Rate for Payer: UnitedHealthcare Commercial	$205.50
Rate for Payer: UnitedHealthcare Community & State	$32.47
Rate for Payer: Wellpoint Medicaid Managed Care	$29.18

CLIPS 360 RESOLUTION

Facility

$1,027.50

Hospital Charge Code	270677227
Hospital Revenue Code	272
Min. Negotiated Rate	$154.12
Max. Negotiated Rate	$154.12
Rate for Payer: Qualcare PPO/HMO/WC	$154.12

CLIPS FOR IRRIGATION TUBE SET

Facility

$84.00

Hospital Charge Code	270674705
Hospital Revenue Code	272
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.60

CLIPS FOR IRRIGATION TUBE SET

Facility

$84.00

Hospital Charge Code	270674705
Hospital Revenue Code	272
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$31.92
Rate for Payer: Aetna Medicare Advantage	$25.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.42
Rate for Payer: Cigna Commercial	$42.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.84
Rate for Payer: Oxford Commercial	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.60
Rate for Payer: UnitedHealthcare Commercial	$16.80
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.39

CLIPS HEMOLOK MEDIUM LG 544230

Facility

$20.80

Hospital Charge Code	270640217
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$10.40
Rate for Payer: Aetna Commercial	$7.90
Rate for Payer: Aetna Medicare Advantage	$6.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.30
Rate for Payer: Cigna Commercial	$10.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.41
Rate for Payer: Oxford Commercial	$4.16
Rate for Payer: Qualcare PPO/HMO/WC	$3.12
Rate for Payer: UnitedHealthcare Commercial	$4.16
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

CLIPS HEMOLOK MEDIUM LG 544230

Facility

$20.80

Hospital Charge Code	270640217
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.12

CLIPS RANYE DISP.

Facility

$11.59

Hospital Charge Code	270600322
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.79
Rate for Payer: Aetna Commercial	$4.40
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.96
Rate for Payer: Cigna Commercial	$5.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.01
Rate for Payer: Oxford Commercial	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.74
Rate for Payer: UnitedHealthcare Commercial	$2.32
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

Know your out-of-pocket cost for care.

All Charges