Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

COUPLER 20MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695590
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

COUPLER 2.0MM

Facility

$1,650.00

Hospital Charge Code	270675009
Hospital Revenue Code	272
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

COUPLER 2.0MM

Facility

$1,650.00

Hospital Charge Code	270675009
Hospital Revenue Code	272
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.00
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Commercial	$330.00
Rate for Payer: UnitedHealthcare Community & State	$52.14
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

COUPLER 2.5MM

Facility

$1,650.00

Hospital Charge Code	270675008
Hospital Revenue Code	272
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.00
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Commercial	$330.00
Rate for Payer: UnitedHealthcare Community & State	$52.14
Rate for Payer: Wellpoint Medicaid Managed Care	$46.86

COUPLER 2.5MM

Facility

$1,650.00

Hospital Charge Code	270675008
Hospital Revenue Code	272
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

COUPLER FIXED LENGTH 22MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696320
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

COUPLER FIXED LENGTH 22MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696320
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

COUPLER FIXED LENGTH 28MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698196
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

COUPLER FIXED LENGTH 28MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

COUPLING ROD HOFFMAN 5H 11MM

Facility

$5,676.20

Service Code	HCPCS C1713
Hospital Charge Code	270700694
Hospital Revenue Code	278
Min. Negotiated Rate	$851.43
Max. Negotiated Rate	$1,373.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,135.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,373.64
Rate for Payer: Qualcare PPO/HMO/WC	$851.43

COUPLING ROD HOFFMAN 5H 11MM

Facility

$5,676.20

Service Code	HCPCS C1713
Hospital Charge Code	270700694
Hospital Revenue Code	278
Min. Negotiated Rate	$161.20
Max. Negotiated Rate	$2,838.10
Rate for Payer: Aetna Commercial	$2,156.96
Rate for Payer: Aetna Medicare Advantage	$1,702.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,447.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,447.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,135.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,447.43
Rate for Payer: Cigna Commercial	$2,838.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,373.64
Rate for Payer: Qualcare PPO/HMO/WC	$851.43
Rate for Payer: UnitedHealthcare Community & State	$179.37
Rate for Payer: Wellpoint Medicaid Managed Care	$161.20

COVER BACK TABLE 90X40

Facility

$12.01

Hospital Charge Code	270649385
Hospital Revenue Code	270
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

COVER BACK TABLE 90X40

Facility

$12.01

Hospital Charge Code	270649385
Hospital Revenue Code	270
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

COVER BACK TABLE STER

Facility

$5.94

Hospital Charge Code	270061495
Hospital Revenue Code	272
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

COVER BACK TABLE STER

Facility

$5.94

Hospital Charge Code	270061495
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.97
Rate for Payer: Aetna Commercial	$2.26
Rate for Payer: Aetna Medicare Advantage	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.51
Rate for Payer: Cigna Commercial	$2.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.54
Rate for Payer: Oxford Commercial	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$1.19
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

COVER BURR HOLE LP 17MM

Facility

$2,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270695507
Hospital Revenue Code	278
Min. Negotiated Rate	$317.25
Max. Negotiated Rate	$511.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$423.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.83
Rate for Payer: Qualcare PPO/HMO/WC	$317.25

COVER BURR HOLE LP 17MM

Facility

$2,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270695507
Hospital Revenue Code	278
Min. Negotiated Rate	$60.07
Max. Negotiated Rate	$1,057.50
Rate for Payer: Aetna Commercial	$803.70
Rate for Payer: Aetna Medicare Advantage	$634.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$539.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$539.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$423.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$539.33
Rate for Payer: Cigna Commercial	$1,057.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.83
Rate for Payer: Qualcare PPO/HMO/WC	$317.25
Rate for Payer: UnitedHealthcare Community & State	$66.83
Rate for Payer: Wellpoint Medicaid Managed Care	$60.07

COVER BURRHOLEMATRIXNEURO15MM

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270698657
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

COVER BURRHOLEMATRIXNEURO15MM

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270698657
Hospital Revenue Code	278
Min. Negotiated Rate	$65.32
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$874.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00
Rate for Payer: UnitedHealthcare Community & State	$72.68
Rate for Payer: Wellpoint Medicaid Managed Care	$65.32

COVER BURRHOLEMATRIXNEURO24MM

Facility

$5,185.00

Service Code	HCPCS C1713
Hospital Charge Code	270700168
Hospital Revenue Code	278
Min. Negotiated Rate	$147.25
Max. Negotiated Rate	$2,592.50
Rate for Payer: Aetna Commercial	$1,970.30
Rate for Payer: Aetna Medicare Advantage	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.17
Rate for Payer: Cigna Commercial	$2,592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.77
Rate for Payer: Qualcare PPO/HMO/WC	$777.75
Rate for Payer: UnitedHealthcare Community & State	$163.85
Rate for Payer: Wellpoint Medicaid Managed Care	$147.25

COVER BURRHOLEMATRIXNEURO24MM

Facility

$5,185.00

Service Code	HCPCS C1713
Hospital Charge Code	270700168
Hospital Revenue Code	278
Min. Negotiated Rate	$777.75
Max. Negotiated Rate	$1,254.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.77
Rate for Payer: Qualcare PPO/HMO/WC	$777.75

COVER BURR TI LP MATRIX 12MM

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270698158
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

COVER BURR TI LP MATRIX 12MM

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270698158
Hospital Revenue Code	278
Min. Negotiated Rate	$65.32
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$874.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00
Rate for Payer: UnitedHealthcare Community & State	$72.68
Rate for Payer: Wellpoint Medicaid Managed Care	$65.32

COVER CLMP BLU STER 4860061013

Facility

$5.00

Hospital Charge Code	270634413
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

COVER CLMP BLU STER 4860061013

Facility

$5.00

Hospital Charge Code	270634413
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

Know your out-of-pocket cost for care.

All Charges