Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CONNECTOR TRANSVERSE 25-31MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698271
Hospital Revenue Code	278
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$68.16

CONNECTOR TRANSVERSE 30-36MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270697977
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

CONNECTOR TRANSVERSE 30-36MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270697977
Hospital Revenue Code	278
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$68.16

CONNECTOR TRANSVERSE 35-42MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698268
Hospital Revenue Code	278
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$68.16

CONNECTOR TRANSVERSE 35-42MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698268
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

CONNECTOR TRANSVERSE 41-50MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698269
Hospital Revenue Code	278
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$68.16

CONNECTOR TRANSVERSE 41-50MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698269
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

CONNECTOR Y TYPE P356

Facility

$5.81

Hospital Charge Code	270300705
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.21
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

CONNECTOR Y TYPE P356

Facility

$5.81

Hospital Charge Code	270300705
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

CONNECTOR Y UNIVERSAL 320

Facility

$46.25

Hospital Charge Code	270611076
Hospital Revenue Code	272
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.03
Rate for Payer: Oxford Commercial	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Community & State	$1.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

CONNECTOR Y UNIVERSAL 320

Facility

$46.25

Hospital Charge Code	270611076
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

CONRAY 30% 50ML BOTTLES 50/CS

Facility

$843.15

Hospital Charge Code	270654544
Hospital Revenue Code	270
Min. Negotiated Rate	$126.47
Max. Negotiated Rate	$126.47
Rate for Payer: Qualcare PPO/HMO/WC	$126.47

CONRAY 30% 50ML BOTTLES 50/CS

Facility

$843.15

Hospital Charge Code	270654544
Hospital Revenue Code	270
Min. Negotiated Rate	$23.95
Max. Negotiated Rate	$421.57
Rate for Payer: Aetna Commercial	$320.40
Rate for Payer: Aetna Medicare Advantage	$252.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.00
Rate for Payer: Cigna Commercial	$421.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.22
Rate for Payer: Oxford Commercial	$168.63
Rate for Payer: Qualcare PPO/HMO/WC	$126.47
Rate for Payer: UnitedHealthcare Commercial	$168.63
Rate for Payer: UnitedHealthcare Community & State	$26.64
Rate for Payer: Wellpoint Medicaid Managed Care	$23.95

CONRAY 60% 50ML

Facility

$65.00

Hospital Charge Code	270332270
Hospital Revenue Code	255
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Commercial	$24.70
Rate for Payer: Aetna Medicare Advantage	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.57
Rate for Payer: Cigna Commercial	$32.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.90
Rate for Payer: Oxford Commercial	$13.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$13.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

CONRAY 60% 50ML

Facility

$65.00

Hospital Charge Code	270332270
Hospital Revenue Code	255
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

CONRAY 60% 50 ML BOTTLES

Facility

$39.50

Hospital Charge Code	270654537
Hospital Revenue Code	270
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna Commercial	$15.01
Rate for Payer: Aetna Medicare Advantage	$11.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.07
Rate for Payer: Cigna Commercial	$19.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.27
Rate for Payer: Oxford Commercial	$7.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.92
Rate for Payer: UnitedHealthcare Commercial	$7.90
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

CONRAY 60% 50 ML BOTTLES

Facility

$39.50

Hospital Charge Code	270654537
Hospital Revenue Code	270
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$5.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.92

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	74308265
Hospital Revenue Code	370
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.36
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$20.10
Rate for Payer: Wellpoint Medicaid Managed Care	$18.06

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	74308265
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	83653150
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

CONSCIOUS SEDAT 5 YRS & OLDER

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	83653150
Hospital Revenue Code	370
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.36
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$20.10
Rate for Payer: Wellpoint Medicaid Managed Care	$18.06

CONSTRAINED 70 RIGHT

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270662792
Hospital Revenue Code	278
Min. Negotiated Rate	$1,030.92
Max. Negotiated Rate	$18,150.00
Rate for Payer: Aetna Commercial	$13,794.00
Rate for Payer: Aetna Medicare Advantage	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,256.50
Rate for Payer: Cigna Commercial	$18,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00
Rate for Payer: UnitedHealthcare Community & State	$1,147.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,030.92

CONSTRAINED 70 RIGHT

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270662792
Hospital Revenue Code	278
Min. Negotiated Rate	$5,445.00
Max. Negotiated Rate	$8,784.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00

CONSTRAINED LINER 65x36MM

Facility

$17,943.50

Service Code	HCPCS C1776
Hospital Charge Code	270675299
Hospital Revenue Code	278
Min. Negotiated Rate	$2,691.53
Max. Negotiated Rate	$4,342.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53

CONSTRAINED LINER 65x36MM

Facility

$17,943.50

Service Code	HCPCS C1776
Hospital Charge Code	270675299
Hospital Revenue Code	278
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$8,971.75
Rate for Payer: Aetna Commercial	$6,818.53
Rate for Payer: Aetna Medicare Advantage	$5,383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,575.59
Rate for Payer: Cigna Commercial	$8,971.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53
Rate for Payer: UnitedHealthcare Community & State	$567.01
Rate for Payer: Wellpoint Medicaid Managed Care	$509.60

Know your out-of-pocket cost for care.

All Charges