Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ACETABULAR REAMER BASKETS 58MM

Facility

$1,345.00

Hospital Charge Code	270668107
Hospital Revenue Code	272
Min. Negotiated Rate	$38.20
Max. Negotiated Rate	$672.50
Rate for Payer: Aetna Commercial	$511.10
Rate for Payer: Aetna Medicare Advantage	$403.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.98
Rate for Payer: Cigna Commercial	$672.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.70
Rate for Payer: Oxford Commercial	$269.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.75
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Community & State	$42.50
Rate for Payer: Wellpoint Medicaid Managed Care	$38.20

ACETABULAR REAMER BASKETS 60MM

Facility

$1,345.00

Hospital Charge Code	270668108
Hospital Revenue Code	272
Min. Negotiated Rate	$201.75
Max. Negotiated Rate	$201.75
Rate for Payer: Qualcare PPO/HMO/WC	$201.75

ACETABULAR REAMER BASKETS 60MM

Facility

$1,345.00

Hospital Charge Code	270668108
Hospital Revenue Code	272
Min. Negotiated Rate	$38.20
Max. Negotiated Rate	$672.50
Rate for Payer: Aetna Commercial	$511.10
Rate for Payer: Aetna Medicare Advantage	$403.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.98
Rate for Payer: Cigna Commercial	$672.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.70
Rate for Payer: Oxford Commercial	$269.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.75
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Community & State	$42.50
Rate for Payer: Wellpoint Medicaid Managed Care	$38.20

ACETABULAR REAMER BASKETS 62MM

Facility

$1,345.00

Hospital Charge Code	270668109
Hospital Revenue Code	272
Min. Negotiated Rate	$38.20
Max. Negotiated Rate	$672.50
Rate for Payer: Aetna Commercial	$511.10
Rate for Payer: Aetna Medicare Advantage	$403.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.98
Rate for Payer: Cigna Commercial	$672.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.70
Rate for Payer: Oxford Commercial	$269.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.75
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Community & State	$42.50
Rate for Payer: Wellpoint Medicaid Managed Care	$38.20

ACETABULAR REAMER BASKETS 62MM

Facility

$1,345.00

Hospital Charge Code	270668109
Hospital Revenue Code	272
Min. Negotiated Rate	$201.75
Max. Negotiated Rate	$201.75
Rate for Payer: Qualcare PPO/HMO/WC	$201.75

ACETABULAR REAMER BASKETS 64MM

Facility

$1,345.00

Hospital Charge Code	270668110
Hospital Revenue Code	272
Min. Negotiated Rate	$38.20
Max. Negotiated Rate	$672.50
Rate for Payer: Aetna Commercial	$511.10
Rate for Payer: Aetna Medicare Advantage	$403.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.98
Rate for Payer: Cigna Commercial	$672.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.70
Rate for Payer: Oxford Commercial	$269.00
Rate for Payer: Qualcare PPO/HMO/WC	$201.75
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Community & State	$42.50
Rate for Payer: Wellpoint Medicaid Managed Care	$38.20

ACETABULAR REAMER BASKETS 64MM

Facility

$1,345.00

Hospital Charge Code	270668110
Hospital Revenue Code	272
Min. Negotiated Rate	$201.75
Max. Negotiated Rate	$201.75
Rate for Payer: Qualcare PPO/HMO/WC	$201.75

ACETABULAR SHELL 48 C PPS G7

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690496
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

ACETABULAR SHELL 48 C PPS G7

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690496
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

ACETABULAR SHELL 58MM TRI PSI

Facility

$4,734.75

Service Code	HCPCS C1776
Hospital Charge Code	270692256
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$1,145.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.81
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

ACETABULAR SHELL 58MM TRI PSI

Facility

$4,734.75

Service Code	HCPCS C1776
Hospital Charge Code	270692256
Hospital Revenue Code	278
Min. Negotiated Rate	$134.47
Max. Negotiated Rate	$2,367.38
Rate for Payer: Aetna Commercial	$1,799.20
Rate for Payer: Aetna Medicare Advantage	$1,420.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.36
Rate for Payer: Cigna Commercial	$2,367.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.81
Rate for Payer: Qualcare PPO/HMO/WC	$710.21
Rate for Payer: UnitedHealthcare Community & State	$149.62
Rate for Payer: Wellpoint Medicaid Managed Care	$134.47

ACETABULAR SHELL G7 OSS 4 62MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270698037
Hospital Revenue Code	278
Min. Negotiated Rate	$446.45
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$496.75
Rate for Payer: Wellpoint Medicaid Managed Care	$446.45

ACETABULAR SHELL G7 OSS 4 62MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270698037
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

ACETAMINOPHEN 10MG/ML IV SOL

Facility

$284.62

Service Code	HCPCS J0131
Hospital Charge Code	60630066
Hospital Revenue Code	636
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$142.31
Rate for Payer: Aetna Commercial	$108.16
Rate for Payer: Aetna Medicare Advantage	$85.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.58
Rate for Payer: Cigna Commercial	$142.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.88
Rate for Payer: Qualcare PPO/HMO/WC	$42.69
Rate for Payer: UnitedHealthcare Community & State	$8.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.08

ACETAMINOPHEN 10MG/ML IV SOL

Facility

$284.62

Service Code	HCPCS J0131
Hospital Charge Code	60630066
Hospital Revenue Code	636
Min. Negotiated Rate	$42.69
Max. Negotiated Rate	$68.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.88
Rate for Payer: Qualcare PPO/HMO/WC	$42.69

ACETAMINOPHEN 120 MG SUPP

Facility

$4.00

Service Code	NDC 45802073233
Hospital Charge Code	60627725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ACETAMINOPHEN 120 MG SUPP

Facility

$4.00

Service Code	NDC 45802073233
Hospital Charge Code	60627725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN 160MG/5ML UD CUP

Facility

$4.00

Hospital Charge Code	83652543
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ACETAMINOPHEN 160MG/5ML UD CUP

Facility

$4.00

Hospital Charge Code	83652543
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN #2 TAB

Facility

$4.00

Service Code	NDC 93005001
Hospital Charge Code	6063943046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ACETAMINOPHEN #2 TAB

Facility

$4.00

Service Code	NDC 93005001
Hospital Charge Code	6063943046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN 325MG/10.15ML SU

Facility

$14.61

Service Code	NDC 121131400
Hospital Charge Code	6063943047
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

ACETAMINOPHEN 325MG/10.15ML SU

Facility

$14.61

Service Code	NDC 121131400
Hospital Charge Code	6063943047
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.30
Rate for Payer: Aetna Commercial	$5.55
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.73
Rate for Payer: Cigna Commercial	$7.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.80
Rate for Payer: Oxford Commercial	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$2.92
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

ACETAMINOPHEN 325 MG SUPP

Facility

$4.42

Service Code	NDC 713016450
Hospital Charge Code	60627727
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

ACETAMINOPHEN 325 MG SUPP

Facility

$4.42

Service Code	NDC 713016450
Hospital Charge Code	60627727
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.15
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$0.88
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

Know your out-of-pocket cost for care.

All Charges