Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CONNECTOR 25 MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685953
Hospital Revenue Code	278
Min. Negotiated Rate	$121.69
Max. Negotiated Rate	$2,142.50
Rate for Payer: Aetna Commercial	$1,628.30
Rate for Payer: Aetna Medicare Advantage	$1,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.67
Rate for Payer: Cigna Commercial	$2,142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75
Rate for Payer: UnitedHealthcare Community & State	$135.41
Rate for Payer: Wellpoint Medicaid Managed Care	$121.69

CONNECTOR # 3

Facility

$8,010.00

Service Code	HCPCS C1713
Hospital Charge Code	270684914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,201.50
Max. Negotiated Rate	$1,938.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,602.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,938.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.50

CONNECTOR # 3

Facility

$8,010.00

Service Code	HCPCS C1713
Hospital Charge Code	270684914
Hospital Revenue Code	278
Min. Negotiated Rate	$227.48
Max. Negotiated Rate	$4,005.00
Rate for Payer: Aetna Commercial	$3,043.80
Rate for Payer: Aetna Medicare Advantage	$2,403.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,042.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,042.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,602.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,042.55
Rate for Payer: Cigna Commercial	$4,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,938.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.50
Rate for Payer: UnitedHealthcare Community & State	$253.12
Rate for Payer: Wellpoint Medicaid Managed Care	$227.48

CONNECTOR 4A CROSSLINK

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270659160
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

CONNECTOR 4A CROSSLINK

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270659160
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONNECTOR 50MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685954
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$1,036.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

CONNECTOR 50MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685954
Hospital Revenue Code	278
Min. Negotiated Rate	$121.69
Max. Negotiated Rate	$2,142.50
Rate for Payer: Aetna Commercial	$1,628.30
Rate for Payer: Aetna Medicare Advantage	$1,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.67
Rate for Payer: Cigna Commercial	$2,142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: Qualcare PPO/HMO/WC	$642.75
Rate for Payer: UnitedHealthcare Community & State	$135.41
Rate for Payer: Wellpoint Medicaid Managed Care	$121.69

CONNECTOR A1

Facility

$7,000.00

Hospital Charge Code	270669375
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONNECTOR A1

Facility

$7,000.00

Hospital Charge Code	270669375
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

CONNECTOR A4 CROSSLINK

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270675637
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR A4 CROSSLINK

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270675637
Hospital Revenue Code	278
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$201.45
Rate for Payer: Wellpoint Medicaid Managed Care	$181.05

CONNECTOR A7 55mm

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270679902
Hospital Revenue Code	278
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$201.45
Rate for Payer: Wellpoint Medicaid Managed Care	$181.05

CONNECTOR A7 55mm

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270679902
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR AXOGUARD 2X15MM

Facility

$10,390.00

Service Code	HCPCS C1763
Hospital Charge Code	270700135
Hospital Revenue Code	278
Min. Negotiated Rate	$295.08
Max. Negotiated Rate	$5,195.00
Rate for Payer: Aetna Commercial	$3,948.20
Rate for Payer: Aetna Medicare Advantage	$3,117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,649.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,649.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,078.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,649.45
Rate for Payer: Cigna Commercial	$5,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,514.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,558.50
Rate for Payer: UnitedHealthcare Community & State	$328.32
Rate for Payer: Wellpoint Medicaid Managed Care	$295.08

CONNECTOR AXOGUARD 2X15MM

Facility

$10,390.00

Service Code	HCPCS C1763
Hospital Charge Code	270700135
Hospital Revenue Code	278
Min. Negotiated Rate	$1,558.50
Max. Negotiated Rate	$2,514.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,078.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,514.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,558.50

CONNECTOR FLEXIBLE 3 15X22MM

Facility

$6.24

Hospital Charge Code	270655632
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.94

CONNECTOR FLEXIBLE 3 15X22MM

Facility

$6.24

Hospital Charge Code	270655632
Hospital Revenue Code	270
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.12
Rate for Payer: Aetna Commercial	$2.37
Rate for Payer: Aetna Medicare Advantage	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.59
Rate for Payer: Cigna Commercial	$3.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Oxford Commercial	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.94
Rate for Payer: UnitedHealthcare Commercial	$1.25
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

CONNECTOR IV SWABABLE

Facility

$7.00

Hospital Charge Code	270650184
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

CONNECTOR IV SWABABLE

Facility

$7.00

Hospital Charge Code	270650184
Hospital Revenue Code	270
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CONNECTOR LAT 5.5 TI A1

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270667966
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR LAT 5.5 TI A1

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270667966
Hospital Revenue Code	278
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$201.45
Rate for Payer: Wellpoint Medicaid Managed Care	$181.05

CONNECTOR LAT 5.5 TI A2

Facility

$6,375.00

Hospital Charge Code	270669376
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR LAT 5.5 TI A2

Facility

$6,375.00

Hospital Charge Code	270669376
Hospital Revenue Code	278
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$201.45
Rate for Payer: Wellpoint Medicaid Managed Care	$181.05

CONNECTOR LAT 5.5 TI A3

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270667965
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR LAT 5.5 TI A3

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270667965
Hospital Revenue Code	278
Min. Negotiated Rate	$181.05
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$201.45
Rate for Payer: Wellpoint Medicaid Managed Care	$181.05

Know your out-of-pocket cost for care.

All Charges