Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

CLOSURE DEVICE MYNX MX 6700

Facility

$1,025.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941S
Hospital Revenue Code	278
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$29.11

CLOSURE DEVICE MYNX MX 6700

Facility

$1,025.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CLOSURE DEVICE MYNX MX 6700

Facility

$1,050.00

Service Code	HCPCS C1760
Hospital Charge Code	270642941N
Hospital Revenue Code	278
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

CLOSURE EYELID BY SUTURES

Facility

$5,703.05

Service Code	HCPCS 67875
Hospital Charge Code	1600000596
Hospital Revenue Code	360
Min. Negotiated Rate	$161.97
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$3,221.35
Rate for Payer: Aetna Medicare Advantage	$3,837.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,296.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,296.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,184.32
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	$4,296.12
Rate for Payer: Cigna Commercial	$2,373.97
Rate for Payer: Cigna Medicare Advantage	$1,184.32
Rate for Payer: Clover Medicare Advantage	$1,125.10
Rate for Payer: EmblemHealth Commercial	$3,552.96
Rate for Payer: Humana Medicare Advantage	$1,219.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,184.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.79
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.46
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$180.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,184.32
Rate for Payer: Wellcare Medicare Advantage	$1,184.32
Rate for Payer: Wellpoint Medicaid Managed Care	$161.97

CLOSURE EYELID BY SUTURES

Facility

$5,703.05

Service Code	HCPCS 67875
Hospital Charge Code	1600000596
Hospital Revenue Code	360
Min. Negotiated Rate	$855.46
Max. Negotiated Rate	$855.46
Rate for Payer: Qualcare PPO/HMO/WC	$855.46

CLOSUREFAST INTRODUC SET 7

Facility

$152.50

Hospital Charge Code	270703633
Hospital Revenue Code	272
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$76.25
Rate for Payer: Aetna Commercial	$57.95
Rate for Payer: Aetna Medicare Advantage	$45.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.89
Rate for Payer: Cigna Commercial	$76.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.65
Rate for Payer: Oxford Commercial	$30.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.88
Rate for Payer: UnitedHealthcare Commercial	$30.50
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.33

CLOSUREFAST INTRODUC SET 7

Facility

$152.50

Hospital Charge Code	270703633
Hospital Revenue Code	272
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$22.88

CLOSUREFAST PROCEDURE PACK

Facility

$447.50

Hospital Charge Code	270703631
Hospital Revenue Code	272
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$223.75
Rate for Payer: Aetna Commercial	$170.05
Rate for Payer: Aetna Medicare Advantage	$134.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.11
Rate for Payer: Cigna Commercial	$223.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.35
Rate for Payer: Oxford Commercial	$89.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.12
Rate for Payer: UnitedHealthcare Commercial	$89.50
Rate for Payer: UnitedHealthcare Community & State	$14.14
Rate for Payer: Wellpoint Medicaid Managed Care	$12.71

CLOSUREFAST PROCEDURE PACK

Facility

$447.50

Hospital Charge Code	270703631
Hospital Revenue Code	272
Min. Negotiated Rate	$67.12
Max. Negotiated Rate	$67.12
Rate for Payer: Qualcare PPO/HMO/WC	$67.12

CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP

Facility

$11,961.90

Service Code	CPT 46288
Hospital Revenue Code	360
Min. Negotiated Rate	$3,132.68
Max. Negotiated Rate	$11,961.90
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,961.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,961.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
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	$11,961.90
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56

CLOSURE PRELUDE 24CM 10

Facility

$175.00

Hospital Charge Code	270689933S
Hospital Revenue Code	272
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

CLOSURE PRELUDE 24CM 10

Facility

$175.00

Hospital Charge Code	270689933S
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

CLOSURE PRELUDE 24 CM 10 ML

Facility

$175.00

Hospital Charge Code	270689933
Hospital Revenue Code	272
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

CLOSURE PRELUDE 24 CM 10 ML

Facility

$175.00

Hospital Charge Code	270689933
Hospital Revenue Code	272
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

CLOSURE SYSTEM WECK EFX

Facility

$525.00

Service Code	HCPCS C1760
Hospital Charge Code	270693986
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

CLOSURE SYSTEM WECK EFX

Facility

$525.00

Service Code	HCPCS C1760
Hospital Charge Code	270693986
Hospital Revenue Code	278
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

CLOSURE TOP

Facility

$393.00

Hospital Charge Code	270339053
Hospital Revenue Code	272
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$196.50
Rate for Payer: Aetna Commercial	$149.34
Rate for Payer: Aetna Medicare Advantage	$117.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.22
Rate for Payer: Cigna Commercial	$196.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.18
Rate for Payer: Oxford Commercial	$78.60
Rate for Payer: Qualcare PPO/HMO/WC	$58.95
Rate for Payer: UnitedHealthcare Commercial	$78.60
Rate for Payer: UnitedHealthcare Community & State	$12.42
Rate for Payer: Wellpoint Medicaid Managed Care	$11.16

CLOSURE TOP

Facility

$393.00

Hospital Charge Code	270339053
Hospital Revenue Code	272
Min. Negotiated Rate	$58.95
Max. Negotiated Rate	$58.95
Rate for Payer: Qualcare PPO/HMO/WC	$58.95

CLOTALYST STD SOLUTION 60ML

Facility

$5,750.00

Hospital Charge Code	270663732
Hospital Revenue Code	272
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

CLOTALYST STD SOLUTION 60ML

Facility

$5,750.00

Hospital Charge Code	270663732
Hospital Revenue Code	272
Min. Negotiated Rate	$163.30
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.00
Rate for Payer: Oxford Commercial	$1,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$1,150.00
Rate for Payer: UnitedHealthcare Community & State	$181.70
Rate for Payer: Wellpoint Medicaid Managed Care	$163.30

CLO TESTS, ENDO AEROBIC ISOL

Facility

$389.24

Service Code	HCPCS 87077
Hospital Charge Code	3009356
Hospital Revenue Code	309
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$58.39
Rate for Payer: Qualcare PPO/HMO/WC	$58.39

CLO TESTS, ENDO AEROBIC ISOL

Facility

$389.24

Service Code	HCPCS 87077
Hospital Charge Code	3009356
Hospital Revenue Code	309
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$194.62
Rate for Payer: Aetna Commercial	$21.98
Rate for Payer: Aetna Medicare Advantage	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.31
Rate for Payer: Cigna Commercial	$194.62
Rate for Payer: Cigna Medicare Advantage	$8.08
Rate for Payer: Clover Medicare Advantage	$7.68
Rate for Payer: EmblemHealth Commercial	$24.24
Rate for Payer: Humana Medicare Advantage	$8.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.39
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.08
Rate for Payer: Wellcare Medicare Advantage	$8.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.05

CLOT FACTOR VIII AHG 1 STAGE

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	401085240
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
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	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CLOT FACTOR VIII AHG 1 STAGE

Facility

$390.00

Service Code	HCPCS 85240
Hospital Charge Code	401085240
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges